Intracranial Rosai-Dorfman Disease: pathophysiology, diagnosis and treatment

Introduction and purpose: ​Rosai-Dorfman Disease (RDD), known also as sinus histiocytosis with massive lymphadenopathy(SHML) is a benign histiocytic proliferative syndrome. The etiology and pathogenesis of RDD remains unclear. Central nervous system involvement is a rare event and concerns approximately 7.8% of RDD cases, whereas intracranial lesions constitute almost 90% of CNS-RDD cases. The aim of this literature review was to summarize current knowledge about the diagnosis and treatment of intracranial manifestation of RDD. We also described possible hypotheses regarding the pathophysiology of this disorder. State of knowledge: ​Even though Rosai-Dorfman disease was thought to be a reactive process, recent evidencedemonstrate the presence of clonality, which means that in this histiocytosis the process that underlies the pathology is neoplastic. Intracranial lesions caused by RDD can be easily misdiagnosed with many diseases such as meningiomas, malignant gliomas or metastatic tumors. The final diagnosis of Rosai-Dorfman disease should be made based on histologic and immunohistochemical examinations. Current therapeutic options for this condition include surgery, radiotherapy, chemotherapy, corticosteroids and immunotherapy. Surgical treatment often constitutes the first-line treatment for intracranial RDD and is the most beneficial treatment option. However, the implementation of adjuvant therapies is very important to avoid the recurrence of lesions, which appear in approximately 14% of subjects after about 10 years from surgery. Conclusion: ​This literature review presents current data about pathophysiology, diagnosis and treatment of intracranial involvement of Rosai-Dorfman disease. Further studies on this topic should focus on exploring etiologic mechanisms underlying on this pathology and comparing available treatment methods

Alveolar osteitis: the current state of knowledge

Introduction and purpose: Alveolar osteitis, also known as dry socket is a common complication after tooth extraction, especially third molar extraction. Taking into consideration only third molar extractions, the prevalence of dry socket reaches even 45%. The aim of this literature review was to describe current knowledge about etiology, risk factors, treatment, and prevention of dry socket. State of knowledge: The symptoms of alveolar osteitis most frequently are reported between the first and third post-extraction days and they include discomfort, lancing, and intense pain which radiates to the neck and ear. The etiopathogenesis of dry socket remains unclear. However, the currently accepted hypothesis describes a loss of formed after an extraction blood clot from the alveolar socket as the main cause of this pathology. Several factors may increase the risk of dry socket and include smoking, oral hygiene, female gender, oral contraceptive drugs, and anesthesia. In the treatment of alveolar osteitis, irrigation of the socket with chlorhexidine gluconate, iodopovidone, or physiological saline followed by filling the socket with intra-alveolar dressing constitute a current fundamental procedure. Plenty of substances are currently used as an intra-alveolar dressing. Part of them exhibits only pain-decreasing features, whereas some drugs can also stimulate the regeneration of treated tissue. In the prevention, the use of alveolar osteitis warm saline, antibiotics, chlorhexidine, ozone gas, or autologous platelet therapy may be useful maneuvers. Conclusion: This literature review summarizes the current state of knowledge about causes, risk factors, and therapeutic and preventive methods with regard to alveolar osteitis

Rozwój i nowe perspektywy leczenia choroby moyamoya

Choroba moyamoya jest niezwykle rzadką chorobą naczyń mózgowych, występującą głównie u dziecii młodych dorosłych. Charakteryzuje się przewlekłym jedno- lub obustronnym zarastaniem i zwężaniemkońcowego odcinka tętnic szyjnych wewnętrznych i ich gałęzi końcowych, co prowadzi do udaru mózguoraz zaburzeń neurologicznych. Podstawą leczenia choroby moyamoya jest chirurgiczna rewaskularyzacjanaczyń, mająca na celu przywrócenie prawidłowego krążenia mózgowego i zmniejszenie częstościwystępowania objawów klinicznych. Chirurgiczne metody rewaskularyzacji stosowane w leczeniu chorobymoyamoya obejmują techniki bezpośrednie, pośrednie oraz metody łączące techniki bezpośredniez pośrednimi. Pośrednie metody rewaskularyzacji są bezpieczniejszym i łatwiejszym w przeprowadzeniusposobem leczenia niż metody bezpośrednie, zwłaszcza u pacjentów młodszych i u pacjentów z chorobamiwspółistniejącymi. Metody bezpośrednie, mimo większego ryzyka powikłań w postaci udaru czy przemijającejhiperperfuzji mózgowej, cechują się natychmiastowym przywróceniem prawidłowego przepływukrwi w zwężonych naczyniach. Ostatnio zauważa się wyraźną przewagę stosowania metod łączonych, naco wskazują liczne badania

Multidisciplinary approach for a severe head burn caused by high-voltage electrical shock - a case report

In modern reconstructive medicine, personalized bone substitutes provide therapeutic hope for patients with non-standard bone defects. The study aims to present a description of a case of using a personalized bone substitute material, taking into account the vascular connections formed after a previous skin transplant.  The 29-year-old patient was admitted to the plastic surgery department urgently after being electrocuted with high voltage. Due to extensive scalp burns, a skin graft was performed in the area of previously removed skin along with a charred skull bone vault.  After a few months, the patient was qualified for cranioplasty with the use of personalized bone substitutes. The necessity to make cuts around the vascular connections present in the transplanted tissue was the main difficulty in the for the operator.  The operation was successful and the recovery was uneventful. The patient was discharged home in good general and local condition.  The presented case illustrates the need to take into account creating vascular connections with the use of personalized bone substitutes in patients after skin transplants

Severe course of radiation-induced meningioma — a new insight in screening for patients after radiotherapy?

Meningiomas, being mostly benign tumours, are derived from the arachnoid cap cells. Their etiopathogenesis is based on various factors, including past radiation. The presented case of a 25-year-old patient, who developed a radiation-induced superior sagittal sinus meningioma based on his past head radiation distributed during acute lymphocytic leukaemia. The tumour’s clinical image presented at first as headache, nausea, and dizziness, computer tomography and subsequently MRI were performed. The imaging examination revealed a very extensive, contrast-enhanced tumour mass located centrally on both sides and within the superior sagittal sinus. With the most likely diagnosis of parasagittal meningioma, the patient was qualified for tumour excision. The surgery was performed successfully resulting in maximal safe subtotal resection. After the surgery, the patient developed complications including hydrocephalus, which resulted in 5-months long hospitalization. The presented case illustrated the need for increased clinical attention in patients threatened by radiation (including radiotherapy), focused on possible head lesions

The Incidence, Localization and Clinical Relevance of Arterial Fenestrations and Their Association to Brain Aneurysms: A Case–Control Study Based on the STROBE Guidelines

Background: Fenestrations are rare, but well-known, vascular variations of the cerebral arteries. They are mostly incidental, asymptomatic angiographic findings and might precipitate vascular lesions such as AVM, aneurysmal dilatation, or even ischemic symptoms. However, association between arterial fenestration and brain aneurysms has not been clearly established. Objective: To evaluate whether incidence of arterial fenestrations are associated with brain aneurysm development and investigate the prevalence and most-common localizations of arterial fenestrations of the human brain. Design: Case–control study. Setting: All patients examined by CT angiography in University Hospital No. 4 in Lublin from 2009 to 2019. Patients: Each patient showing at least one cerebral aneurysm was included in the case group and each patient without cerebral aneurysm on CT angiography was included in the control group. Measurements: CT angiography examinations were conducted using the standard protocol used in the 1st Department of Radiology, Medical University of Lublin, Poland. The database and statistical research were conducted by use of the Statistica software (ver. 13.3, Tibco Software Inc., Palo Alto, CA, USA). Results: A total of 6545 CTA examinations were included in the study. Most of the aneurysms were located on the MCA: 629 (38.59%), ICA: 466 (28.59%) and AComA: 192 (11.78%). Cerebral arterial fenestration showed a non-statistically significant elevated risk for brain aneurysms in the entire study population (OR: 1.157; 95% CI: 0.826–1.621; p = 0.39). Among 6545 cranial CTA examinations, cerebral vessel fenestration was found in 49 of them, which constituted 0.75%. The most common vascular fenestrations were those located in the ACA (30.61%), BA (30.61%) and AComA (22.45%), while other fenestrations occurred infrequently. There were no significant differences in the age of patients in the individuals with vascular fenestration (p > 0.05). VA fenestration was slightly more common in men (16.67%) than in women (5.41%). However, these differences were not statistically significant (p = 0.216). Limitations: Our study has several limitations, including selection bias regarding examined population. Second, we assume that the total number of fenestrations detected in our study was underestimated due to the limitations of the CT method in comparison to other radiologic modalities. Conclusions: Cerebral arterial fenestrations are rare vascular malformations. The ACA is the most common localization of fenestrations, followed by BA and AComA. Fenestrations of cerebral arteries insignificantly increase the risk of cerebral aneurysm formation. Further prospective studies are necessary to make this association more precise

Metallic Implants Used in Lumbar Interbody Fusion

Over the last decade, pedicle fixation systems have evolved and modifications in spinal fusion techniques have been developed to increase fusion rates and improve clinical outcomes after lumbar interbody fusion (LIF). Regarding materials used for screw and rod manufacturing, metals, especially titanium alloys, are the most popular resources. In the case of pedicle screws, that biomaterial can be also doped with hydroxyapatite, CaP, ECM, or tantalum. Other materials used for rod fabrication include cobalt–chromium alloys and nitinol (nickel–titanium alloy). In terms of mechanical properties, the ideal implant used in LIF should have high tensile and fatigue strength, Young’s modulus similar to that of the bone, and should be 100% resistant to corrosion to avoid mechanical failures. On the other hand, a comprehensive understanding of cellular and molecular pathways is essential to identify preferable characteristics of implanted biomaterial to obtain fusion and avoid implant loosening. Implanted material elicits a biological response driven by immune cells at the site of insertion. These reactions are subdivided into innate (primary cellular response with no previous exposure) and adaptive (a specific type of reaction induced after earlier exposure to the antigen) and are responsible for wound healing, fusion, and also adverse reactions, i.e., hypersensitivity. The main purposes of this literature review are to summarize the physical and mechanical properties of metal alloys used for spinal instrumentation in LIF which include fatigue strength, Young’s modulus, and corrosion resistance. Moreover, we also focused on describing biological response after their implantation into the human body. Our review paper is mainly focused on titanium, cobalt–chromium, nickel–titanium (nitinol), and stainless steel alloys

Molecular Mechanisms and Clinical Application of Multipotent Stem Cells for Spinal Cord Injury

Spinal Cord Injury (SCI) is a common neurological disorder with devastating psychical and psychosocial sequelae. The majority of patients after SCI suffer from permanent disability caused by motor dysfunction, impaired sensation, neuropathic pain, spasticity as well as urinary complications, and a small number of patients experience a complete recovery. Current standard treatment modalities of the SCI aim to prevent secondary injury and provide limited recovery of lost neurological functions. Stem Cell Therapy (SCT) represents an emerging treatment approach using the differentiation, paracrine, and self-renewal capabilities of stem cells to regenerate the injured spinal cord. To date, multipotent stem cells including mesenchymal stem cells (MSCs), neural stem cells (NSCs), and hematopoietic stem cells (HSCs) represent the most investigated types of stem cells for the treatment of SCI in preclinical and clinical studies. The microenvironment of SCI has a significant impact on the survival, proliferation, and differentiation of transplanted stem cells. Therefore, a deep understanding of the pathophysiology of SCI and molecular mechanisms through which stem cells act may help improve the treatment efficacy of SCT and find new therapeutic approaches such as stem-cell-derived exosomes, gene-modified stem cells, scaffolds, and nanomaterials. In this literature review, the pathogenesis of SCI and molecular mechanisms of action of multipotent stem cells including MSCs, NSCs, and HSCs are comprehensively described. Moreover, the clinical efficacy of multipotent stem cells in SCI treatment, an optimal protocol of stem cell administration, and recent therapeutic approaches based on or combined with SCT are also discussed

Molecular Mechanisms and Clinical Application of Multipotent Stem Cells for Spinal Cord Injury

Spinal Cord Injury (SCI) is a common neurological disorder with devastating psychical and psychosocial sequelae. The majority of patients after SCI suffer from permanent disability caused by motor dysfunction, impaired sensation, neuropathic pain, spasticity as well as urinary complications, and a small number of patients experience a complete recovery. Current standard treatment modalities of the SCI aim to prevent secondary injury and provide limited recovery of lost neurological functions. Stem Cell Therapy (SCT) represents an emerging treatment approach using the differentiation, paracrine, and self-renewal capabilities of stem cells to regenerate the injured spinal cord. To date, multipotent stem cells including mesenchymal stem cells (MSCs), neural stem cells (NSCs), and hematopoietic stem cells (HSCs) represent the most investigated types of stem cells for the treatment of SCI in preclinical and clinical studies. The microenvironment of SCI has a significant impact on the survival, proliferation, and differentiation of transplanted stem cells. Therefore, a deep understanding of the pathophysiology of SCI and molecular mechanisms through which stem cells act may help improve the treatment efficacy of SCT and find new therapeutic approaches such as stem-cell-derived exosomes, gene-modified stem cells, scaffolds, and nanomaterials. In this literature review, the pathogenesis of SCI and molecular mechanisms of action of multipotent stem cells including MSCs, NSCs, and HSCs are comprehensively described. Moreover, the clinical efficacy of multipotent stem cells in SCI treatment, an optimal protocol of stem cell administration, and recent therapeutic approaches based on or combined with SCT are also discussed