Epidural lipomatosis and congenital small spinal canal in spinal anaesthesia: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Complications after lumbar anaesthesia and epidural blood patch have been described in patients with congenital small spinal canal and increased epidural fat or epidural lipomatosis. These conditions, whether occurring separately or in combination, require magnetic resonance imaging for diagnosis and grading, but their clinical significance is still unclear.</p> <p>Case presentation</p> <p>A 35-year-old Caucasian woman who was undergoing a Caesarean section developed a longstanding L4-L5 unilateral neuropathy after the administration of spinal anaesthesia. There were several attempts to correctly position the needle, one of which resulted in paraesthesia. A magnetic resonance image revealed that the patient's bony spinal canal was congenitally small and had excess epidural fat. The cross-sectional area of the dural sac was then reduced, which left practically no free cerebrospinal fluid space.</p> <p>Conclusion</p> <p>The combination of epidural lipomatosis of varying degrees and congenital small spinal canal has not been previously discussed with spinal anaesthesia. Due to the low cerebrospinal fluid content of the small dural sac, the cauda equina becomes a firm system with a very limited possibility for the nerve roots to move away from the puncture needle when it is inserted into the dural sac. This constitutes risks of technical difficulties and neuropathies with spinal anaesthesia.</p

GM-144, a novel lipophilic vaginal contraceptive gel-microemulsion

In a systematic effort to develop a dual-function intravaginal spermicide as well as a drug delivery vehicle against sexually transmitted pathogens, a submicron particle size (30–80 nm), lipophilic and spermicidal gel-microemulsion (viz GM-144) containing the pharmaceutical excipients propylene glycol, Captex 300, Cremophor EL, Phospholipon 90G, Rhodigel, Pluronic F-68, and sodium benzoate was formulated. GM-144 completely immobilized sperm in human or rabbit semen in less than 30 seconds. Therefore, thein vivo contraceptive potency of intravaginally applied GM-144 was compared in the standard rabbit model to those of the detergent spermicide, nonoxynol-9 (N-9)-containing formulation. Eighty-four ovulated New Zealand White rabbits in subgroups of 28 were artificially inseminated with and without intravaginal administration of GM-144 or 2% N-9 (Gynol II) formulation and allowed to complete term pregnancy. GM-144 showed remarkable contraceptive activity in the rigorous rabbit model. When compared with control, intravaginal administration of GM-144 and Gynol II resulted in 75% and 70.8% inhibition of fertility (P<.0001 versus control, Fisher’s exact test), respectively. Thus, GM-144 as a vaginal contraceptive was as effective as the commercially available N-9 gel. In the rabbit vaginal irritation test, none of the 6 rabbits given daily intravaginal application of spermicidal GM-144 for 10 days developed epithelial ulceration, edema, leukocyte influx, or vascular congestion characteristic of inflammation (total score = 5). Therefore, GM-144 has the potential to become a clinically useful safe vaginal contraceptive and a vehicle for formulating lipophilic drugs used in reducing the risk of heterosexual transmission of sexually tranmitted diseases

Alteration in autophagic-lysosomal potential during aging and neurological diseases: the microRNA perspective

Macroautophagy (shortly autophagy) is an evolutionary conserved degradation pathway that targets cytoplasmic substrates including long-lived proteins, protein aggregates and damaged organelles, and leads to their degradation in lysosomes. Beyond its role in adaptation to cellular stresses such as nutrient deprivation, hypoxia and toxins; recent studies attributed a central role to autophagy in aging and lifespan determination. Moreover, alterations and abnormalities of autophagy may contribute to a number of important health problems, including cancer, myopathies, metabolic disorders, and the focus of this review, ageing-related neurodegenerative diseases. Some disease-related, mutant and aggregation-prone proteins may be cleared by autophagy, on the other hand, disregulation of the autophagy pathways may also contribute to neurotoxicity observed in degenerative pathologies. microRNAs (miRNAs) are endogenous regulators of gene expression, and their deregulation was reported in several ageing-related conditions. Studies in the last few years introduced miRNAs as novel and potent regulators of autophagy. In this review article, we will summarize the connection between autophagy, ageing and Alzheimer’s, Parkinson’s and Huntington’s diseases, and discuss the role of autophagy-related miRNAs in this context