Epidural varicosis as a possible cause of radicular pain: a case report

<p>Abstract</p> <p>Introduction</p> <p>The incidence rate of epidural varicosis has declined by 0.07% to 1.2% since the introduction of computed tomography and magnetic resonance imaging. Despite the use of these modern imaging methods it can still be difficult to distinguish the diagnosis of epidural varicosis from other causes, such as nucleus pulposus prolapse.</p> <p>Case presentation</p> <p>We present the case of a 48-year-old Caucasian woman who had been experiencing sciatic pain for seven years. A physical examination showed nerve root pain at L5 on the right side, with positive signs of neurotension. During an elective hysterectomy due to endometriosis, unusually pronounced varicosis in her lesser pelvis was seen that had not previously been detected. Postoperatively, our patient developed a symptomatic pulmonary embolism. Findings from magnetic resonance tomography of her lumbar spine, in conjunction with our patient's history, were considered by the radiologist to be indicative of epidural varicosis. No further pathological abnormalities that could have been the cause of the nerve root pain were found.</p> <p>Conclusions</p> <p>In cases of epidural varicosis with irritation of neural structures as a result of inferior vena cava hypoplasia, surgical treatment leads to unsatisfactory results. Significantly better results can be achieved by resolving the cause of the vena cava pathology. In cases of hypoplasia or aplasia of the inferior vena cava this is not always possible; consequently, as in the case of our patient, only a symptomatic therapy in combination with an anticoagulant and compression therapy can be performed.</p

Instrumented posterolateral fusion – clinical and functional outcome in elderly patients

Background: Data on the clinical outcome after spinal fusion in the elderly patient are rare. Limitation of most studies were small population, evaluation of the perioperative complication rate and the radiographic assesment. Therefore the aim of the current study was to evaluate the clinical outcome of patients older than 75 years who underwent a spinal fusion procedure (instrumentation and posterolateral fusion) for degenerative spinal stenosis with instability

Digital Innovation Champions: Which Champions drive the Usage of Digital Innovation Management Systems and its Impact on New Product Development Performance

Managers and researchers lack an understanding of how specific new product development (NPD) software champions, i.e. digital innovation champions, function. This is particularly the case for digital innovation management systems (DIMS). Innovation, R&D, and IT managers and top management all might take distinct roles that influence the usage of such software. These distinct roles suggest the need for more detailed investigations of 1) which champions drive the usage of DIMS, 2) if they enhance distinct NPD applications, and 3) the links to NPD performance. This study addresses this need by developing and analyzing hypotheses for the role of digital innovation champions for DIMS usage. Therefore, the authors use unique survey data from managers together with objective patent and revenue data. The results reveal that executives as digital innovation champions encourage the usage and NPD performance of DIMS, whereas, IT and R&D managers can even hinder these outcomes

Early experience with the NexGen® CR-Flex Mobile knee arthroplasty system: results of 2-year follow-up

We evaluated our initial results in 57 patients who received the NexGen® CR-Flex Mobile knee system using the standard anterior approach in a prospective study. The bicondylar surface implant was cemented in position (Palacos®) without posterior patellar resurfacing. The clinical outcome and perioperative and post-operative complications were documented over 24 months of its use. Overall, after two years, good results were obtained for the categories of pain and ROM (range of motion), and for the HSS (knee society score) (pre-operative: 42/57; post-operative: 87/80). No pathological radiological findings were made during this period. Two patients, however, felt that the primary operation had not been successful because of lateral patellar tilt. This was corrected with revision surgery. It was remarkable that our patients achieved greater than 100° flexion within the first 14 days of the immediate post-operative period. Evaluation and comparison of the scores with those of conventional bicondylar surface replacement systems showed no relevant differences

Protective and Aggravating Effects of Nlrp3 Inflammasome Activation in IBD Models: Influence of Genetic and Environmental Factors

Background: Inflammatory bowel disease (IBD) is characterized by chronic intestinal inflammation due to dysregulation of the mucosal immune system. The cytokines IL-1 beta and IL-18 appear early in intestinal inflammation and their pro-forms are processed via the caspase-1-activating multiprotein complex, the Nlrp3 inflammasome. Previously, we reported that the uptake of dextran sodium sulfate (DSS) by macrophages activates the Nlrp3 inflammasome and that Nlrp3(-/-) mice are protected in the acute DSS colitis model. Of note, other groups have reported opposing effects in regards to DSS susceptibility in Nlrp3(-/-) mice. Recently, mice lacking inflammasomes were found to develop a distinct intestinal microflora. Methods: To reconcile the contradicting observations, we investigated the role of Nlrp3 deficiency in two different IBD models: acute DSS colitis and TNBS (2,4,6-trinitrobenzene sulfonic acid)-induced colitis. In addition, we in-vestigated the impact of the intestinal flora on disease severity by performing cohousing experiments of wild-type and Nlrp3(-/-) mice, as well as by antibiotic treatment. Results: Nlrp3(-/-) mice treated with either DSS or TNBS exhibited attenuated colitis and lower mortality. This protective effect correlated with an increased frequency of CD103+ lamina propria dendritic cells expressing a tolerogenic phenotype in Nlrp3(-/-) mice in steady state conditions. Interestingly, after cohousing, Nlrp3(-/-) mice were as susceptible as wild-type mice, indicating that transmission of endogenous bacterial flora between the two mouse strains might increase susceptibility of Nlrp3(-/-) mice towards DSS-induced colitis. Accordingly, treatment with antibiotics almost completely prevented colitis in the DSS model. Conclusions: The composition of the intestinal microflora significantly influences disease severity in IBD models comparing wild-type and Nlrp3(-/-) mice. This observation may - at least in part - explain contradictory results concerning the role of the inflammasome in different labs. Further studies are required to define the role of the Nlrp3 inflammasome in noninflamed mucosa under steady state conditions and in IBD. Copyright (C) 2012 S. Karger AG, Base

Coherent light scattering from a two-dimensional Mott insulator

We experimentally demonstrate coherent light scattering from an atomic Mott insulator in a two-dimensional lattice. The far-field diffraction pattern of small clouds of a few hundred atoms was imaged while simultaneously laser cooling the atoms with the probe beams. We describe the position of the diffraction peaks and the scaling of the peak parameters by a simple analytic model. In contrast to Bragg scattering, scattering from a single plane yields diffraction peaks for any incidence angle. We demonstrate the feasibility of detecting spin correlations via light scattering by artificially creating a one-dimensional antiferromagnetic order as a density wave and observing the appearance of additional diffraction peaks.Comment: 4 pages, 4 figure

Immune response to functionalized mesoporous silica nanoparticles for targeted drug delivery

Multifunctional mesoporous silica nanoparticles (MSN) have attracted substantial attention with regard to their high potential for targeted drug delivery. For future clinical applications it is crucial to address safety concerns and understand the potential immunotoxicity of these nanoparticles. In this study, we assess the biocompatibility and functionality of multifunctional MSN in freshly isolated, primary murine immune cells. We show that the functionalized silica nanoparticles are rapidly and efficiently taken up into the endosomal compartment by specialized antigen-presenting cells such as dendritic cells. The silica nanoparticles showed a favorable toxicity profile and did not affect the viability of primary immune cells from the spleen in relevant concentrations. Cargo-free MSN induced only very low immune responses in primary cells as determined by surface expression of activation markers and release of pro-inflammatory cytokines such as Interleukin-6, -12 and -1β. In contrast, when surface-functionalized MSN with a pH-responsive polymer capping were loaded with an immune-activating drug, the synthetic Toll-like receptor 7 agonist R848, a strong immune response was provoked. We thus demonstrate that MSN represent an efficient drug delivery vehicle to primary immune cells that is both non-toxic and non-inflammagenic, which is a prerequisite for the use of these particles in biomedical applications

Comparing Microwave and Classical Synthesis of Oxymethylene Dimethyl Ethers

Polyoxymethylene dimethyl ethers (OME n ) are considered as substituents or additives for fossil diesel fuel. Efficiency of the synthesis is crucial for the development of industrial scale production plants. Therefore, the design of suitable catalysts and the efficient heating play important roles in OME fuel synthesis. In this work, microwave‐assisted synthesis (MAS) is carried out and compared to a classical approach using standard thermal heating. Different polymeric materials, e.g., Amerlyst15, are utilized as catalysts, and screened for the catalytic synthesis of OME. Within this approach, the kinetics of the reaction are analyzed in detail