Chiari malformation, cervical spine anomalies, and neurologic deficits in velocardiofacial syndrome

The purpose of this investigation was to evaluate the prevalence of Chiari malformation, cervical spine anomalies, and neurologic deficits in patients with velocardio-facial syndrome. This study was a prospective evaluation of 41 consecutive patients with velocardiofacial syndrome, documented by fluorescence in situ hybridization, between March of 1994 and September of 1998. The 23 girls and 18 boys ranged in age from 0.5 to 15.2 years, with a mean age of 6.7 years. Nineteen patients were assessed with magnetic resonance imaging, 39 underwent lateral cephalometric radiography, and all patients were examined for neurologic deficits. Eight of 19 patients (42 percent) had anomalies of the craniovertebral junction, including Chiari type I malformations (n = 4), occipitalization of the atlas (n = 3), and narrowing of the foramen magnum (n = 1). One patient with Chiari malformation required suboccipital craniectomy with laminectomy and decompression. Fourteen of 41 patients (34 percent) had demonstrated neurologic deficits; 10 patients (24 percent) had velar paresis (6 unilateral and 4 bilateral). Chiari malformations, cervical spine anomalies, and neurologic deficits are common in velocardiofacial syndrome. Because these findings may influence the outcome of surgical intervention, routine assessment of patients with velocardiofacial syndrome should include careful orofacial examination, lateral cephalometric radiography, and magnetic resonance imaging of the craniovertebral junction.     

Tennis elbow and the cervical spine.

The exact cause of tennis elbow, a common condition, is still obscure. While the condition may well be entirely due to a local disorder at the elbow, the results of a study of 50 patients whose condition was resistant to 4 weeks of treatment directed to the elbow suggest that the underlying condition may have been (at least in these patients) a reflex localization of pain from radiculopathy at the cervical spine. Clinical, radiologic and electromyographic findings supported this suggestion. The pain was demonstrated to be muscular tenderness, which was maximal and specific at motor points. Treatment directed to the cervical spine appeared to give relief in the majority of patients. The more resistant the condition, the more severe were the radiologic and electromyographic findings in the cervical spine.     

Biomechanical study of pediatric human cervical spine: a finite element approach

Although considerable effort has been made to understand the biomechanical behavior of the adult cervical spine, relatively little information is available on the response of the pediatric cervical spine to external forces. Since significant anatomical differences exist between the adult and pediatric cervical spines, distinct biomechanical responses are expected. The present study quantified the biomechanical responses of human pediatric spines by incorporating their unique developmental anatomical features. One-, three-, and six-year-old cervical spines were simulated using the finite element modeling technique, and their responses computed and compared with the adult spine response. The effects of pure overall structural scaling of the adult spine, local component developmental anatomy variations that occur to the actual pediatric spines, and structural scaling combined with local component anatomy variations on the responses of the pediatric spines were studied. Age- and component-related developmental anatomical features included variations in the ossification centers, cartilages, growth plates, vertebral centrum, facet joints, and annular fibers and nucleus pulposus of the intervertebral discs. The flexibility responses of the models were determined under pure compression, pure flexion, pure extension, and varying degrees of combined compression-flexion and compression-extension. The pediatric spine responses obtained with the pure overall (only geometric) scaling of the adult spine indicated that the flexibilities consistently increase in a uniform manner from six- to one-year-old spines under all loading cases. In contrast, incorporation of local anatomic changes specific to the pediatric spines of the three age groups (maintaining the same adult size) not only resulted in considerable increases in flexibilities, but the responses also varied as a function of the age of the pediatric spine and type of external loading. When the geometric scaling effects were added to these spines, the increases in flexibilities were slightly higher; however, the pattern of the responses remained the same as found in the previous approach. These results indicate that inclusion of developmental anatomical changes characteristic of the pediatric spines has more of a predominant effect on biomechanical responses than extrapolating responses of the adult spine based on pure overall geometric scaling.     

The management of cubital tunnel syndrome: a meta-analysis of clinical studies

Despite extensive clinical experience in treating cubital tunnel syndrome, optimal surgical management remains controversial. A meta-analysis of 30 studies with accurate preoperative and postoperative staging was undertaken. Patients were staged preoperatively into minimum, moderate, and severe groups on the basis of clinical presentation. Treatment modalities included nonoperative management, surgical decompression, medial epicondylectomy, anterior subcutaneous transposition, and anterior submuscular transposition. Statistical analysis using a standard SAS database with analysis of variance and chi-square tests was used to assess the efficacy of each therapeutic modality. For minimum-staged patients, all modalities produced similar degrees of satisfaction. However, total relief occurred most after medial epicondylectomy and least after anterior subcutaneous transposition. Patients treated nonoperatively had the highest rate of recurrence. For moderate-staged patients, submuscular transposition was most efficacious, whereas patients with nonoperative management fared the worst. Finally, for severe-staged patients, current therapeutic modalities were not consistently effective, with medial epicondylectomy producing the poorest operative result. This article reveals statistically significant differences in outcomes among therapeutic modalities, which may assist in treatment planning; it introduces standardized methods to aid in determining, analyzing, and communicating treatment outcomes.     

Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement

Background

Eccrine carcinoma is a quite rare malignant tumor that typically arises from a normal sweat gland and that features a rather high recurrence rate subsequent to simple excision. Given its rather poor response to adjuvant therapy, wide excision of the lesion with tumor-free margins may offer a reasonable chance for long-term control of this neoplasm.

Case presentation

Herein, we report on an unusual case of perianal eccrine carcinoma, initially presenting as a perianal abscess.

Conclusion

Even though eccrine carcinomas would appear to be rare, when dealing with recurrent skin tumors or recurrent perianal fistulas, the possibility of eccrine carcinoma should be considered by consulting clinicians.     

An in-vitro study of the kinematics of the normal, injured and stabilized cervical spine

The relative motion between various vertebrae of multi-level cervical ligamentous spinal segments (C2-T2), using Bryant angles, is described. A three-dimensional sonic digitizer was utilized to study the motion in flexion, extension, right lateral bending and right axial rotation. Effects of a number of injuries and stabilization (interspinous wiring and acrylic cement, PMMA) on the motion behavior of C5-C6 (injured) and C4-C5 (superior to injured) levels were investigated. The data were normalized with respect to intact specimens. The injury to capsular ligaments at C5-C6 produced a significant increase in the relative motion at C4-C5. Although the interspinous wiring reduced the motion at C5-C6 the C4-C5 motion was still higher. The application of PMMA made the motion at C4-C5 comparable to the intact specimen.     

Comparative study: conventional cervical and ThinPrep Pap tests in a routine clinical setting.

The conventional Papanicolaou smear is associated with variable false positive and false negative rates, difficulties with interpretation and high unsatisfactory and suboptimal rates. Newer fluid-based methods such as the ThinPrep 2000 system (Cytyc Corp., Boxborough, MA) are said to overcome these difficulties. The aim of this study was to compare the conventional smear with the ThinPrep method in a busy, routine cytology screening laboratory setting. One thousand split samples were evaluated. Using ThinPrep, the results showed an increased sensitivity and a dramatic improvement in specimen adequacy, with a combined 17.2% reduction in 'unsatisfactory' and 'suboptimal' reports. Screening time per slide was also reduced to 3-4 min. In conclusion, we report an increase in sensitivity, a reduction in screening time and a dramatic improvement in specimen adequacy with the ThinPrep method.     

Reye's syndrome: a clinical review.

Reye''s syndrome is a virus-associated biphasic disease that causes acute encephalopathy in infants and children. Epidemiologic and experimental data support the hypothesis that it is a multifactorial disease of modern civilization. Just as young patients seem to be recovering uneventfully from the first phase of the illness, usually a nonspecific viral-like illness such as a respiratory tract infection or gastroenteritis, the second phase, encephalopathy, starts unexpectedly, with vomiting and sensorial changes. Identifying the syndrome early ;in the second phase and referring the child to a specialized centre with the experience, staff and facilities to manage this phase has improved the numbers and neurologic condition of survivors, though the overall mortality is still about 20%. Therapy is primarily directed at facilitating adequate cerebral perfusion pressure.     

Letter to Editor: Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement

A response to Chalidis et al: Carpal tunnel syndrome due to an atypical deep soft tissue leiomyoma: The risk of misdiagnosis and mismanagement. World J Surg Oncol 2007, 5:92.     

Static and dynamic bending responses of the human cervical spine.

The quasi-static and dynamic bending responses of the human mid-lower cervical spine were determined using cadaver intervertebral joints fixed at the base to a six-axis load cell. Flexion bending moment was applied to the superior end of the specimen using an electrohydraulic piston. Each specimen was tested under three cycles of quasi-static load-unload and one high-speed dynamic load. A total of five specimens were included in this study. The maximum intervertebral rotation ranged from 11.0 to 15.4 deg for quasi-static tests and from 22.9 to 34.4 deg for dynamic tests. The resulting peak moments at the center of the intervertebral joint ranged from 3.8 to 6.9 Nm for quasi-static tests and from 14.0 to 31.8 Nm for dynamic tests. The quasi-static stiffness ranged from 0.80 to 1.35 Nm/deg with a mean of 1.03 Nm/deg (+/- 0.11 Nm/deg). The dynamic stiffness ranged from 1.08 to 2.00 Nm/deg with a mean of 1.50 Nm/deg (+/- 0.17 Nm/deg). The differences between the two stiffnesses were statistically significant (p < 0.01). Exponential functions were derived to describe the quasi-static and dynamic moment-rotation responses. These results provide input data for lumped-parameter models and validation data for finite element models to better investigate the biomechanics of the human cervical spine.     

Developmental biomechanics of the cervical spine: Tension and compression

Epidemiological data and clinical indicia reveal devastating consequences associated with pediatric neck injuries. Unfortunately, neither injury prevention nor clinical management strategies will be able to effectively reduce these injuries or their effects on children, without an understanding of the cervical spine developmental biomechanics. Thus, we investigated the relationship between spinal development and the functional (stiffness) and failure biomechanical characteristics of the cervical spine in a baboon model. A correlation study design was used to define the relationships between spinal tissue maturation and spinal biomechanics in both tension and compression. Eighteen baboon cervical spine specimens distributed across the developmental spectrum (1–26 human equivalent years) were dissected into osteoligamentous functional spinal units. Using a servo-hydraulic MTS, these specimens (Oc–C2, C3–C4, C5–C6, C7–T1) were non-destructively tested in tension and compression and then displaced to failure in tension while measuring the six-axes of loads and displacements. The functions describing the developmental biomechanical response of the cervical spine for stiffness and normalized stiffness exhibited a significant direct relationship in both tension and compression loading. Similarly, the tensile failure load and normalized failure load demonstrated significant maturational increases. Further, differences in biomechanical response were observed between the spinal levels examined and all levels exhibited clinically relevant failure patterns. These data support our understanding of the child cervical spine from a developmental biomechanics perspective and facilitate the development of injury prevention or management schema for the mitigation of child spine injuries and their deleterious effects.