bluuebunny/crossref_metadata_2025 huggingface dataset:
A hypothesis of cerebral venous system regulation based on a study of the junction between the cortical bridging veins and the superior sagittal sinus
Authors: Vignes Jean-Rodolphe , Dagain Arnaud , Guérin Jean , Liguoro Dominique
Published: December 2007

Object

The cerebral venous regulation involved in various physiological and pathological processes has received little attention. Here the authors describe the anatomy of the junction between the cortical vein and the superior sagittal sinus (SSS) and propose a new theory of cerebral venous regulation.

Methods

Ten adult human cadaveric heads (20 sides), including five specimens into which stained latex had been injected, were used for anatomical study. Formalin-fixed cadaver heads were dissected to demonstrate the cortical veins along the SSS. The characteristics of the cortical bridging veins and their openings into the SSS were established by anatomical, histological, immunohistochemical, and ultrastructural study of the junction.

Results

After their subarachnoid course, the cortical bridging veins penetrated the SSS at different points in the dura mater depending on their rostrocaudal position. The venous endothelium stretched beyond the sinus endothelium. The orientation of the collagen fibers changed at the level of the venous openings, with the luminal diameter becoming narrow and oval-shaped. The major finding was the organization of the smooth-muscle cells at the end of each cortical vein. At this site and particularly in the frontoparietal region, the vessel resembled a myoendothelial “sphincter.” The authors hypothesize that this organization is involved in cerebral venous system regulation.

Conclusions

The point of convergence between the cortical veins and the SSS is a key area. The authors also hypothesize that the myoendothelial junction acts as a smooth sphincter and that it plays a role in cerebral venous hemodynamics and pathological conditions.
Contralateral vertebral approach for stenting and coil embolization of a large, thrombosed vertebral–posterior inferior cerebellar artery aneurysm
Authors: Ecker Robert D. , Hanel Ricardo A. , Levy Elad I. , Hopkins L. Nelson
Published: December 2007

✓The authors report the successful staged stenting and coil embolization of a large vertebral artery–posterior inferior cerebellar artery (VA-PICA) aneurysm using the contralateral VA for access. A 67-year-old woman presented with a large ruptured VA-PICA aneurysm. Initial attempts to stent the wide-necked aneurysm from the ipsilateral side failed, so coil embolization of the dome was performed. During a second endovascular session, the aneurysm neck was successfully stented from the contralateral VA into the PICA. Six weeks later, coils were inserted into the aneurysm from the ipsilateral side. The coil result was stable at the 3-month follow-up examination.
External carotid artery angioplasty and stenting to augment cerebral perfusion in the setting of subacute symptomatic ipsilateral internal carotid artery occlusion
Authors: Adel Joseph G. , Bendok Bernard R. , Hage Ziad A. , Naidech Andrew M. , Miller Jeffery W. , Batjer H. Hunt
Published: December 2007

✓The authors performed external carotid artery (ECA) angioplasty and stenting in a 45-year-old man who had presented with right hemispheric crescendo ischemic symptoms stemming from acute right internal carotid artery occlusion (ICAO). This unique application of ECA angioplasty and stenting augmented cerebral perfusion and improved clinical symptoms. In certain situations, ECA stenting can increase cerebral perfusion in the setting of ICAO and ECA stenosis. The authors are the first to describe this approach in this context.
Preservation of the lesser occipital nerve during microvascular decompression for hemifacial spasm
Authors: Fujimaki Takamitsu , Son Jae-Hyun , Takanashi Shigehiko , Ishii Teruyuki , Furuya Kazuhide , Mochizuki Toshihiro , Ueno Toshiaki , Nakagomi Tadayoshi
Published: December 2007

✓The authors report on their technique for preserving the lesser occipital nerve (LON) during lateral suboccipital craniotomy. In their technique, the LON, which runs along the surface of or just beneath the sternocleidomastoid muscle, is identified and preserved. Lesser occipital nerve preservation using their technique was attempted in 25 patients who underwent microvascular decompression for hemifacial spasm. The LON was successfully preserved in 16 of these patients, was impossible to preserve in two patients, and could not be identified in seven patients. Among the patients in whom LON preservation was successful, 87.5% were free of sensory disturbance 6 months after surgery, whereas both patients in whom the LON could not be preserved complained of sensory disturbances in the occipital area and the posterior part of the auricula. Fifty-seven percent of the patients whose LON could not be identified complained of sensory disturbance. Thus, this technique for preserving the LON reduces the incidence of sensory disturbance in the occipital region after suboccipital craniotomy for microvascular decompression for hemifacial spasm.
New transparent peel-away sheath with neuroendoscopic orientation markers
Authors: Oi Shizuo , Abdullah Saad Hamdan
Published: December 2007

✓The peel-away sheath in neuroendoscopic surgery offers numerous advantages and has many potential applications. However, currently available nontransparent sheaths have a critical disadvantage in that disorientation can occur, given the limited visible operative field. To overcome this obstacle, the authors have developed and clinically applied a new transparent sheath with “navigational orientation markers.” The clear peel-away sheath provides a transparenchymal route, parenchymal protection, and, most importantly, direct visualization of the surroundings along the whole trajectory and at the distal edge. The navigational orientation markers add further benefits in terms of facilitating orientation in the endoscope trajectory, making this tool extremely useful in neuroendoscopic surgery.
Changes in sagittal alignment after restoration of lower lumbar lordosis in patients with degenerative flat back syndrome
Authors: Jang Jee-Soo , Lee Sang-Ho , Min Jun-Hong , Maeng Dae Hyeon
Published: December 2007

Object

The authors investigate the correlation between thoracic and lumbar curves in patients with degenerative flat back syndrome, and demonstrate the predictability of spontaneous correction of the thoracic curve and sacral angle after surgical restoration of lower lumbar lordosis.

Methods

The cases of 28 patients treated with combined anterior and posterior spinal arthrodesis were retrospectively reviewed. Inclusion criteria included loss of lower lumbar lordosis resulting in sagittal imbalance. Total lumbar lordosis, thoracic kyphosis, sacral slope, and C-7 plumb line length were measured on pre- and postoperative lateral views of the whole spine. Postoperative changes in thoracic kyphosis, sacral slope, and length of the C-7 plumb line were measured and evaluated according to extent of lumbar lordosis restoration.

Results

The mean (± standard deviation) preoperative sagittal imbalance was 64.6 ± 63.2 mm, which improved to 15.8 ± 20.7 mm after surgery (p < 0.0001). The preoperative mean lumbar lordosis was 15.6 ± 14.1°, which increased to 40.3 ± 14.5° at follow-up (p < 0.0001). The preoperative mean thoracic kyphosis was 1.6 ± 10.5° and increased to 17.2 ± 12.5° at follow-up (p < 0.0001). Significant preoperative correlations existed between kyphosis and lordosis (r = 0.628, p = 0.0003), and between lordosis and sacral slope (r = 0.647, p = 0.0002). Postoperative correlations also existed between kyphosis and lordosis (r = 0.718, p < 0.0001 and r = 0.690, p < 0.0001, respectively).

Conclusions

Lower lumbar lordosis plays an important role in sagittal alignment and balance. Surgical restoration of lumbar lordosis results in predictable spontaneous correction of the thoracic curve and sacral slope in patients with degenerative flat back syndrome.
A comparison of two techniques in image-guided thoracic pedicle screw placement: a retrospective study of 37 patients and 277 pedicle screws
Authors: Lekovic Gregory P. , Potts Eric A. , Karahalios Dean G. , Hall Graham
Published: December 2007

Object

The goal of this study was to compare the accuracy of thoracic pedicle screw placement aided by two different image-guidance modalities.

Methods

The charts of 40 consecutive patients who had undergone stabilization of the thoracic spine between January 2003 and January 2005 were retrospectively reviewed. Three patients were excluded from the study because, on the basis of preoperative findings, small pedicle diameter precluded the use of pedicle screws. Thus, a total of 37 patients had 277 screws placed with the aid of either virtual fluoroscopy or isocentric C-arm 3D navigation. The indications for surgery included trauma, degenerative disease, and tumor, and were similar in both groups. All 37 patients underwent postoperative computed tomography scanning, and an independent reviewer graded all screws based on axial, sagittal, and coronal projections for a full determination of the placement of the screw in the pedicle.

Results

The rate of unintended perforations was found to depend on pedicle diameter (p < 0.0001). There were no statistical differences between groups with regard to rate or grade of cortical perforations. Overall, the rate and grade of perforations was low, and there were no neurological or vascular complications.

Conclusions

The authors have shown that either image-guidance system may be used with a high degree of accuracy and safety. Because both systems were found to be comparably safe and accurate, the choice of image-guidance modality may be determined by the level of surgeon comfort and/or availability of the system.
The frequency and clinical significance of congenital defects of the posterior and anterior arch of the atlas
Authors: Senoglu Mehmet , Safavi-Abbasi Sam , Theodore Nicholas , Bambakidis Nicholas C. , Crawford Neil R. , Sonntag Volker K. H.
Published: December 2007

Object

In this study the authors investigated the anatomical, clinical, and imaging features as well as incidence of congenital defects of the C-1 arch.

Methods

The records of 1104 patients who presented with various medical problems during the time between January 2006 and December 2006 were reviewed retrospectively. The craniocervical computed tomography (CT) scans obtained in these patients were evaluated to define the incidence of congenital defects of the posterior arch of C-1. In addition, 166 dried C-1 specimens and 84 fresh human cadaveric cervical spine segments were evaluated for anomalies of the C-1 arch.

Results

Altogether, 40 anomalies (2.95%) were found in 1354 evaluated cases. Of the 1104 patients in whom CT scans were acquired, 37 (3.35%) had congenital defects of the posterior arch of the atlas. The incidence of each anomaly was as follows: Type A, 29 (2.6%); Type B, six (0.54%); and Type E, two (0.18%). There were no Type C or D defects. One patient (0.09%) had an anterior arch cleft. None of the reviewed patients had neurological deficits or required surgical intervention for their anomalies. Three cases of Type A posterior arch anomalies were present in the cadaveric specimens.

Conclusions

Most congenital anomalies of the atlantal arch are found incidentally in asymptomatic patients. Congenital defects of the posterior arch are more common than defects of the anterior arch.
Neck pain in multisport athletes
Authors: Villavicencio Alan T. , Hernández Theresa D. , Burneikiene Sigita , Thramann Jeff
Published: December 2007

Object

The sport of triathlon is very physically demanding and has experienced rapid growth in recent years. The number of triathletes seen for spine disorders at neurosurgery clinics is increasing. Neck pain and overuse injuries have not been adequately studied in multisport athletes. The authors undertook an epidemiological study to establish the lifetime incidence of neck pain and the prevalence of possible discogenic pain, and to identify risk factors among triathletes in the Boulder, Colorado area.

Methods

An online questionnaire was developed to collect information about physical characteristics, training habits, athletic status, number of races completed, and neck pain among triathletes. The incidence of possible cervical discogenic pain was defined according to the duration of symptoms for the most recent pain episode.

Results

One hundred and sixty-four athletes responded to the questionnaire. The lifetime incidence of neck pain was 47.6% (78 athletes), with 15.4% possibly being of discogenic origin based on the duration of symptoms. Approximately 64% of responding athletes reported that their neck pain was sports related. Although the number of previous triathlons was not predictive of neck pain, total years in the sport (p = 0.029) and number of previous sports-related injuries (p < 0.0001) were.

Conclusions

Two major risk factors for long-term spinal problems in triathletes are sports-related injuries and overuse. This report is one of the first comprehensive studies of neck pain and overuse injury in multisport athletes.
The effects of topical granulocyte-macrophage colony–stimulating factor on dural healing in rats after induced cerebrospinal fluid leakage
Authors: Kurt Gökhan , Börcek Alp Özgün , Cemil Berker , Uçankuş NeşE Lortlar , Doğulu Fikret , Baykaner M. Kemali
Published: December 2007

Object

Dural defects must be repaired to protect the central nervous system from contamination. Although there are various experimental and commercial substances available for this purpose, the ultimate method of watertight dural closure has yet to be discovered. In this study, the authors investigate the effects of topically applied recombinant mouse granulocyte-macrophage colony–stimulating factor (GM-CSF) on dural healing in a rat model of dural injury and cerebrospinal fluid leakage.

Methods

In this experimental model, a dural defect at the level of the L1–2 vertebrae was created in 32 Wistar rats. Sixteen animals were treated with locally applied recombinant mouse GM-CSF postoperatively, and 16 animals received normal saline. The effects of GM-CSF on dural healing, cerebrospinal fluid leakage, and wound healing were assessed 2 and 4 weeks postoperatively. Dural healing was evaluated histologically.

Results

Dural healing was increased in rats treated with GM-CSF compared with rats in the control group. This difference was statistically significant (p < 0.05).

Conclusions

Cerebrospinal fluid leakage may impede healing of dural defects. Topically applied GM-CSF seems to aid in dural healing.
A periosteal chondroma in the lumbar spinal canal
Authors: Ogata Tadanori , Miyazaki Tatsuhiko , Morino Tadao , Nose Masato , Yamamoto Haruyasu
Published: December 2007

✓ Periosteal chondromas located in the spine are rare. The authors document a case of periosteal chondroma in the lumbar spinal canal of a 77-year-old man. The patient had severe pain in his right leg and used a wheelchair because of weakness in both legs. Magnetic resonance imaging revealed a round tumor that was hypo- or isointense on T1-weighted images and uniformly hyperintense on T2-weighted images. Administration of gadolinium-diethylenetriamine pentaacetic acid resulted in margin enhancement on T1-weighted images. During the operation, a round tumor 1.5 cm in diameter was found on the surface of the anterior wall of the L-3 lamina. Histological examination revealed that the tumor consisted of chondroid tissue with typical chondrocytes, indicating that it was a periosteal chondroma.
Epidural Lipomatosis
Authors: Borré Daniel G.
Published: December 2007

Object

Idiopathic symptomatic spinal epidural lipomatosis (SEL) is a rare condition, and few reports have discussed diagnostic imaging criteria. To evaluate factors relating to its clinical symptoms, correlations between clinical features and the presence of spinal epidural fat were investigated, and the literature concerning idiopathic SEL was reviewed.

Methods

Morphological gradings of epidural fat were evaluated in seven patients with idiopathic SEL by using magnetic resonance (MR) imaging. In addition, body mass index (BMI), the number of involved vertebral levels, grade, and preoperative Japanese Orthopaedic Association (JOA) score were analyzed. Surgery resulted in symptomatic relief, with a mean JOA score recovery rate of 67.4%. Grading of epidural fat tended to display a slight negative correlation with preoperative JOA score, whereas a strong significant positive correlation was found between the number of involved vertebral levels and BMI.

Conclusions

The number of involved vertebral levels and obesity are strongly correlated, whereas severity of dural compression is not always significantly associated with neurological complications. These results indicate that epidural fat of the lumbar spine contributes to neurological deficits. In addition, weight-reduction therapy appears to decrease the number of vertebral levels involved. Magnetic resonance imaging–based grading is helpful for the diagnosis and evaluation of idiopathic lumbar SEL. Moreover, symptoms and neurological findings are important for determining the surgical approach.
Embolization of spinal intramedullary arteriovenous malformations using the liquid embolic agent, Onyx: a single-center experience in a series of 17 patients
Authors: Corkill Rufus A. , Mitsos Aristotelis P. , Molyneux Andrew J.
Published: December 2007

Object

The aim of this study was to analyze the endovascular treatment results of using the Onyx liquid embolic system for spinal intramedullary arteriovenous malformations (AVMs).

Methods

The clinical and radiological records of 17 patients with symptomatic spinal intramedullary AVMs treated exclusively by embolization with Onyx between 1999 and 2003 were retrospectively reviewed. There were 12 females and five males in the patient series (mean age 29 years). Four of these AVMs were located in the cervical spine, eight in the thoracic spine, and five in the lumbar spine. The clinical presentation of these AVMs included upper motor neuron signs and symptoms, and hemorrhage was the initial presentation in 12 patients. Neurological and functional evaluation was performed before and after treatment with Onyx in all patients.

Results

Thirteen patients underwent a single endovascular treatment and four patients underwent two endovascular treatments (average 1.23 sessions per patient). Intraprocedural complications occurred on two occasions without neurological consequences. The mean follow-up duration was 24.3 months. Angiographic outcomes included total AVM obliteration in six patients (37.5%), subtotal obliteration in five patients (31.25%), and partial obliteration in five patients (31.25%). Improvement in neurological and/or functional status was noted in 14 patients, resulting in an 82% rate of overall good clinical outcome.

Conclusions

Embolization using the Onyx system is a promising treatment method for spinal vascular malformations, even for challenging intramedullary AVMs. Larger studies with longer follow-up durations will further enhance our knowledge on the safety and efficacy of this relatively new liquid embolic agent.
Percutaneous multilevel decompressive laminectomy, foraminotomy, and instrumented fusion for cervical spondylotic radiculopathy and myelopathy: assessment of feasibility and surgical technique
Authors: Scheufler Kai-michael , Kirsch Eberhard
Published: December 2007

Object

Extensive muscle dissection associated with conventional dorsal approaches to the cervical spine frequently results in local pain, muscle wasting, and temporarily painful and restricted neck movement. The utility of a percutaneous muscle-sparing access technique and specifically modified instrumentation for multilevel posterior cervical decompression and fusion were evaluated.

Methods

Eleven patients (six men, five woman; mean age 72.8 ± 6.3 years) presenting with refractory neck pain and progressive multilevel cervical radiculopathy and/or myelopathy due to cervical spondylosis with spinal canal and neural foraminal stenosis underwent multilevel laminectomy, foraminotomy, and subsequent instrumented posterior fusion via bilateral or unilateral percutaneous muscle dilation approaches. A novel cannulated polyaxial instrumentation system was used for unilateral transpedicular/translaminar fixation.

Results

Significant reduction of Neck Disability Index and Nurick Scale scores and partial or complete recovery of upper extremity radicular deficits was observed during follow-up (mean 14.6 months). Mean procedural blood loss was 45.5 ml, and mean length of stay in hospital was 5.7 days. Fusion was demonstrated in 10 patients between 12 and 14 months postoperatively. Operative exposure and instrumentation were significantly facilitated by specific modifications of retractor/access port systems, surgical instruments, and implants.

Conclusions

Muscle sparing posterior decompression and instrumented fusion constitutes a safe and effective surgical option in a selected subgroup of patients with multilevel cervical spondylotic radiculomyelopathy. Specific modifications in surgical technique, instrumentation, and implants are mandatory for effective achievement of the surgical goals. The use of refined image guidance technology and intraoperative imaging can further improve surgical safety and efficacy.
Spinal Kaposi sarcoma presenting without cutaneous manifestations
Authors: Omeis Ibrahim , Siems Ashley L. , Harrington William , Johnson Livette S. , Destian Sylvie , DeMattia Joseph A.
Published: December 2007

✓ Kaposi sarcoma (KS) is one of the most common tumors in patients with human immunodeficiency virus (HIV), which characteristically presents with cutaneous lesions. The authors report a rare case of spinal KS with no cutaneous manifestation in a 32-year-old man with the acquired immunodeficiency syndrome who presented with abdominal pain. A computed tomography scan revealed incidental lesions in his lumbar spine, and additional imaging studies revealed numerous lesions in the lumbosacral spine and pelvis. An open biopsy was performed, and histopathological examination of the lesion confirmed the diagnosis of KS. At the time of presentation, the patient had no skin lesion or any other manifestation indicative of KS. The authors suggest that in HIV-positive patients who present with spinal lesions, KS should be included in the differential diagnosis.
Lymphocele formation after anterior lumbar interbody fusion at L4–5
Authors: Pee Yong Hun , Kim Ki Joon , Choi Young-Geun , Jeon Sang Hyeop , Park Jong Dae , Lee Sang-Ho
Published: December 2007

✓ In this report, the authors present the case of patient with a lymphocele in the retroperitoneal area following anterior lumbar interbody fusion at L4–5. A lymphocele is a rare complication of spinal operations, especially lower lumbar spinal surgeries. The authors discuss this complicating factor and describe its features and treatments.
Syndrome of occipitoatlantoaxial hypermobility, cranial settling, and Chiari malformation Type I in patients with hereditary disorders of connective tissue
Authors: Milhorat Thomas H. , Bolognese Paolo A. , Nishikawa Misao , McDonnell Nazli B. , Francomano Clair A.
Published: December 2007

Object

Chiari malformation Type I (CM-I) is generally regarded as a disorder of the paraxial mesoderm. The authors report an association between CM-I and hereditary disorders of connective tissue (HDCT) that can present with lower brainstem symptoms attributable to occipitoatlantoaxial hypermobility and cranial settling.

Methods

The prevalence of HDCT was determined in a prospectively accrued cohort of 2813 patients with CM-I. All patients underwent a detailed medical and neuroradiological workup that included an assessment of articular mobility. Osseous structures composing the craniocervical junction were investigated morphometrically using reconstructed 3D computed tomography and plain x-ray images in 114 patients with HDCT/CM-I, and the results were compared with those obtained in patients with CM-I (55 cases) and healthy control individuals (55 cases).

Results

The diagnostic criteria for Ehlers–Danlos syndrome and related HDCT were met in 357 (12.7%) of the 2813 cases. Hereditability was generally compatible with a pattern of autosomal dominant transmission with variable expressivity. The diagnostic features of HDCT/CM-I were distinguished from those of CM-I by clinical stigmata of connective tissue disease, a greater female preponderance (8:1 compared with 3:1, p < 0.001), and a greater incidence of lower brainstem symptoms (0.41 compared with 0.11, p < 0.001), retroodontoid pannus formation (0.71 compared with 0.11, p < 0.001), and hypoplasia of the oropharynx (0.44 compared with 0.02, p < 0.001). Measurements of the basion–dens interval, basion–atlas interval, atlas–dens interval, dens–atlas interval, clivus–atlas angle, clivus–axis angle, and atlas–axis angle were the same in the supine and upright positions in healthy control individuals and patients with CM-I. In patients with HDCT/CM-I, there was a reduction of the basion–dens interval (3.6 mm, p < 0.001), an enlargement of the basion–atlas interval (3.0 mm, p < 0.001), and a reduction of the clivus–axis angle (10.8°, p < 0.001), clivus–atlas angle (5.8°, p < 0.001), and atlas–axis angle (5.3°, p < 0.001) on assumption of the upright position. These changes were reducible by cervical traction or returning to the supine position.

Conclusions

The identification of HDCT in 357 patients with CM-I establishes an association between two presumably unrelated mesodermal disorders. Morphometric evidence in this cohort—cranial settling, posterior gliding of the occipital condyles, and reduction of the clivus–axis angle, clivus–atlas angle, and atlas–axis angle in the upright position—suggests that hypermobility of the occipitoatlantal and atlantoaxial joints contributes to retroodontoid pannus formation and symptoms referable to basilar impression.
Neuroprotective potential of erythropoietin and darbepoetin alfa in an experimental model of sciatic nerve injury
Authors: Grasso Giovanni , Meli Francesco , Fodale Vincenzo , Calapai Gioacchino , Buemi Michele , Iacopino Domenico G.
Published: December 2007

Object

The objectives of this study were to examine whether the systemic administration of recombinant human erythropoietin (rHuEPO) and its long-lasting derivative darbepoetin alfa expedited functional recovery in a rat model of sciatic nerve injury, and to compare the effects of these agents in the model.

Methods

Thirty male Sprague–Dawley rats received a crush injury to the left sciatic nerve and subsequently underwent either placebo treatment, daily injections of rHuEPO, or weekly injections of darbepoetin alfa.

Results

Both rHuEPO and darbepoetin alfa were effective in reducing neurological impairment and improving compound muscle action potentials following nerve injury. Darbepoetin alfa, however, shortened the duration of peripheral nerve recovery and facilitated recovery from the neurological and electrophysiological impairment following crush injury significantly better than rHuEPO. Examination of the footprint length factor data revealed that darbepoetin alfa–treated animals recovered preinjury function by postoperative Day 10, 4 days earlier than animals treated with rHuEPO and 11 days earlier than animals treated with placebo.

Conclusions

These results suggest that recovery of neurological function in a model of peripheral nerve injury is more rapid with weekly administration of darbepoetin alfa than with daily rHuEPO treatment. Agents that facilitate nerve regeneration have the potential to limit the extent of motor endplate loss and muscle atrophy. The administration of EPO in its long-lasting recombinant forms affords significant neuroprotection in peripheral nerve injury models and may hold promise for future clinical applications.
Acute paraparesis from hemorrhagic spinal ependymoma: diagnostic dilemma and surgical management
Authors: Heuer Gregory G. , Stiefel Michael F. , Bailey Robert L. , Schuster James M.
Published: December 2007

✓Spinal ependymomas are a common type of primary spinal cord neoplasm that frequently occurs in the lumbar spine. The authors report on two patients who presented with acute neurological decline after hemorrhage into ependymomas of the filum terminale. Both were transferred to the authors' institution because of diagnostic uncertainty and a concern about possible intradural vascular abnormalities. Both patients underwent lumbar laminectomies for tumor resection. The pathological finding in each case was myxopapillary ependymoma. Both patients made a significant recovery and were ambulatory and continent at follow-up review. These cases illustrate the rare but clinically significant incidence of acute neurological decline caused by hemorrhagic cauda equina ependymomas, including the potential for delayed diagnosis and treatment.
Dissecting aneurysm of the radiculomedullary artery originating from extracranial vertebral artery dissection in a patient with rheumatoid cervical spine disease: an unusual cause of subarachnoid hemorrhage
Authors: Toyota Shingo , Wakayama Akatsuki , Fujimoto Yasunori , Sugiura Shiro , Yoshimine Toshiki
Published: December 2007

✓The authors report the case of a 65-year-old woman with atlantoaxial subluxation caused by rheumatoid arthritis. The patient had been hospitalized because of an infection after a total-knee replacement, when she suddenly lost consciousness and became apneic after an episode of intractable neck pain. Cranial computed tomography scanning demonstrated subarachnoid hemorrhage (SAH), and angiography revealed a dissecting aneurysm of the radiculomedullary artery that had originated from an extracranial vertebral artery dissection at the level of the atlantoaxial joint. Although coil embolization for the parent artery, including the dissecting aneurysm, was performed successfully, the patient died of worsening infection. The authors believe that the SAH occurred because of a ruptured dissecting aneurysm in the intradural portion of the radiculomedullary artery.
Iatrogenic pyogenic osteomyelitis of C-1 and C-2 treated with transoral decompression and delayed posterior occipitocervical arthrodesis
Authors: Reid Patrick J. , Holman Paul J.
Published: December 2007

✓The authors describe a case of osteomyelitis of the craniocervical junction caused by iatrogenic infection of the spine during corticosteroid injection therapy. This 58-year-old diabetic man presented with acute exacerbation of neck pain that had began 4 months prior to admission. He did not experience the associated fever, chills, or sweats, but he did notice transient weakness in the right upper extremity. A computed tomography (CT) scan of the cervical spine demonstrated a destructive process involving the odontoid and the left occipitocervical and atlantoaxial joints that was not present on a CT obtained 2 months earlier, just before trigger-point and left-sided C1–2 facet joint corticosteroid injections. A diagnosis of staphylococcal osteomyelitis was made, and initial treatment with external immobilization and appropriate antibiotic therapy failed to control radiographically demonstrated and clinical progression. The patient was successfully treated using staged anterior decompression and posterior instrumented fusion with prolonged antibiotic therapy.

To the authors' knowledge this case is the first reported instance of iatrogenic pyogenic osteomyelitis of the craniocervical junction successfully treated with anterior decompression and delayed posterior arthrodesis.
Management of Arthralgias Associated with Aromatase Inhibitor Therapy
Authors: Thorne Carter
Published: December 2007

For the upfront adjuvant therapy of postmenopausal estrogen receptor–positive breast cancer, the third-generation aromatase inhibitors (AIS) have shown a more favourable overall risk–benefit profile than has tamoxifen. Benefits of the AIS include less frequent gynecologic, cerebrovascular, and thromboembolic adverse events; greater disease-free survival; and lower tumour recurrence. Although approximately 25% of postmenopausal women with early breast cancer report experiencing symptoms of arthralgia with AI therapy, 68-month data from the Arimidex, Tamoxifen, Alone or in Combination trial showed that, compared with tamoxifen, anastrozole treatment was associated with only a modest increase in the incidence of joint symptoms. The events, which were mostly mild-to-moderate in intensity, led to treatment withdrawal in 2% of patients on anastrozole as compared with 1% in the tamoxifen arm. The symptoms and changes correlate with clinical, biochemical, and radiologic findings in symptomatic women. To determine appropriate intervention, it is therefore essential to perform a comprehensive evaluation of musculoskeletal complaints to distinguish natural menopause-related degenerative disease from AI-related effects. The present review explores the advantages of differential diagnosis with an emphasis on history and physical and musculoskeletal examination; laboratory investigations are used to corroborate or rule out clinical impressions. The transient symptoms associated with the AIS are manageable with an appropriate combination of lifestyle changes, including exercise and joint protection in conjunction with pharmacologic approaches.
Role of Vaccine Therapy in Cancer: Biology and Practice
Authors: Schlom J. , Gulley J. L. , Arlen P. M.
Published: December 2007

Vaccines constitute a potential new therapeutic approach for a range of human cancers. Unlike other therapeutics, vaccines initiate a dynamic process in the host immune system that can be exploited with subsequent therapies. Indeed, recent preclinical and clinical studies with cancer vaccines have provided evidence that this unique therapeutic modality should lead to consideration of new paradigms in both clinical trial design and endpoints and in combination therapies. The present article reviews and sets out a rationale for these new paradigms, with a focus on prostate cancer.
Nanodot‐Enhanced High‐Efficiency Pure‐White Organic Light‐Emitting Diodes with Mixed‐Host Structures
Authors: Jou J.‐H. , Chen C.‐C. , Chung Y.‐C. , Hsu M.‐F. , Wu C.‐H. , Shen S.‐M. , Wu M.‐H. , Wang W.‐B. , Tsai Y.‐C. , Wang C.‐P. , Shyue J.‐J.
Published: December 2007

A relatively high‐efficiency, fluorescent pure‐white organic light‐emitting diode was fabricated using a polysilicic acid (PSA) nanodot‐embedded polymeric hole‐transporting layer (HTL). The diode employed a mixed host in the single emissive layer, which comprised 0.5 wt % yellow 5,6,11,12‐tetra‐phenylnaphthacene doped in the mixed host of 50 % 2‐(N,N‐diphenyl‐amino)‐6‐[4‐(N,N‐diphenylamino)styryl]naphthalene and 50 % N,N′‐bis‐(1‐naphthyl)‐N,N′‐diphenyl‐1,10‐biphenyl‐4‐4′‐diamine. By incorporating 7 wt % 3 nm PSA nanodot into the HTL of poly(3,4‐ethylene‐dioxythiophene)‐poly‐(styrenesulfonate), the efficiency at 100 cd m–2 was increased from 13.5 lm W–1 (14.7 cd A–1; EQE: 7.2 %) to 17.1 lm W–1 (17.6 cd A–1; EQE: 8.3 %). The marked efficiency improvement may be attributed to the introduction of the PSA nanodot, leading to a better carrier‐injection‐balance.
The Photophysical Properties of Dipyrenylbenzenes and Their Application as Exceedingly Efficient Blue Emitters for Electroluminescent Devices
Authors: Wu K.‐C. , Ku P.‐J. , Lin C.‐S. , Shih H.‐T. , Wu F.‐I. , Huang M.‐J. , Lin J.‐J. , Chen I‐C. , Cheng C.‐H.
Published: December 2007

Three blue‐light emitting dipyrenylbenzene derivatives, 1‐(4‐(1‐pyrenyl)phenyl)pyrene (PPP), 1‐(2,5‐dimethoxy‐4‐(1‐pyrenyl)phenyl)pyrene (DOPPP), and 1‐(2,5‐dimethyl‐4‐(1‐pyrenyl)phenyl)pyrene (DMPPP), have been prepared by the Suzuki coupling reaction of aryl dibromides with pyreneboronic acid in high yields. These compounds exhibit high glass‐transition temperatures of 97–137 °C and good film‐forming ability. As revealed from single‐crystal X‐ray analysis, these dipyrenylbenzenes adopt a twisted conformation with inter‐ring torsion angles of 44.5°–63.2° in the solid state. The twisted structure is responsible for the low degree of aggregation in the thin films that leads to fluorescence emission of the neat films at 446–463 nm, which is shorter than that of the typical pyrene excimer emission. The low degree of aggregation is also conducive for the observed high fluorescence quantum yields of 63–75%. In organic light‐emitting diode (OLED) applications, these dipyrenylbenzenes can be used as either the charge transporter or host emitter. The non‐doped blue OLEDs that employ these compounds as the emissive layer can achieve a very high external quantum efficiency (ηext) of 4.3–5.2%. In particular, the most efficient DMPPP‐based device can reach a maximum ηext of 5.2% and a very high luminescence of 40 400 cd m–2 in the deep‐blue region with Commission Internationale d'Énclairage (CIE) coordinates of (0.15, 0.11).
Carbon Nanotube Biofiber Formation in a Polymer‐Free Coagulation Bath
Authors: Razal J. M. , Gilmore K. J. , Wallace G. G.
Published: December 2007

A novel solution spinning method to produce highly conducting carbon nanotube (CNT) biofibers is reported. In this process, carbon nanotubes are dispersed using biomolecules such as hyaluronic acid, chitosan, and DNA, and these dispersions are used as spinning solutions. Unlike previous reports in which a polymer binder is used in the coagulation bath, these dispersions can be converted into fibers simply by altering the nature of the coagulation bath via pH control, use of a crosslinking agent, or use of a biomolecule‐precipitating solvent system. With strength comparable to most reported CNT fibers to date, these CNT biofibers demonstrate superior electrical conductivities. Cell culture experiments are performed to investigate the cytotoxicity of these fibers. This novel fiber spinning approach could simplify methodologies for creating electrically conducting and biocompatible platforms for a variety of biomedical applications, particularly in those systems where the application of an electrical field is advantageous?for example, in directed nerve and/or muscle repair.
The inguinal ligament and its lateral attachments: Correcting an anatomical error
Authors: Acland Robert D.
Published: December 2007

The inguinal portions of the internal oblique and transversus abdominis muscles are generally described as arising from the inguinal ligament. Previous authors have shown that this description is incorrect. A new dissection study in 15 lightly embalmed cadavers confirms that in reality the inguinal portions of these muscles arise from a thickened strip of ilipsoas fascia that forms the superolateral part of the ilio‐pectineal arch. Details are given of a new dissection technique that fully exposes the deep aspect of the inguinal ligament, without disrupting its continuity. The historical background of the persistent textbook error is explored. It originated at a time when there was widespread descriptive and semantic confusion regarding the structure now known as the inguinal ligament. Clin. Anat. 21:55–61, 2008. © 2007 Wiley‐Liss, Inc.
Longitudinal Dispersion Coefficient Modeling in Natural Channels using Fuzzy Logic
Authors: Fuat Toprak Z. , Savci M. Emin
Published: December 2007

Researchers have long used differential equations to investigate longitudinal dispersion processes, which can be derived under certain assumptions and include a longitudinal dispersion coefficient (D1). In practice, most empirical equations are developed only for D1. Unfortunately, many critical assumptions in the derivation of these equations are not considered, and consequently, these equations can only be used with precautions and reservations. The goal of this study is to develop a fuzzy model to predict D1 in natural channels. The model depends on 65 data sets extracted from the literature. The variables are the depth, width and mean cross‐sectional velocity of the flow, shear velocity and D1. The data is divided for training and testing phases. The model is compared with measured data and seven existing equations. The comparison depends on seven statistical characteristics, four different error modes, and a contour map. It is observed that the fuzzy model yields results that are more reliable than existing methods and it can be used more easily and efficiently.
Migraine genetics and prospects for pharmacotherapy
Authors: Colson N.J. , Fernandez F. , Griffiths L.R.
Published: December 2007

Migraine is a common complex neurological disorder with a well‐known but poorly characterized genetic liability. The search for migraine susceptibility genes has been the focus of intense research. It is now believed that common migraine is not a single gene disorder, but attributable to several potentially interacting genetic variants. These variants may differ in each sufferer and interact with environmental factors to set the individual migraine threshold. This genetic liability may play an important role in the clinical heterogeneity seen in migraine and also in the variability of treatment response. This review will look at genetic loci implicated in migraine to date and consider their current or prospective role in migraine therapy. To elucidate the complex nature of migraine genetic liability, approaches that consider detailed endophenotypic profiles that encompass treatment response may provide much more relevant information than simple end diagnosis. Drug Dev Res 68:282–293, 2007. © 2007 Wiley‐Liss, Inc.
Triptan efficacy in migraine attacks: from appropriate diagnosis to metabolic profiles and pharmacogenomics
Authors: Buzzi M. Gabriella
Published: December 2007

A major, revolutionary advance in acute migraine therapy was the development of sumatriptan, a selective 5‐HT1B/1D receptor agonist. After sumatriptan, the so‐called second generation‐triptans have become available and at present 7 triptans are on the market. Activation of the trigeminal nerve is a key component of the cascade that leads to, and perpetuates, a migraine attack. Sumatriptan and the other triptans currently on the market (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, zolmitriptan) are potent agonists of the 5‐HT1B and 5‐HT1D receptors, and some are potent 5‐HT1F agonists. The use of a variety of endpoints for a certain drug, measuring treatment success in terms of both efficacy and tolerability, should aid in the selection of agents that can offer patients the highest likelihood of consistent treatment success. Further possibilities are offered by studying metabolic profiles of molecules in order to tailor the best treatment option for each patient, and obtain the best efficacy profiles and the lower rate of drug‐adverse events. Drug Dev Res 68:335–340, 2007. © 2007 Wiley‐Liss, Inc.
Preventive therapies of pediatric migraine
Authors: Pakalnis Ann
Published: December 2007

Migraine headaches are a common neurological condition in children and adolescents. Frequent headaches can negatively impact a child's school attendance and leisure activities. Secondary effects can be disruptive to family dynamics with parental work absences and stress involved in caring for an ill child. Preventive therapies for pediatric migraine have not been well studied and reproducible data from clinical trials is notable for its paucity in the neurological literature. Antihistamines, B‐blockers, and other older therapies have limited data. Many of the newer therapies have been developed from anti‐epileptic drugs, which have reproducible safety data from pediatric epilepsy trials. This has generated further interest in evaluation of these newer agents such as topiramate and levetiracetam. However, for children and adolescents who will require preventive therapy to decrease migraine frequency; there is little evidence available for clinicians from randomized controlled trials. Drug Dev Res 68:350–354, 2007. © 2007 Wiley‐Liss, Inc.
Looking in the wrong place? The search for an ideal migraine preventative
Authors: Lambert Geoffrey A.
Published: December 2007

The cause of migraine headache is still unknown, although triggers for it are often apparent. There are, in consequence, no reliable migraine headache preventative drugs that act through an influence on known causal pathways. This review discusses the pathophysiology of migraine, the link between migraine triggers and the consequent headache and the putative mode of action of different classes of migraine drugs in the light of a number of pathophysiological models. It advances the idea that migraine triggers produce headache because they increase cortical excitability and discharge, which in turn reduces the inhibitory drive of the descending pain control system, selectively for trigeminovascular sensation. Supporting evidence for such a mechanism is presented and suggestions made as to the modes and sites of action of future improved migraine preventative agents. Drug Dev Res 68:376–388, 2007. © 2007 Wiley‐Liss, Inc.
3‐Spirocyclopropanedihydro‐ and ‐tetrahydropyridin‐4‐ones from Nitrone Cycloadducts of Bicyclopropylidene via 1‐(1′‐Aminomethylcyclopropyl)cyclopropanol under PdII Catalysis
Authors: Revuelta Julia , Cicchi Stefano , de Meijere Armin , Brandi Alberto
Published: December 2007

A series of 3‐spirocyclopropanedihydro‐ and ‐tetrahydropyrid‐4‐ones have been synthesized by nitrone cycloaddition to 1,1′‐bicyclopropylidene (BCP), chemoselective reduction of the N–O bond of the isoxazolidine ring, and PdII‐catalyzed cascade rearrangement of the β‐aminocyclopropanol derivatives into the final products. The new tetrahydropyridone derivatives were also prepared by thermal rearrangement of the isoxazolidines. (© Wiley‐VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2008)
Poly(ortho‐toluidine) Modified Carbon Paste Electrode: A Sensor for Electrocatalytic Reduction of Nitrite
Authors: Ojani Reza , Raoof Jahan‐Bakhsh , Zarei Ebrahim
Published: December 2007

The electrocatalytic reduction of nitrite has been studied by poly(ortho‐toluidine) films modified carbon paste electrode (P‐OT/MCPE). Cyclic voltammetry and chronoamperometry techniques were used to investigate the suitability of poly(ortho‐toluidine) as a mediator for the electrocatalytic nitrite reduction in aqueous solution with various pH. Results showed that pH 0.00 is the most suitable for this purpose. In the optimum pH, the reduction of nitrite occurs at a potential about 600 mV more positive than unmodified carbon paste electrode. The catalytic reaction rate constant, (kh), was calculated 8.68×102 M−1 s−1 by the data of chronoamperometry. The catalytic reduction peak current was linearly dependent on the nitrite concentration and the linearity range obtained was 5.00×10−4 M–1.90×10−2 M. Detection limit has been found to be 3.38×10−4 M (2σ). This method has been successfully employed for quantification of nitrite in real sample.
Real‐Time Nitrophenol Detection Using Single‐Walled Carbon Nanotube Based Devices
Authors: Liu Ningyi , Cai Xianpeng , Zhang Qing , Lei Yu , Chan‐Park Mary B.
Published: December 2007

Single‐walled carbon nanotube (SWNT) based devices have been developed for the real‐time detection of nitrophenols in aqueous solution. SWNTs are assembled to electrodes using AC dielectrophoresis technique. The SWNT devices exhibit not only high sensitivity to nitrophenol compounds, but also good reusability. Charge transfer between nitro group and SWNTs, and the metal‐nanotube interface modification are hypothesized to be the possible origins of conductance change. These results indicated that the SWNT devices can be utilized as a simple, low cost, sensitive, and reusable platform for real‐time detection of nitrophenol compounds.