bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of the distribution of enrofloxacin by circulating leukocytes to sites of inflammation in dogs
Authors: Boothe D. M. , Boeckh A. , Boothe H. W.
Published: January 2009

Objective—To determine the effect of WBC accumulation on the concentration of enrofloxacin in inflamed tissues in dogs.

Animals—6 adult Bloodhounds.

Procedures—Dogs were instrumented bilaterally with tissue chambers. Peripheral WBCs collected from each dog were exposed in vitro to radiolabeled enrofloxacin (14C-ENR). Inflammation was induced with carrageenan in 1 chamber. Ten hours later, treated cells were administered IV to each dog such that 14C-ENR was delivered at a mean ± SD dosage of 212 ± 43 μg. Samples of extracellular fluid from inflammation and control chambers and circulating blood were then collected before (baseline) and for 24 hours after WBCs were administered. Samples were centrifuged to separate WBCs from plasma (blood) or chamber fluid. Radiolabeled enrofloxacin was scintigraphically detected and pharmacokinetically analyzed. Comparisons were made between extra- and intracellular chamber fluids by use of a Student paired t test.

Results—14C-ENR was not detectable in plasma, peripheral WBCs, control chambers, or baseline samples from inflammation chambers. However, 14C-ENR was detected in extra- cellular fluid from inflammation chambers (mean ± SD maximum concentration, 2.3 ± 0.5 ng/mL) and WBCs (maximum concentration, 7.7 ± 1.9 ng/mL). Mean disappearance half-life of 14C-ENR from extracellular fluid and WBCs from inflammation chambers was 26 ± 10 hours and 17 ± 6 hours, respectively.

Conclusions and Clinical Relevance—WBCs were responsible for the transport and release of 14C-ENR at sites of inflammation. Accumulation of drug by WBCs might increase the concentration of drug at the site of infection, thus facilitating therapeutic success.
Evaluation of age-related changes in the structure of the equine tarsometatarsal osteochondral unit
Authors: Murray Rachel C. , Blunden Tony S. , Branch Marion V. , Tranquille Carolyne A. , Dyson Sue J. , Parkin Tim D. H. , Goodship Allen E.
Published: January 2009

Objective—To investigate effects of age on thickness and morphologic characteristics of hyaline cartilage, calcified cartilage, total cartilage, and subchondral bone (SCB) in the equine tarsometatarsal joint.

Sample Population—23 tarsal joints from cadavers of 23 ponies (11 days to 25 years old); ponies were limited to pasture exercise and euthanatized for reasons not related to this study.

Procedures—Tarsi were allocated into several age groups (11 days old [n = 3], 6 to 9 months old [4], 2 to 3 years old [3], 6 to 8 years old [4], 11 to 17 years old [6], and 20 to 25 years old [3]). Histologic examination and histomorphometric measurement of hyaline cartilage, calcified cartilage, total cartilage, and SCB were performed at medial and lateral sites.

Results—A significant decrease was detected in thickness of hyaline cartilage and total cartilage with increasing age, but there was a significant increase in thickness of calcified cartilage and SCB with increasing age. Differences in chondrocyte and collagen fiber arrangement, tidemark, and osteochondral junction morphology were evident among age groups.

Conclusions and Clinical Relevance—These findings suggested that the various tissues of the osteochondral unit change in different ways with age. The response of each tissue may be related to relative response of the tissues to strains induced by pasture exercise but could have an influence on how the overall properties of the osteochondral unit change with age. The findings may also be suggestive of changes that develop prior to the onset of osteoarthritis.
Monitoring of the repair process of surgically created lesions in equine superficial digital flexor tendons by use of computerized ultrasonography
Authors: van Schie Hans T. M. , Bakker Erwin M. , Cherdchutham Worakij , Jonker A. Mieke , van de Lest Chris H. A. , van Weeren P. René
Published: January 2009

Objective—To evaluate quantitative ultrasonography for objective monitoring of the healing process and prognostication of repair quality in equine superficial digital flexor (SDF) tendons.

Animals—6 horses with standardized surgical lesions in SDF tendons of both forelimbs.

Procedures—Healing was monitored for 20 weeks after surgery by use of computerized ultrasonography. Pixels were categorized as C (intact fasciculi), B (incomplete fasciculi), E (accumulations of cells and fibrils), or N (homogenous fluid or cells). Four scars with the best quality of repair (repair group) and 4 scars with the lowest quality (inferior repair group) were identified histologically. Ratios for C, B, E, and N in both groups were compared.

Results—During 4 weeks after surgery, lesions increased 2- to 4-fold in length and 10-fold in volume. Until week 3 or 4, structure-related C and B ratios decreased sharply, whereas E and N ratios increased. After week 4, C and B ratios increased with gradually decreasing E and N ratios. At week 12, C and B ratios were equivalent. After week 12, C ratio increased slowly, but B ratio more rapidly. At week 20, C ratio remained constant, B ratio was substantially increased, and E and N ratios decreased. Values for the inferior repair group were most aberrant from normal. Ratios for C differed significantly between repair and inferior repair groups at weeks 16 and 18 and for B beginning at 14 weeks.

Conclusions and Clinical Relevance—Computerized ultrasonography provided an excellent tool for objective monitoring of healing tendons in horses and reliable prognostication of repair quality.
Evaluation of economic effects and the health and performance of the general cattle population after exposure to cattle persistently infected with bovine viral diarrhea virus in a starter feedlot
Authors: Hessman Bill E. , Fulton Robert W. , Sjeklocha David B. , Murphy Timothy A. , Ridpath Julia F. , Payton Mark E.
Published: January 2009

Objective—To evaluate economic effects and health and performance of the general cattle population after exposure to cattle persistently infected (PI) with bovine viral diarrhea virus (BVDV) in a feedlot.

Animals—21,743 high-risk calves from the southeastern United States.

Procedures—PI status was determined by use of an antigen-capture ELISA (ACE) and confirmed by use of a second ACE, reverse transcriptase–PCR assay of sera, immunohistochemical analysis, and virus isolation from sera. Groups with various amounts of exposure to BVDV PI cattle were used. After being placed in the feedlot, identified PI cattle were removed from 1 section, but PI cattle remained in another section of the feedlot. Exposure groups for cattle lots arriving without PI animals were determined by spatial association to cattle lots, with PI animals remaining or removed from the lot.

Results—15,348 cattle maintained their exposure group. Performance outcomes improved slightly among the 5 exposure groups as the risk for exposure to BVDV PI cattle decreased. Health outcomes had an association with exposure risk that depended on the exposure group. Comparing cattle lots with direct exposure with those without direct exposure revealed significant improvements in all performance outcomes and in first relapse percentage and mortality percentage in the health outcomes. Economic analysis revealed that fatalities accounted for losses of $5.26/animal and performance losses were $88.26/animal.

Conclusions and Clinical Relevance—This study provided evidence that exposure of the general population of feedlot cattle to BVDV PI animals resulted in substantial costs attributable to negative effects on performance and increased fatalities.
Genetic characterization of bovine viral diarrhea viruses isolated from persistently infected calves born to dams vaccinated against bovine viral diarrhea virus before breeding
Authors: Bolin Steven R. , Lim Ailam , Grotelueschen Dale M. , McBeth William W. , Cortese Victor S.
Published: January 2009

Objective—To collect and partially characterize strains of bovine viral diarrhea viruses(BVDVs) isolated from persistently infected (PI) calves born to vaccinated dams, determine genetic diversity of the isolated viruses, and identify regional distribution of genetically similar virus subpopulations.

Sample Population—17 noncytopathic (NCP) BVDVs from PI calves from 11 herds of beef or dairy cattle.

Procedures—Viral RNA was extracted from infected cell cultures, and BVDV-specific PCR primers were used to amplify > 1,000 bases of the viral genome. Derived sequences were used for molecular phylogenetic analyses to determine the viral genotype and viral genogroup and to assess genetic similarity among BVDVs.

Results—Analysis of the 17 NCP strains of BVDV failed to detect a viral genotype or viral genogroup not already reported to exist in the United States. One virus was classified as genotype 1, genogroup 1b, and 16 viruses were classified as genotype 2, genogroup 2a. Genotype 2 strains were genetically diverse, and genetic similarities were not obvious among viruses from geographic regions larger than a small locale.

Conclusions and Clinical Relevance—Viruses isolated from herds where a genotype 1, genogroup 1a BVDV vaccine was administered prior to breeding were primarily genetically diverse genotype 2, genogroup 2a BVDVs. Vaccination with multiple BVDV genotypes may be needed to improve protection. Methods used in this study to obtain and analyze field strains are applicable to assessing efficacy of current BVDV vaccines. Candidates for future vaccines are viruses that appear able to elude the immune response of cattle vaccinated against BVDV with existing vaccines.
Evaluation of the control of pathogen load by an anti-Salmonella bacterium in a herd of cattle with persistent Salmonella infection
Authors: Patton Toni G. , Sharma Vijay K. , Carlson Steve A.
Published: January 2009

Objective—To determine whether an anti-Salmonella bacterium is involved in control of pathogen load in persistently infected cattle herds.

Animals—24 Holstein calves experimentally infected and 39 Holstein cows naturally infected with Salmonella spp.

Procedures—An Escherichia coli (designated as P8E5) that possessed anti-Salmonella activity was isolated from Salmonella-negative bovine feces obtained from a herd with endemic Salmonella infection. In vitro analysis involved enumerating Salmonella enterica serovar Typhimurium coincubated with E coli P8E5. In vivo analysis involved coadministration of Salmonella spp and E coli P8E5 or an E coli control strain to neonatal Holstein calves. Fecal samples were collected on multiple days after inoculation, and quantitative PCR assay was performed by use of Salmonella-specific primers.

Results—E coli P8E5 reduced viability of Salmonella spp in vitro. Shedding of Salmonella organisms was diminished in calves administered E coli P8E5, whereas the control strain of E coli had no effect on shedding of Salmonella organisms.

Conclusions and Clinical Relevance—In this study, an E coli strain was identified that possessed bacteriocin-like activity and was able to decrease viability of Salmonella organisms in vitro and in vivo. Therefore, it is possible that this organism could be representative of native microbiota that dampen Salmonella spp in persistently infected cattle herds.
Epidemiologic analysis of nosocomial Salmonella infections in hospitalized horses
Authors: Ekiri Abel B. , MacKay Robert J. , Gaskin Jack M. , Freeman David E. , House Amanda M. , Giguère Steeve , Troedsson Mats R. , Schuman Crystal D. , von Chamier Maria M. , Henry Katherine M. , Hernandez Jorge A.
Published: January 2009

Objective—To examine the relationship between abdominal surgery and nosocomial Salmonella infections and the relationship between high caseload in combination with abdominal surgery and nosocomial Salmonella infections in hospitalized horses with signs of gastrointestinal tract disease.

Animals—140 horses.

Design—Case-control study.

Procedures—To accomplish the first objective, 1 to 4 control horses were matched with each nosocomial case horse on the basis of admission date of a primary case horse. The frequency of abdominal surgery and other investigated exposure factors were compared between nosocomial case horses and control horses. For the second objective, 4 control horses were matched with each nosocomial case horse on the basis of year of admission. The frequency of high caseload (≥ 26 inpatients), abdominal surgery, and other factors was compared between nosocomial case horses and control horses.

Results—The odds of nosocomial Salmonella infection were 8 times as high (odds ratio = 8.2; 95% confidence interval = 1.11, 60.24) in horses that underwent abdominal surgery, compared with the odds for horses that did not undergo surgery. High caseload alone or in combination with abdominal surgery was not associated with increased risk of nosocomial Salmonella infection.

Conclusions and Clinical Relevance—Abdominal surgery was identified as a risk factor for nosocomial Salmonella infections in horses. Horses that undergo abdominal surgery require enhanced infection control and preventative care. Risk of nosocomial Salmonella infections may be reduced by implementation of biosecurity measures (such as the use of plastic boots, gloves, and footbaths) immediately after surgery.
Baseline plasma cortisol and ACTH concentrations and response to low-dose ACTH stimulation testing in ill foals
Authors: Wong David M. , Vo Dai Tan , Alcott Cody J. , Peterson Anna D. , Sponseller Brett A. , Hsu Walter H.
Published: January 2009

Objective—To evaluate baseline plasma cortisol and ACTH concentrations and responses to low-dose ACTH stimulation testing in ill foals.

Design—Cross-sectional study.

Animals—58 ill foals.

Procedures—Baseline cortisol and ACTH concentrations and cortisol concentrations after administration of a low dose of cosyntropin were determined within 6 hours after admission. Foals were assigned to 4 groups on the basis of age (≤ 24 hours vs 1 to 56 days) and presence of septicemia (yes vs no). Values were compared among groups and with values previously reported for healthy foals.

Results—Plasma cortisol concentrations 30 and 60 minutes after cosyntropin administration in foals ≤ 24 hours old were significantly higher than corresponding cortisol concentrations in older foals. In all 4 groups, plasma cortisol concentration 30 minutes after cosyntropin administration was significantly higher than baseline cortisol concentration or concentration 60 minutes after cosyntropin administration. No differences in baseline cor-tisol or ACTH concentration or in the ACTH-to-cortisol ratio were detected between groups or when ill foals were compared with healthy foals. A small number of ill foals had low baseline cortisol and ACTH concentrations or low responses to cosyntropin administration, compared with healthy foals.

Conclusions and Clinical Relevance—Results indicated that most ill foals in the present study population had adequate responses to cosyntropin administration. However, a small subset of ill foals appeared to have dysfunction of the hypothalamic-pituitary-adrenal axis.
Effectiveness and safety of cefovecin sodium, an extended-spectrum injectable cephalosporin, in the treatment of cats with abscesses and infected wounds
Authors: Six Robert , Cleaver Dawn M. , Lindeman Cindy J. , Cherni Judith , Chesebrough Robert , Papp Georg , Skogerboe Terry L. , Weigel Dan J. , Boucher Joseph F. , Stegemann Michael R.
Published: January 2009

Objective—To evaluate the effectiveness and safety of cefovecin sodium in the treatment of cats with naturally occurring skin infections (abscesses and infected wounds).

Design—Multicenter (26 sites), randomized, double-blind, controlled clinical trial.

Animals—Client-owned cats of any breed with naturally occurring skin infections with associated clinical signs and confirmatory bacteriologic culture results.

Procedures—Cats with clinical signs of skin and soft tissue infection were randomly allocated to receive a single dose of cefovecin (8 mg/kg [3.6 mg/lb], SC) followed by placebo drops administered orally once daily for 14 days or 1 SC placebo injection followed by cefadroxil (22 mg/kg [10 mg/lb], PO, once daily for 14 days). Only one 14-day treatment course was permitted.

Results—Effectiveness of cefovecin in the treatment of cats with abscesses and infected wounds was similar to that of cefadroxil. At the final assessment on day 28, 97% (86/89) of cefovecin-treated cats and 91% (80/88) of cefadroxil-treated cats were considered treatment successes. There were no serious adverse events or deaths related to treatment.

Conclusions and Clinical Relevance—1 SC injection of 8 mg of cefovecin/kg for the treatment of cats with naturally occurring skin infections (wounds and abscesses) was safe and as effective as cefadroxil administered orally at 22 mg/kg, once daily for 14 days.
Erythrocyte glutathione and plasma cysteine concentrations in young versus old dogs
Authors: Moyer Katherine L. , Trepanier Lauren A.
Published: January 2009

Objective—To determine whether older, otherwise healthy, client-owned dogs were deficient in glutathione or cysteine, compared with young healthy pet dogs.

Design—Cross-sectional study.

Animals—35 healthy dogs between 7 and 14 years old (older dogs) and 26 healthy dogs between 1 and 3 years old (young dogs).

Procedures—In all dogs, erythrocyte reduced glutathione concentration and plasma cysteine concentration were determined by means of high-performance liquid chromatography.

Results—Median erythrocyte reduced glutathione and plasma cysteine concentrations were not significantly different between young (1.7 mM and 8.3 μM, respectively) and older (1.7 mM and 7.6 μM, respectively) dogs. Significant differences were also not identified when values for young dogs were compared with values for only those dogs ≥ 11 years old. Similarly, no differences were found between males and females overall or between males and females within age groups, although most dogs were neutered.

Conclusions and Clinical Relevance—Results suggested that otherwise healthy older pet dogs fed a variety of commercial diets do not have deficiencies in glutathione or cysteine, compared with younger dogs. Findings do not support the routine empirical use of antioxidant supplements, such as precursors of glutathione, to treat presumed circulating antioxidant deficiencies in older healthy dogs.
Pediatric spinal clear cell meningioma
Authors: Colen Chaim B. , Rayes Mahmoud , McClendon Jamal , Rabah Raja , Ham Steven D.
Published: January 2009

In this report the authors describe a unique case of spinal clear cell meningioma in a 13-year-old girl. Clear cell meningiomas (CCMs) are not uncommon. To the authors' knowledge, 14 cases of pediatric CCM occurring in the spinal canal have been reported. Factors lending resistance to meningioma initiation and invasion are analyzed. This 13-year-old girl presented with pain radiating down her left leg. Admission MR imaging showed an inhomogeneous enhancing intradural-extramedullary mass at the L4–5 level. Resection revealed a CCM, and radiotherapy was subsequently administered. Postoperatively there has been no recurrence in > 2 years. In this paper the authors report a case of CCM and provide a comprehensive literature review on this disease. Current recommendations for its management are still debatable, especially in the pediatric population, and the authors propose an algorithm for its treatment and surveillance.
Changes in cerebral perfusion hormone profile and cerebrospinal fluid flow across the third ventriculostomy after endoscopic third ventriculostomy in patients with aqueductal stenosis: a prospective study
Authors: Garg Anil Kumar , Suri Ashish , Sharma Bhavani S. , Shamim Shamin A. , Bal Chander S.
Published: January 2009

Object

The object of the present study was 3-fold: 1) to study regional cerebral perfusion before and after endoscopic third ventriculostomy (ETV) in patients with obstructive hydrocephalus by using 99mTc ethyl cysteinate dimer SPECT: 2) to study any correlation between clinically successful third ventriculostomy and CSF flow across the third ventriculostomy; and 3) to determine any changes in hormone profile following ETV.

Methods

The authors prospectively studied 15 patients with aqueductal stenosis who underwent ETV during the last 2 years. All the patients underwent pre- and postoperative MR imaging, brain 99mTc ethyl cysteinate dimer SPECT, and hormone profile studies.

Results

Eight patients were infants. The mean follow-up duration was 17.6 months. Thirteen patients (86.7%) exhibited clinical improvement after surgery. In all patients with clinical improvement the studies documented CSF flow through the ventriculostomy site. Clinical progress could be correlated with SPECT changes in 14 cases (93.3%). In the 13 clinically successful cases, 12 were substantiated by improvement on SPECT scans, whereas in the 2 failed cases, SPECT images revealed no improvement of perfusion defects. Hormone analysis conducted in 14 patients revealed hyperprolactinemia in 8, low triiodothyronine values in 2 patients, and hypocortisolemia in 1, which was reversed after ETV.

Conclusions

Clinical improvement is not well correlated with a decrease in ventricular size following ETV. Brain SPECT is a valuable tool for the follow-up of patients with hydrocephalus after ETV, particularly in cases in which MR imaging findings are not clear. There are subtle hormonal changes in patients with hydrocephalus that may improve following ETV.
Congenital cavernous hemangioma of the calvaria
Authors: Vural Murat , Acikalin Mustafa F. , Adapinar Baki , Atasoy Metin A.
Published: January 2009

The authors present the case of a 6-month-old infant with a cavernous hemangioma of the parietal bone and discuss the radiological, operative, and pathological features and differential diagnosis of these extremely rare lesions in infants. Only 1 case of an infant with a calvarial cavernous hemangioma without intracranial invasion has previously been reported, and that case involved a 4 month old.

Although a cavernous hemangioma of the calvaria is extremely rare in the newborn, this condition should be included in the differential diagnosis of calvarial lesions. During surgical treatment of calvarial cavernous hemangiomas, utmost attention should be paid to avoid blood loss, which could be fatal in infants.
Spinal congenital dermal sinus in a chick embryo model
Authors: van Aalst Jasper , Boselie Toon F. M. , Beuls Emile A. M. , Vles Johan S. H. , van Straaten Henny W. M.
Published: January 2009

Object

The origin of spinal congenital dermal sinuses is not known. A local nondisjunction of the closing neural tube and the epidermal ectoderm is thought to be the cause of this malformation. In this experimental study, a nondisjunction was mimicked in chick embryos to create an animal model for the dermal sinus.

Methods

A piece of amniotic tissue was implanted in the closing neural tube in ovo in chick embryos at 2 days of incubation. A total of 50 embryos were manipulated. After a further incubation time of 2–7 days, the embryos were macroscopically and histologically evaluated.

Results

Dermal sinus–like anomalies were induced in 24 embryos. The induced abnormalities varied from superficial, epidermal lesions to epidermal dimples continuing as a strand of tissue toward the neural tube. This strand invariably was of nonneuronal origin. Additionally, in 3 embryos a split cord malformation was noted, most likely caused by damage to the neural tube during implantation.

Conclusions

Implantation of donor amniotic tissue in the closing chick neural tube does result in a dimple, from which a strand of tissue continues to the neural tube in various cases, indicating that formation of a dermal sinus–like anomaly can be successfully induced by experimental continuation of the connection between neural tube and surface ectoderm. This finding strengthens the hypothesis that a human dermal sinus arises after nondisjunction of neural tube and surface ectoderm.
Management of vagal nerve stimulator infections: do they need to be removed?
Authors: Air Ellen L. , Ghomri Yashar M. , Tyagi Rachana , Grande Andrew W. , Crone Kerry , Mangano Francesco T.
Published: January 2009

Object

Vagal nerve stimulators (VNSs) have been used successfully to treat medically refractory epilepsy. Although their efficacy is well established, appropriate management of infections is less clearly defined. In the authors' experience, patients who have gained a benefit from VNS implantation have been reluctant to have the device removed. The authors therefore sought conservative management options to salvage infected VNS systems.

Methods

The authors performed a retrospective review of 191 (93 female and 98 male) consecutive patients in whom VNS systems were placed between 2000 and 2007.

Results

They identified 10 infections (5.2%). In 9 of 10 patients the cultured organism was Staphylococcus aureus. Three (30%) of 10 patients underwent early removal (within 1 month) of the VNS as the initial treatment. The remaining 7 patients were initially treated with antibiotics. Two (28.6%) of these patients were successfully treated using antibiotics without VNS removal. Patients in whom conservative treatment failed were given cephalexin as first-line antibiotic treatment. All patients recovered completely regardless of treatment regimen.

Conclusions

This study confirms the low rate of infection associated with VNS placement and suggests that, in the case of infection, treatment without removal is a viable option. However, the authors' data suggest that oral antibiotics are not the best first-line therapy.
Tentorial cavernous angioma with profuse bleeding
Authors: Mori Hiroshi , Koike Toshiro , Endo Shin , Takii Yoshitaka , Uzuka Takeo , Takahashi Hitoshi , Ito Jusuke , Tanaka Ryuichi
Published: January 2009

This 15-year-old boy with a tentorial cavernous angioma reported occasional headache and scintillation in his left visual field. Magnetic resonance imaging revealed a well-demarcated, homogeneously enhanced tumor originating from the right cerebellar tentorium and extending into both the supratentorial and infratentorial spaces. Although a meningioma was suspected, vertebral artery angiography revealed a thickened meningeal branch originating from the right posterior inferior cerebellar artery and flecked tumor stain with pooling of contrast medium until the late venous phase. A cavernous angioma of the tentorium was suspected based on this finding, and as expected from the radiological findings, profuse bleeding was encountered during tumor removal. The histological diagnosis was a cavernous angioma. A cavernous angioma of the tentorium is extremely rare but should be differentiated from a meningioma preoperatively given that a cavernous angioma of dural origin tends to bleed massively during removal.
Intraventricular baclofen for dystonia: techniques and outcomes
Authors: Albright A. Leland , Ferson Susan S.
Published: January 2009

Object

The aim of this study was to evaluate the use of intraventricular baclofen (IVB) for the treatment of severe generalized secondary and heredodegenerative dystonia.

Methods

Nine children and 1 adult with severe dystonia unresponsive to multiple oral medications were treated with IVB. Intraventricular catheters were positioned endoscopically in the third ventricle.

Results

Eight of the 10 patients responded to IVB; their mean dystonia scores on the Barry-Albright dystonia scale decreased from 23 to 8. The 2 patients who did not respond had not responded to previous high doses of intrathecal baclofen. No adverse side effects related to IVB occurred. One child developed a pump infection that required pump removal, 1 developed a CSF infection that cleared after antibiotic administration, and 1 developed ventriculomegaly that required a shunt placement.

Conclusions

Intraventricular baclofen is an effective method of infusing baclofen to treat severe, generalized secondary dystonia, and, at times, heredodegenerative dystonia. The site of baclofen's activity when treating dystonia may be at the cortical level, and intraventricular infusion may result in higher baclofen concentrations over the cortex than intrathecal infusion. Additional studies are necessary to determine whether IVB is effective at lower doses than those used with intrathecal baclofen administration.
Active spontaneous decompression of a suprasellar-prepontine arachnoid cyst detected with routine magnetic resonance imaging
Authors: Thomas Bradley P. , Pearson Matthew M. , Wushensky Curtis A.
Published: January 2009

Arachnoid cysts are congenital CSF collections that arise adjacent to arachnoid cisterns. These lesions can be incidental neuroimaging findings but may also cause symptoms and necessitate treatment, particularly in children. The authors present their experience with a male infant harboring a large suprasellar-prepontine arachnoid cyst who underwent spontaneous decompression into the ventricular system, as evidenced by a visualized CSF flow jet observed on routine MR imaging.
Primary choroid plexus papilloma of the sacral nerve roots
Authors: Boldorini Renzo , Panzarasa Gabriele , Girardi Paola , Monga Guido
Published: January 2009

The authors describe a unique case of a choroid plexus papilloma of the sacral nerve roots. This 60-year-old woman was admitted to the hospital because of a 1-year history of sacral pain, rectal and urinary bladder retention, and paradoxical episodic incontinence. Physical examination revealed sensory abnormalities in the S-2 dermatomes and poor rectal and bladder sphincter contractions. Contrast-enhanced spinal MR imaging showed a well-circumscribed, ovoid, homogeneously enhancing mass at the S1–2 level suggesting a diagnosis of ependymoma or schwannoma, and surgery allowed the identification and complete removal of a soft gray mass intimately adhering to the sacral nerve roots. Histological examination revealed a tumor consisting of papillary structures lined by a single layer of columnar cells, with an immunophenotype that satisfied the diagnostic criteria of choroid plexus papilloma. After diagnosis, contrast-enhanced brain MR imaging excluded the presence of a primary choroid plexus papilloma in the cerebral ventricles, thus ruling out a drop metastasis along the CSF pathways. A review of the literature did not reveal any similar cases of choroid plexus papilloma, and so the authors also discuss the inclusion of primary or metastatic papillary tumors in this unusual location as part of the differential diagnosis.
Rapid magnetic resonance imaging–guided reduction of craniovertebral junction deformities
Authors: Darsaut Tim E. , Sartawi Muthana M. , Dhaliwal Perry , Fox Richard J.
Published: January 2009

The authors demonstrate the utility of an MR imaging–compatible traction board for the rapid reduction of craniovertebral junction (CVJ) deformities. To choose the appropriate surgical management, patients with compressive CVJ deformities often undergo a trial of traction. Conventional traction trials require the treating surgeon to infer from plain radiographs the manner in which traction forces affect neural and ligamentous structures at the CVJ. To avoid overdistraction injury, low increments of weight are added in a gradual fashion, a process that typically requires 48–72 hours. The authors outline the use of an MR imaging–compatible traction board to determine reducibility safely and rapidly in 4 patients with compressive CVJ deformities. Four patients with advanced CVJ deformities underwent a trial of MR imaging–guided traction performed using an MR imaging–compatible spine board. Serial sagittal images were acquired at baseline and following each sequential addition of force. All patients tolerated traction without neurological worsening. The neural elements were seen to be adequately decompressed in all cases during a single MR imaging session. Patients subsequently underwent craniocervical stabilization and fusion. Postoperative imaging showed maintenance of the reduction without neural compression. An MR imaging–guided trial of traction can facilitate the rapid and safe determination of the reducibility of compressive lesions in patients with advanced CVJ deformities. Rapidly acquired sagittal MR images permit the surgeon to evaluate the effects of traction on the soft tissues at the CVJ, thereby expediting the traction trial and avoiding the risks of immobility in this often-fragile patient population.
Characteristics of thoracolumbar intramedullary subependymomas
Authors: Orakcioglu Berk , Schramm Peter , Kohlhof Patricia , Aschoff Alfred , Unterberg Andreas , Halatsch Marc-Eric
Published: January 2009

Object

Thoracolumbar intraspinal subependymomas are very rare intramedullary low-grade tumors. The authors report on the clinical and morphological features of 2 cases of thoracolumbar intraspinal subependymomas and provide midterm follow-up data.

Methods

The clinical and radiological profiles of 2 patients with progressive spinal cord dysfunction due to thoracolumbar intraspinal subependymomas were retrospectively studied and compared with previously reported cases.

Results

Patients with intraspinal subependymomas initially presented with back pain and long-tract signs. The tumors were hyperintense on T2-weighted MR imaging, isointense on T1-weighted imaging, and noncontrast enhancing. Within 1 of the tumors, a medial septum was present on axial T2-weighted imaging. The tumors were intramedullary but grew exophytically and were amenable to gentle surgical separation from normal neural structures. Therefore, gross-total resection was feasible, and neurological outcome was good. No further adjuvant therapy was conducted. On follow-up (at 58 and 18 months, respectively), no tumor recurrence was observed.

Conclusions

Symptomatic thoracolumbar intraspinal subependymomas with a distinct appearance on MR imaging are amenable to complete excision with favorable neurological outcome. In this study no tumor recurrence was observed at midterm follow-up in either patient, neither of whom underwent adjuvant therapy.
Effect of hyperglycemia on progressive paraparesis in a rat metastatic spinal tumor model
Authors: McGirt Matthew J. , Gok Beril , Shepherd Starane , Noggle Joseph , Garcés Ambrossi Giannina L. , Bydon Ali , Gokaslan Ziya L.
Published: January 2009

Object

Hyperglycemia has been shown to potentiate ischemic injury of the spinal cord by quenching vasodilators and potentiating tissue acidosis and free radical production. Steroid-induced hyperglycemia is a common event in the surgical management of metastatic epidural spinal cord compression (MESCC). The goal in this study was to determine whether experimentally induced hyperglycemia accelerates neurological decline in an established animal model of MESCC.

Methods

Sixteen Fischer 344 rats underwent a transabdominal approach for implantation of a CRL-1666 breast adenocarcinoma cell line within the vertebral body of L-6. After 72 hours of recovery from tumor implantation, the animals received intraperitoneal injections every 12 hours of either 2 g/kg dextrose in 5 ml 0.09% saline (hyperglycemia, 8 rats) or 5 ml 0.09% saline alone (normoglycemia, 8 rats). Weights were taken daily, and the hindlimb function was tested daily after tumor implantation by using the Basso-Beattie-Bresnahan (BBB) scale (score range 1–21). Animals were killed at time of paralysis (BBB Score < 7), and the volume of epidural tumor growth within the spinal canal was measured. To determine the degree of hyperglycemia induced by this dextrose regimen, a surrogate group of 10 Fischer 344 rats underwent intraperitoneal injections of 2 g/kg dextrose (5 rats) or 0.09% saline (5 rats) every 12 hours, and serum glucose levels were assessed 1, 3, 6, 8, 10, and 12 hours after injections for 24 hours.

Results

Dextrose versus saline injections resulted in elevated mean serum glucose at 3 (259 vs 103 μg/dl), 6 (219 vs 102 μg/dl), 8 (169 vs 102 μg/dl), and 10 hours (118 vs 99 μg/dl) after injection, returning to normal levels by 12 hours (96 vs 103 μg/dl) just prior to subsequent injection. All rats had normal hindlimb function for the first 8 days after tumor implantation. Hyperglycemic versus normoglycemic rats demonstrated a worsened median BBB score by postimplantation Day 9 (Score 20 vs 21, p = 0.023) through Day 16 (Score 8 vs 12, p = 0.047). Epidural tumor volume demonstrated a near-linear growth rate across both groups; however, hyperglycemic rats developed paralysis earlier (median 15.5 vs 17.5 days, p = 0.0035), with significantly less epidural tumor volume (2.75 ± 0.38 cm3 vs 4 ± 0.41 cm3, p < 0.001) at time of paralysis.

Conclusions

In a rat model of metastatic epidural spinal cord compression, rats maintained in a hyperglycemic state experienced accelerated time to paralysis. Also, less epidural tumor volume was required to cause paralysis in hyperglycemic rats. These results suggest that hyperglycemic states may contribute to decreased spinal cord tolerance to compression resulting from MESCC. Clinical studies evaluating the effect of aggressive glucose control in patients with MESCC may be warranted.
Mini-open removal of extradural foraminal tumors of the lumbar spine
Authors: Lu Daniel C. , Dhall Sanjay S. , Mummaneni Praveen V.
Published: January 2009

Spinal extradural foraminal neoplasms are uncommon lesions that are traditionally resected via an open laminectomy and facetectomy approach. In this paper the authors present their mini-open approach for the removal of 3 such tumors. The authors retrospectively reviewed 3 patients with extradural schwannoma who underwent mini-open resection and fusion between June 2006 and July 2007. Clinical data, tumor characteristics, and outcomes were analyzed. All 3 patients underwent successful mini-open treatment of their spinal neoplasms. Postoperative MR imaging demonstrated complete resection in 2 cases and subtotal resection in 1 case. Extradural foraminal neoplasms can be safely and effectively treated with mini-open techniques. Reductions in blood loss, hospitalization, and tissue disruption may be potential benefits of this approach.
Trap-door rib-head osteotomies for posterior placement of expandable cages after transpedicular corpectomy: an alternative to lateral extracavitary and costotransversectomy approaches
Authors: Chou Dean , Wang Vincent Y.
Published: January 2009

Lateral extracavitary and costotransversectomy approaches have been well described, and they are useful for posterior thoracic corpectomies. However, these approaches require pleural dissection and are associated with welldocumented morbidities, including hemothorax, pneumothorax, and pneumonia. But without removing the rib head, the window through which an expandable cage can be placed from a posterior approach is narrow. Thus, smaller nonexpandable mesh cages or methylmethacrylate constructs are commonly used for anterior column reconstruction. The authors describe a technique of using a “trap-door” rib-head osteotomy that avoids pleural dissection, yet allows a large expandable cage to be placed from an entirely posterior approach.
Memory outcome following transsylvian selective amygdalohippocampectomy in 62 patients with hippocampal sclerosis
Authors: Morino Michiharu , Ichinose Tsutomu , Uda Takehiro , Kondo Kyoko , Ohfuji Satoko , Ohata Kenji
Published: January 2009

Object

It remains unclear whether selective amygdalohippocampectomy, an operative technique developed for use in epilepsy surgery to spare unaffected brain tissue and thus minimize the cognitive consequences of temporal lobe surgery, actually leads to a better memory outcome. The present study was performed to determine the effects of selective surgery on memory outcome in patients with intractable mesial temporal lobe epilepsy due to hippocampal sclerosis treated using transsylvian selective amygdalohippocampectomy (TSA).

Methods

The study population consisted of 62 patients with left hemisphere language dominance who underwent left-(31 patients) or right-sided (31 patients) TSA. All patients underwent comprehensive neuropsychological testing before and 1 month and 1 year after unilateral TSA. Verbal Memory I, Nonverbal Memory I, Total Memory, Attention, and Delayed Recall were assessed using the Wechsler Memory Scale–Revised, whereas Verbal Memory II was assessed using the Miyake Verbal Retention Test (MVRT), and Nonverbal Memory II was assessed using the Benton Visual Retention Test. Separate repeated-measures multivariate analysis of variance (MANOVA) were performed for these intervals with memory scores.

Results

The results of MANOVA indicated that patients who underwent right-sided TSA showed significant improvements in Verbal Memory I (preoperatively vs 1 month postoperatively, p < 0.0001; and preoperatively vs 1 year postoperatively, p = 0.0002), Nonverbal Memory I (preoperatively vs 1 month postoperatively, p = 0.0003; and preoperatively vs 1 year postoperatively, p = 0.006), and Delayed Recall (preoperatively vs 1 month postoperatively, p = 0.028) at both 1-month and 1-year follow-ups. In addition, Verbal Memory II (MVRT) was also significantly improved 1 year after surgery (p = 0.001). In the group of patients who underwent left-sided TSA, both Verbal Memory I and II were maintained at the same level 1 month after surgery, whereas the Verbal Memory I score 1 year after surgery increased with marginal significance (p = 0.074). In addition, Verbal Memory II showed significant improvement 1 year after surgery (p = 0.049). There were no significant changes in Nonverbal Memory I and II, Attention, or Delayed Recall at either the 1-month or 1-year follow-up.

Conclusions

Results of the present study indicated that left-sided TSA for hippocampal sclerosis tends to improve verbal memory function with the preservation of other types of memory function. Moreover, right-sided TSA for hippocampal sclerosis can lead to significant improvement in memory function, with memory improvement observed 1 month after right-sided TSA and persisting 1 year after surgery.
Effectiveness of surgical treatment for traumatic central cord syndrome
Authors: Chen Liang , Yang Huilin , Yang Tongqi , Xu Yaozeng , Bao Zhaohua , Tang Tiansi
Published: January 2009

Object

The authors undertook a study in patients with traumatic central cord syndrome (TCCS) who underwent surgical intervention. They retrospectively assessed the motor score improvement and functional status and identified prognostic predictors of improvement.

Methods

Between March 1999 and May 2004, 49 patients with TCCS were surgically treated. Motor scores were collected at admission and follow-up using the American Spinal Injury Association (ASIA) Impairment Scale. The 36-Item Short Form Health Survey (SF-36) was administered. Other parameters including walking index, spasticity, bladder management, and neuropathic pain scores were recorded. Patients were asked to assess their level of satisfaction with their final symptoms.

Results

The average ASIA score, converted into numeric values, was increased from 54.9 at admission to 81.9 and 89.6 at 6 months and final follow-up, respectively. Significant improvement of ASIA score was achieved within the first 6 months of surgery. No significant difference was found between patients who underwent surgery within 4 days of injury or after 4 days of injury, adopting different approaches (anterior, posterior, or a combination), or with different pathological entities (acute disc herniation, fracture or dislocation, or multilevel degeneration). The ASIA score improvement had a positive correlation with the age at injury (r = 0.505, p = 0.023). The SF-36 data at 6 months and final follow-up were not as satisfactory as the improvement in ASIA scores, and almost one-third of patients expressed dissatisfaction with their final symptoms. For patients who were older than 65 years at injury, the mean follow-up Walking Index for Spinal Cord Injury (WISCI) score was statistically lower than it was in younger patients. The presence of spasticity or neuropathic pain at follow-up was not related to age, sex, ASIA motor score, or WISCI outcome.

Conclusions

Surgical intervention can be safely applied in patients with TCCS. Significant improvement of ASIA score was achieved during the first 6-month period of follow-up. Factors including type of lesion, timing of surgery within or after 4 days of injury, and surgical approach were not significantly associated with final ASIA score. The improvement in the ASIA motor score was positively correlated with age at injury. No significant correlation was found between or among the presence of spasticity, neuropathic pain, and ASIA score at final visit. Almost one-third of patients were not satisfied with their final symptoms.
Introduction: Spinal Vascular Malformations
Authors: Oldfield Edward H.
Published: January 2009

From the earliest observations of spinal vascular malformations, successful management has been challenging. Initially the challenges were diagnosing, understanding, and treating these lesions. They were originally considered all to be the same, or at least to be a single general type, of disease. With the introduction of selective spinal arteriography in the 1960s and more recently with the introduction and widespread use of MR imaging, the initial challenge of diagnosing spinal vascular malformations was overcome, and significant progress has been made in understanding their anatomy as well as the pathophysiology that underlies the myelopathy commonly associated with them. The anatomical features defined by selective arteriography and the observations permitted with the operating microscope ultimately led to distinctions between the major categories of the vascular lesions affecting the spinal cord; these distinctions were based on the lesions' anatomy, epidemiology, and the mechanism of spinal cord injury.
Intracranial subarachnoid hemorrhage resulting from cervical spine dural arteriovenous fistulas: literature review and case presentation
Authors: Fassett Daniel R. , Rammos Stylianos K. , Patel Pankti , Parikh Harsh , Couldwell William T.
Published: January 2009

Cervical dural arteriovenous fistulas (dAVFs) are a rare cause of intracranial subarachnoid hemorrhage (SAH) but should be considered when other sources are not found. Subarachnoid hemorrhage caused by dAVF is thought to occur as a result of venous hypertension in most cases. The clinical presentation, acute onset of severe headache, is similar to that in patients with other causes of SAH; however, severe neurological deficits (Hunt and Hess Grade IV and V SAH) have not been reported in SAH caused by cervical dAVFs. Patients with this type of SAH commonly report suboccipital headache, neck pain, and nausea, and thus these hemorrhages can be easily dismissed as perimesencephalic SAH. Vigilant evaluation with 4-vessel cerebral angiography, including selective catherization of both proximal vertebral arteries, should be performed. The practice of unilateral vertebral artery injection with reflux into the contralateral vertebral and posterior inferior cerebellar arteries has the potential to overlook cervical dAVF. Magnetic resonance imaging may be useful to evaluate for other causes of SAH but is probably not sensitive for the identification of a cervical dAVF. Surgical treatment of this lesion has an excellent outcome.