1/75. Creutzfeldt-Jakob disease with florid-type plaques after cadaveric dura mater grafting.BACKGROUND: Many reported cases of iatrogenic Creutzfeldt-Jakob disease (CJD) developed after grafting cadaveric dura mater contaminated with CJD prions (dura-associated CJD). They are known to be clinicopathologically similar to sporadic CJD. We report herein 2 autopsy cases of dura-associated CJD with atypical clinicopathological features. patients: Two patients presented with progressive ataxia and mental deterioration 10 or 11 years after neurosurgical treatment with cadaveric dural grafting, which led to their deaths at 8 and 17 months, respectively, after onset. RESULTS: The cases were clinically atypical in exhibiting no or late occurrence of myoclonus and periodic synchronous discharges on electroencephalographic studies. They were pathologically unique in several aspects. The most striking feature was the presence of many prion protein (PrP) plaques in multiple areas in the brain. Some of them were the "florid" type surrounded by a zone of spongiform changes known to be a hallmark for the new variant CJD. The distribution of spongiform degeneration was also unique in that it was intense in the thalamus, basal ganglia, and the dentate nuclei of the cerebellum but milder in the cerebrum. There were no mutations in the PrP gene of the patients. There was no major difference in the size and glycoform pattern between the abnormal isoform of PrP extracted from the brain tissue from the dura-associated cases of CJD and that from a sporadic case of CJD. CONCLUSIONS: These 2 cases are clinicopathologically distinct from typical dura-associated cases of CJD. They may be a subtype with florid-type plaques in dura-associated CJD.- - - - - - - - - - ranking = 1keywords = area (Clic here for more details about this article) |
2/75. Orbital volume expansion of dysthyroid ophthalmopathy by surgical placement of lateral rim implants: a case study.PURPOSE: To measure the increase in orbital volume expansion effected by surgical placement of a lateral rim implant. methods: Computed tomography was used to obtain 1-mm axial sections of a normal human cadaver skull. A computer program was used to measure the orbital area of each section and integrate the sum of the areas to obtain the total orbital volume. Following placement of a lateral orbital rim implant, this procedure was repeated to obtain the new orbital volume. RESULTS: The orbital volume increased from 22.2 cm3 to 23.6 cm3 (an increase of 6%) following placement of the lateral orbital rim implant. CONCLUSION: Surgical placement of a lateral orbital rim implant can be an effective method of orbital volume expansion in dysthyroid ophthalmopathy.- - - - - - - - - - ranking = 2keywords = area (Clic here for more details about this article) |
3/75. Transplantation of autologous and allogeneic bone marrow with liver from a cadaveric donor for primary liver cancer.BACKGROUND: In histocompatibility mismatched experimental animals, a combination of T-cell-depleted autologous and allogeneic marrow may induce mixed chimerism and tolerance. patients with large primary liver tumors have a poor outcome. We investigated whether it were possible to induce mixed chimerism and obtain an antitumor effect in a patient with a large primary liver cancer after combined liver and bone marrow transplantation (BMT). methods: A 46-year-old female with a primary non resectable liver cancer received a liver transplant from a cadaveric donor. Subsequently, she was conditioned with 4x2 Gy of total lymphoid irradiation, 120 mg/kg cyclophosphamide, and 7.5 Gy total body irradiation. Twelve days after liver transplantation, she received T-cell-depleted autologous:cadaveric 5/6 antigen HLA-mismatched marrow in a proportion of CD34 cells of 0.5:3.0x10(6)/kg. chimerism status was determined with polymerase chain reaction amplification of variable number tandem repeats from dna obtained from CD3 , CD19 , and CD45 magnetic-bead-separated cells. RESULTS: The early posttransplant period was uneventful; liver function was normal and the hematopoietic engraftment of donor and recipient origin was prompt. Alpha-fetoprotein levels dropped from 440 to 35 microg/l. One month after marrow transplantation, donor T-cells decreased markedly. Monoclonal antibody OKT-3 and 10(5)/kg donor T-cells were given. One month later, the patient developed diarrhea and abdominal pain. A colonoscopy showed moderate gastrointestinal acute graft-versus-host disease and a cryptosporidium infection. Three months after BMT, she became a complete donor chimera. chimera cells showed little, if any, reactivity in mixed lymphocyte cultures to recipient and donor cells, but reacted to third party. Five months after BMT, she developed progressive aspergillus fumigatus pneumonia and died. No tumor was found at the autopsy. CONCLUSION: We obtained mixed donor-recipient hematopoietic chimerism without severe acute graft-versus-host-disease, after combined T-cell depleted autologous and allogeneic BMT and a transplantation of a liver from an HLA-mismatched cadaveric donor. Additional donor T-cells enhanced donor bone marrow engraftment, but rejected the autograft. On the basis of this first attempt, further clinical studies are warranted.- - - - - - - - - - ranking = 1.334458034264keywords = pain (Clic here for more details about this article) |
4/75. The search for "Yvonne": a case example of the delineation of a grave using near-surface geophysical methods.Shallow electromagnetic (EM) and ground-penetrating radar (GPR) surveys were conducted in an area north of Auckland, new zealand to assist the search for human remains. The body had been buried for almost 12 years in a plantation forest that was irregularly disrupted and modified by tree harvesting and the partial removal of stumps. EM identified anomalous areas of potential interest, because a target need only be nearby to generate an EM response. GPR was then used to map subsurface layering, layering disruption, and buried objects, immediately adjacent to an EM anomaly. Because of the nature of the site, numerous geophysical anomalies were present. GPR was particularly sensitive to site disturbance resulting from the forestry operations. An isolated EM anomaly on the fringes of an expanded survey area was coincident with the location of the body. Whether for criminal investigations or for archaeological work, a combination of geophysical techniques is recommended.- - - - - - - - - - ranking = 3keywords = area (Clic here for more details about this article) |
5/75. A keyhole approach for endoscopically assisted pedicle screw fixation in lumbar spine instability.OBJECTIVE: The standard approach for dorsal transpedicular fixation in lumbar spine instability requires extensive exposure of the vertebral column. This increases the risk of potential complications and possibly destabilizes healthy neighboring segments because of the dissection and denervation of paravertebral muscles. The majority of spinal disorders are currently treated successfully via limited and tailored approaches. Accordingly, a keyhole approach for dorsal fusion of the lumbar spine was developed on the basis of an anatomic study. methods: The new endoscopic technique entails the transmuscular insertion of a pedicle screw-rod fixation device via a rigid operating sheath. As a prerequisite, the endoscopic microanatomy of the target area, as visible through the operating sheath, was first evaluated on lumbar bone specimens. To localize the exact screw entry point into the pedicle, we identified the bony and ligamentous landmarks on partly macerated specimens. To determine the course of the pedicle screws, we deduced the corresponding angles of convergence from transparent polyester casting models of average vertebrae from T12 to S1. These angles were transferred into the operative situation and measured on-line with an inclinometer. The approach was finally tested on 12 cadavers for clinical feasibility and accuracy of screw placement and then successfully implemented in patients. RESULTS: After extracutaneous localization of the pedicles at lateral fluoroscopy, paramedian skin incisions were made above the pedicles of the motion segment to be stabilized. The operative windows were exposed by use of a rigid operating sheath (length, 50 mm; diameter, 15 mm), which was inserted transmuscularly in the pedicle axis. The screw entry point into the pedicles was localized by endoscopic dissection of the mamilloaccessory ligament, bridging the mamilloaccessory notch. The pilot holes were created via insertion of a blunt-tipped pedicle probe. The adequate angles of convergence were constantly controlled during hollowing of the pedicles by an inclinometer mounted to the pedicle probe handle. The pedicle screws were then inserted through the operating sheaths. After removal of the operating sheaths, the connecting rods were inserted transmuscularly and anchored in the pedicle screw heads. Posterior bone grafting was performed after completion of the dorsal instrumentation. The dorsal fusion site was exposed by reinserting the operating sheath and tilting it medially. CONCLUSION: This new approach significantly reduces surgical traumatization and destabilization of adjacent motion segments. An endoscopic operating sheath, adopted from thoracoscopic surgery, creates space for visualization and surgical manipulations. The newly defined anatomic landmarks provide guidance to the screw entry point into the pedicle in the center of the exposure. observation of the exact corresponding angles of convergence during screw insertion by an inclinometer facilitates correct screw placement. In accordance with the initial anatomic studies, this approach was successfully performed on 12 cadavers and then used in six patients. Two illustrative cases are presented.- - - - - - - - - - ranking = 1keywords = area (Clic here for more details about this article) |
6/75. Aortocoronary vein graft surgery in a cadaver kidney transplant recipient.A case of Prinzmetal angina occurred in a recipient of a cadaver kidney transplant who was treated with aortocoronary vein graft. The patient had severe retrosternal chest pain associated with ST-segment elevation in the precordial leads. Coronary arteriograms disclosed two major lesions in the proximal anterior descending artery. Aortocoronary vein graft was successfully performed with no untoward effect on the renal status. The patient has been free of angina approximately two years postoperatively.- - - - - - - - - - ranking = 1.6828358577663keywords = pain, chest (Clic here for more details about this article) |
7/75. Subclavius posticus muscle: supernumerary muscle as a potential cause for thoracic outlet syndrome.During routine dissection a subclavius posticus muscle was found on the left side of a male cadaver. This muscle arose from the upper margin of the scapula and transverse scapular ligament, inserted in the superior side of the first rib cartilage, and was innervated by a small branch from the suprascapular nerve. The anatomical relationships of the supernumerary muscle with the brachial plexus and the subclavian artery is suggestive of a possible cause of the thoracic outlet syndrome and therefore of clinical significance.- - - - - - - - - - ranking = 111.39725860799keywords = plexus (Clic here for more details about this article) |
8/75. Rescue of exposed scleral buckles with cadaveric pericardial patch grafts.PURPOSE: To describe a new method for salvaging externally exposed silicone scleral exoplants (buckles) to avoid removal and the consequent risk of retinal redetachment. DESIGN: A retrospective, noncomparative, interventional case series. PARTICIPANTS: Four patients with exposed, clinically uninfected scleral buckles after initial surgery for the treatment of rhegmatogenous retinal detachment. INTERVENTION: Processed human donor pericardium patch grafts (Tutoplast; Innovative Ophthalmic Products, INC:, Costa Mesa, CA) were used to cover exposed areas of scleral buckles in concert with conjunctivoplasty. MAIN OUTCOME MEASURES: Scleral buckle preservation was the goal of this new treatment strategy. RESULTS: In four eyes treated with pericardial patch grafts to cover segments of exposed scleral buckles, three (75%) were managed successfully with one surgery. One eye (25%) had this treatment method fail and required scleral buckle removal. CONCLUSIONS: Processed human donor pericardium patch grafting is one useful way to avoid removing exposed scleral buckles, and consequently, sparing patients the risk of recurrent retinal detachment.- - - - - - - - - - ranking = 1keywords = area (Clic here for more details about this article) |
9/75. Renal cell carcinoma detected in a cadaveric donor after orthotopic liver and contralateral renal transplantation in two recipients: four-year follow-up.BACKGROUND: Although rare, renal cell carcinoma has been found during renal recovery for cadaveric organ transplantation. Previously, we reported this incidence to be 0.9%. In one cadaveric donor, the liver and left kidney had been transplanted before the discovery of renal cell carcinoma (T1) in the right kidney. methods: We retrospectively reviewed the medical records of two patients who had received cadaveric allografts from a donor with a known renal cell carcinoma. RESULTS: Both patients have been followed for 4 years with blood chemistries and chest x-ray every 3 months for year 1, every 4 months for years 2 and 3, and every 6 months thereafter. They also underwent allograft ultrasound every 6 months and an annual CT scan of the abdomen. Both patients have shown no evidence of metastatic disease throughout their follow-up. DISCUSSION: In the rare instance that a patient receives an organ from a cadaveric donor with a known renal cell carcinoma, it is mandatory to follow these patients closely observing for both allograft recurrence and metastatic disease.- - - - - - - - - - ranking = 0.34837782350227keywords = chest (Clic here for more details about this article) |
10/75. A case of rapid progressive glomerulonephritis with IgA deposits after renal transplantation.A 46-yr-old Japanese male who underwent a second cadaveric kidney transplantation on 31 October 1996 after suffering Type II diabetic mellitus for 25 yr was admitted to our institute on 23 January 1999, because of colicky abdominal pain and abdominal discomfort. Elevated levels of serum creatinine, severe proteinuria and microscopic haematuria were observed. The allograft biopsy specimen disclosed crescentic glomerulonephritis. Immunofluorescence showed granular deposits of mainly IgA and C3 along glomerular capillary walls and mesangial areas. Electron microscopy showed extensive subepithelial and mesangial electron dense deposits. Rapid and irreversible worsening of graft function led to resumption of haemodialysis on 31 May 1999. We speculated that this case was an atypical form of de novo Henoch-Schonlein purpura nephritis (HSPN) in transplanted kidney because of the histopathological findings of the allograft biopsy and clinical symptoms.- - - - - - - - - - ranking = 2.334458034264keywords = pain, area (Clic here for more details about this article) |
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