We measured diffusing capacities for carbon monoxide (DLCO) and nitric oxide, lung volume, and cardiac output by a rebreathing technique at two alveolar O2 tensions (PAO2) at rest and exercise. Membrane diffusing capacity for CO (DMCO) and VC were estimated from DLCO by the Roughton-Forster (RF) method and also from simultaneous lung diffusing capacity for NO and DLCO measured at one O2 tension (modified RF method). Estimates by these methods agreed closely in normal subjects (Tamhane et al., Chest 2001;120:1850-1856). Using these methods, we studied patients with stages II-III pulmonary sarcoidosis to determine (1) whether the modified RF method accurately estimates DMCO and VC in parenchymal disease and (2) whether sarcoidosis alters recruitment of diffusing capacity with respect to cardiac output. In patients, DMCO and VC estimated by the two methods agreed closely. DMCO was disproportionately reduced relative to VC at any given cardiac output, and the slope of the relationship between DLCO and cardiac output was moderately, though significantly, below normal. We conclude that in sarcoidosis (1) the modified RF method provides comparable estimates of DMCO and VC as the standard RF method and (2) the limitation to diffusive gas transport resides primarily in the membrane barrier, although recruitment of microvascular reserves is also modestly impaired.

✓ Lumbar fusion is a commonly performed procedure for a variety of pathological conditions, and it is frequently used in the treatment of degenerative lumbar instability that is refractory to medical management. Pedicle screws and interbody devices have been used for internal fixation to promote arthrodesis, prevent nonunion, and facilitate early mobilization. Recently, attempts have been made to reduce the morbidity associated with lumbar fusion by using a variety of minimally invasive techniques. Many minimally invasive lumbar fusion procedures require specialized retractors, implants, image guidance systems, or insertion instruments. Other minimally invasive techniques are primarily applied to an ideal patient population (thin, healthy, and with no previous surgery). The authors describe their experience with a paramedian approach for minimally invasive transforaminal lumbar interbody fusion (TLIF) with unilateral pedicle screw (PS) fixation. This procedure requires only standard implants, instruments, and retractors, with direct visualization for all aspects of the procedure. The authors describe encouraging early results in a challenging patient population in which there was a high incidence of obesity, medical comorbidities, and previous surgery at the same level. The paramedian approach for TLIF performed using unilateral lumbar PSs has yielded successful outcomes in this series of 47 patients, and further study of this technique may help define its role as a minimally invasive procedure for spinal fusion.

Guillain-Barré Syndrome (GBS) is a demyelinating polyneuropathy resulting in sensory, motor and autonomic symptoms. The severity of the disease can range from mild to severe but it is classically described as an ascending demyelinating process. Initially thought to be the sequelae of a bacterial or viral infection, the clinical symptoms of post-infective GBS can present up to 4 weeks after sentinel injury. A rarely defined post-surgical GBS has been since described after major cranial, cardiothoracic and gastro-intestinal surgery. Post traumatic GBS is an even more unusual presentation with very few cases reported in contemporary academic literature. We present a case of GBS presenting two weeks after non-operative traumatic brain injury (TBI) and a review of the literature.

Background:Atypical teratoid/rhabdoid tumor (ATRT) is a highly aggressive tumor of the central nervous system (WHO grade IV), which is most frequently found intracranially in young children and infants. Only three prior cases of primary ATRT involving the adult spine were found following a literature review, and the average survival for these patients was only 20 postoperative months.Case Description:A 43 year-old female presented with an acute exacerbation of chronic neck pain. While awaiting magnetic resonance (MR) studies of the cervical spine, she was found pulseless in her room. Although cardiopulmonary resuscitation was successful, she was found to be quadriplegic. The subsequent cervical MR imaging revealed a C1-3 intradural, extramedullary ventrolateral mass, markedly compressing the upper cervical spinal cord. Following successful surgical resection of the lesion, which proved pathologically to be an ATRT, she was treated with a full course of fractionated radiation therapy. Over the successive 6-month period, her neurological examination continued to improve to 4-/5 functional strength in her upper extremities, however, remained with 2/5 nonfunctional strength in her legs.Conclusions:ATRT involving the adult spine are rare and may often be misdiagnosed. This study points out that aggressive surgery followed by radiation therapy may improve outcome.