Simultaneous 3-dimensional printing is the most promising rapid prototyping technique to produce biomodels that meet the high demands of neurovascular surgery.
Neuronal intestinal dysplasia (NID) is a disturbance of the innervation of the gut. Its symptoms resemble the ones seen in Hirschsprung's Disease. Contrary to aganglionosis, however, there is hyperplasia of the ganglia. Our study revealed isolated NID (4/49 cases) to be eight times rarer than aganglionosis (33/49 patients). Combination of both diseases has been reported to occur in 20% of NID cases; we did however find it in 75% (12/16) of our patients. NID was located proximal to the aganglionic segment and reached the stomach in 1 case. Combination of both diseases resulted in superposition of symptoms, thus rendering impossible to differentiate between NID group A (with hypoplasia of sympathetic innervation and acute early onset) and group B (with normal sympathetic innervation and chronic, late onset) on clinical grounds only. Major malformations were present in 5/16 patients with NID; 2 of them had trisomy 21.
Background. Very late recurrence (LR), i.e., >5 years after initial presentation, occurs in about 1% of patients with germ cell tumors of the testis (TGCT) and is associated with poor prognosis. Methods. We retrospectively reviewed the records of patients at the M. D. Anderson Cancer Center who developed LR > 5 years after their initial diagnosis of TGCT. Results. We identified 25 patients who developed LR between July 2007 and August 2020. The median age at the time of LR was 46 years (range, 29–61). Pathology of LR: somatic transformation to carcinoma or sarcoma—11, nonseminoma with yolk sac tumor or teratoma—11, nonseminoma without yolk sac tumor or teratoma—2, not available—1. With a median follow-up of 3.5 years, 68% of patients are alive 3 years after LR. Patients with prior post-chemotherapy consolidation surgery do not have statistically significant longer survival compared to patients who did not receive post-chemotherapy consolidation surgery, 83.3% vs. 60.8% at 3 years, respectively, p = 0.50. Conclusions. Patients with LR > 5 years tend to harbor nonseminoma (with yolk sac tumor and or teratoma). Among these patients, a majority who did not undergo surgery to remove residual disease after chemotherapy developed somatic transformation and succumbed to their LR.
Paraneoplastic cerebellar degeneration (PCD) is a rare set of neurological disorders arising from tumorassociated autoimmunity against antigens within the cerebellum. Anti-Purkinje cell cytoplasmic antibody 1 (PCA-1), or anti-Yo, is the most commonly linked antibody and is classically associated with breast and ovarian cancers. Here we report case series of PCA-1 associated PCD in patients with known breast or ovarian cancer diagnosis not receiving immunotherapy. These cases highlight recognizing PCA-1 paraneoplastic syndrome triggered by cytotoxic chemotherapy, surgery, tumor recurrence and associated with development of second cancer. Diagnosis of the syndrome requires neurological workup with lumbar puncture (LP) with cerebrospinal uids (CSF) studies, serum and CSF paraneoplastic antibody panel, and neuroimaging. Inpatient admission for prompt workup and initiation of treatment is recommended. Treatment most commonly includes immunosuppression with corticosteroids, plasmapheresis, and/or intravenous immune globulin (IVIG); however, we postulate that other immune modulating treatments may warrant consideration. In established cancer patients developing this syndrome, workup and treatment of tumor recurrence or development of second malignancy is recommended. These cases highlight the need for early recognition of the syndrome in patients receiving non immune based chemotherapy, for prompt workup and treatment.
OBJECTIVE To compare the effects of conventional and slanted ventral slot procedures on the biomechanical behavior of the C5-C6 vertebral motion unit (VMU) in dogs. SAMPLE 14 vertebral columns (C4 through C7) from canine cadavers. PROCEDURES Specimens were assigned to a conventional or slanted ventral slot group (n = 7/group). For each specimen, the C5-C6 VMU was tested in ventral and dorsal bending and positive and negative axial torsion before and after surgery. Range of motion (ROM), stiffness, and energy absorption were compared between the 2 groups. RESULTS Both procedures significantly increased the ROM and stiffness and significantly decreased the energy absorption of the C5-C6 VMU in ventral and dorsal bending. Both procedures also increased the ROM in positive and negative axial torsion. In negative torsion, total stiffness and stiffness over the maximum ROM tested decreased less for the slanted slot procedure than for the conventional slot procedure. There were no significant differences between procedures for any of the other biomechanical outcomes examined. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the biomechanical response of the C5-C6 VMU to the conventional and slanted ventral slot procedures was not significantly different, especially when considering postsurgical instability induced by both procedures. This was most likely due to disruption of the nucleus pulposus and dorsal annulus fibrosus of the disk with both procedures. On the basis of these findings, neither procedure appeared biomechanically superior. Comparative clinical studies are warranted to further evaluate the 2 procedures.
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