Identification and surgical ligation of spinal CSF-venous fistula

Background: CSF-venous fistulas (CVF) may cause incapacitating positional headaches resulting from spontaneous intracranial hypotension/hypovolemia (SIH). Their etiology remains unknown, although unrecognized local trauma may precipitate SIH. In addition, they are diagnostically challenging despite various imaging tools available. Here, we present CVF identification using magnetic resonance myelography (MRM) and elaborate on their surgical management techniques. Methods: Retrospective charts of confirmed and treated CVF patients with attention to their diagnostic imaging modalities and management techniques were further reviewed. Results: Six cases were identified of which three are presented here. There were two females and one male patient. All had fistulas on the left side. Two were at T7-T8 while the third was at T9-T10 level. Two underwent hemilaminotomies at the T7-T8 while the third underwent a foraminotomy at T9 level to access the fistula site. All CVF were closed with a combination of an aneurysm clip and a silk tie. On follow-up, all had complete resolution of symptoms with no evidence of recurrence. Conclusion: Of the various imaging modalities available, MRM is particularly sensitive in localizing CVF spinal nerve level and their laterality. In addition, the technique of aneurysm clip ligation and placement of a silk tie is curative for these lesions.

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Transvenous embolization of a cerebrospinal fluid–venous fistula for the treatment of spontaneous intracranial hypotension

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-018160 ◽

2021 ◽

pp. neurintsurg-2021-018160

Author(s):

Nicholas Borg ◽

Soliman Oushy ◽

Luis Savastano ◽

Waleed Brinjikji

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Hypotension ◽

Spontaneous Intracranial Hypotension ◽

Spinal Nerve ◽

Transvenous Embolization ◽

Neural Foramen ◽

Content Type ◽

Venous Fistula ◽

The Right ◽

Video Player

Cerebrospinal fluid–venous fistula is an increasingly recognized cause of spontaneous intracranial hypotension.1 The site of the leak is between the dural sleeve around a spinal nerve root and the surrounding foraminal veins. In appropriately investigated patients, transvenous embolization of the draining foraminal and paraspinal veins has been shown to be an effective way of treating the disease, with low periprocedural morbidity, improvement in symptoms and radiological appearances.2 Video 1 shows the technique employed in a typical case using Onyx (Medtronic, Minnesota, USA) to embolize a CSF–venous fistula at the right T10 neural foramen.Video 1

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Spontaneous spinal CSF–venous fistulas associated with venous/venolymphatic vascular malformations: report of 3 cases

Journal of Neurosurgery Spine ◽

10.3171/2019.8.spine19716 ◽

2020 ◽

Vol 32 (2) ◽

pp. 305-310 ◽

Cited By ~ 3

Author(s):

Wouter I. Schievink ◽

Marcel M. Maya ◽

Franklin G. Moser ◽

Alexander Tuchman ◽

Rachelle B. Cruz ◽

...

Keyword(s):

Soft Tissue ◽

Intracranial Hypotension ◽

Vascular Malformations ◽

Spontaneous Intracranial Hypotension ◽

Proximal Portion ◽

Csf Leak ◽

Venous Fistula

Spontaneous CSF–venous fistulas may be present in up to one-fourth of patients with spontaneous intracranial hypotension. This is a recently discovered type of CSF leak, and much remains unknown about these fistulas. Spinal CSF–venous fistulas are usually seen in coexistence with a spinal meningeal diverticulum, suggesting the presence of an underlying structural dural weakness at the proximal portion of the fistula. The authors now report the presence of soft-tissue venous/venolymphatic malformations associated with spontaneous spinal CSF–venous fistulas in 2 patients with spontaneous intracranial hypotension, suggesting a role for distal venous pathology. In a third patient with spontaneous intracranial hypotension and a venolymphatic malformation, such a CSF–venous fistula is strongly suspected.

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Longitudinal Circulating Levels of miR-23b-3p, miR-126-3p and lncRNA GAS5 in HCC Patients Treated with Sorafenib

Biomedicines ◽

10.3390/biomedicines9070813 ◽

2021 ◽

Vol 9 (7) ◽

pp. 813

Author(s):

Michele Manganelli ◽

Ilaria Grossi ◽

Manuela Ferracin ◽

Paola Guerriero ◽

Massimo Negrini ◽

...

Keyword(s):

Digital Pcr ◽

Droplet Digital Pcr ◽

Healthy Individuals ◽

Roc Curve Analysis ◽

Multikinase Inhibitor ◽

Sorafenib Treatment ◽

The Third ◽

Circulating Levels ◽

Systemic Drug

Human hepatocellular carcinoma (HCC) is the most frequent primary tumor of the liver and the third cause of cancer-related deaths. The multikinase inhibitor sorafenib is a systemic drug for unresectable HCC. The identification of molecular biomarkers for the early diagnosis of HCC and responsiveness to treatment are needed. In this work, we performed an exploratory study to investigate the longitudinal levels of cell-free long ncRNA GAS5 and microRNAs miR-126-3p and -23b-3p in a cohort of 7 patients during the period of treatment with sorafenib. We used qPCR to measure the amounts of GAS5 and miR-126-3p and droplet digital PCR (ddPCR) to measure the levels of miR-23b-3p. Patients treated with sorafenib displayed variable levels of GAS5, miR-126-3p and miR-23b-3p at different time-points of follow-up. miR-23b-3p was further measured by ddPCR in 37 healthy individuals and 25 untreated HCC patients. The amount of miR-23b-3p in the plasma of untreated HCC patients was significantly downregulated if compared to healthy individuals. The ROC curve analysis underlined its diagnostic relevance. In conclusion, our results highlight a potential clinical significance of circulating miR-23b-3p and an exploratory observation on the longitudinal plasmatic levels of GAS5, miR-126-3p and miR-23b-3p during sorafenib treatment.

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Camptodactyly-Arthropathy-Coxa Vara-Pericarditis Syndrome Resembling Juvenile Idiopathic Arthritis: A Single-Center Experience from Southern Turkey

Molecular Syndromology ◽

10.1159/000513111 ◽

2021 ◽

pp. 1-6

Author(s):

Rabia Miray Kisla Ekinci ◽

Sibel Balci ◽

Haldun Dogan ◽

Serdar Ceylaner ◽

Celal Varan ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Pericardial Effusion ◽

Early Onset ◽

Joint Space ◽

Coxa Vara ◽

Single Center ◽

The Third ◽

Single Center Experience ◽

Southern Turkey

Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome, caused by biallelic pathogenic mutations in the PRG4 gene, is characterized by early-onset camptodactyly, noninflammatory arthropathy, coxa vara deformity, and rarely, pericardial effusion. Herein, we report 3 patients with CACP syndrome from 2 unrelated families. All patients are female, born to consanguineous parents, and had camptodactyly since the first years of their lives. Two patients had a prior diagnosis of juvenile idiopathic arthritis. Hip changes were present in 2 patients, and 2 of 3 patients had undergone surgery for camptodactyly. Routine echocardiographic evaluations were normal during the 2-year follow-up. This paper represents the third study including CACP patients from Turkey. Clinically, all 3 patients resembled juvenile idiopathic arthritis cases and received unnecessary medication. There is also an ongoing need for improving awareness of CACP and an effective treatment focusing on the lubrication of the joint space in CACP patients.

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Penile Lymphoepithelioma-Like Carcinoma: A Rare Case With PD-L1 Expression

International Journal of Surgical Pathology ◽

10.1177/1066896920988340 ◽

2021 ◽

pp. 106689692098834

Author(s):

Raquel Machado-Neves ◽

Bernardo Teixeira ◽

Elsa Fonseca ◽

Pedro Valente ◽

Joaquim Lindoro ◽

...

Keyword(s):

Human Papillomavirus ◽

Tumor Cells ◽

Rare Case ◽

Malignant Tumors ◽

Squamous Cell Carcinomas ◽

The Third ◽

The Past ◽

First Case ◽

Lymphoplasmacytic Infiltrate

Most malignant tumors of the penis are squamous cell carcinomas (SCC), being divided in 2 groups, one human papillomavirus (HPV)-related and another non-HPV-related, with lymphoepithelioma-like carcinoma (LELC) being one of the rarest HPV-related SCC. In this article, we report a case of a 50-year-old man who presented testicular swelling and pain for the past 3 months. A penile mass was identified, and the patient was submitted to a total penectomy. The penectomy specimen showed an ulcerated lesion at the glans reaching the cavernous bodies. Microscopic examination showed undifferentiated epithelial cells with syncytial growth pattern mix with a dense lymphoplasmacytic infiltrate, consistent with LELC. The tumor cells expressed p16 and all 3 different clones of PDL1 (22C3, SP263, and SP142). The patient is alive and well with a follow-up of 3 months. To our knowledge, this is the third LELC of the penis reported in literature and the first case reported with PDL1 expression.

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WoundClot® Hemostatic Gauze Reduces Bleeding Time after Arterial Venous Fistula Decannulation

Blood Purification ◽

10.1159/000514934 ◽

2021 ◽

pp. 1-7

Author(s):

Orit Kliuk-Ben Bassat ◽

Doron Schwartz ◽

Alexander Zubkov ◽

Amir Gal-Oz ◽

Alexander Gorevoy ◽

...

Keyword(s):

Bleeding Time ◽

Control Group ◽

Dialysis Adequacy ◽

Cotton Gauze ◽

Single Center Study ◽

Time Required ◽

Venous Fistula ◽

Thrombosis Rate

Introduction: Decannulation of the arteriovenous fistula (AVF) after each hemodialysis session requires a precise compression on the needle puncture site. The objective of our study was to evaluate the bleeding time (BT) needed to achieve hemostasis using WoundClot, an innovative hemostatic gauze, and to assess whether its long-term use can improve AVF preservation. Methods: This is a prospective single center study. Initially, the time to hemostasis after AVF decannulation was compared between WoundClot and cotton gauze in 24 prevalent hemodialysis patients. Thereafter, the patients continued to use WoundClot for 12 months and were compared to a control group consisting of 25 patients using regular cotton gauze. Follow-up data included parameters of dialysis adequacy, AVF interventions, and thrombotic events. Results: WoundClot use shortened significantly the time needed for hemostasis. Mean venous BT decreased by 3.99 (±4.6) min and mean arterial BT by 6.38 (±4.8) min when using WoundClot compared to cotton gauze (p < 0.001). At the end of the study, dialysis adequacy expressed by spKt/V was higher in the WoundClot group compared to control (1.73 vs. 1.53, respectively, p = 0.047). Although patients in WoundClot group had a higher baseline BT, arterial and venous pressures did not differ between the groups after a median follow up of 10.8 months. AVF thrombosis rate was similar between the groups. Conclusions: WoundClot hemostatic gauze significantly reduced the time required for hemostasis after AVF decannulation and may be associated with better AVF preservation. We suggest using WoundClot for arterial BT longer than 15 min and for venous BT longer than 12.5 min.

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690 Intracranial Hypotension Due to CSF Leak Secondary to Ventral Thoracic Osteophyte Complex: Resolution After Transdural Thoracic Discectomy and Dural Repair

British Journal of Surgery ◽

10.1093/bjs/znab134.313 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

B Kewlani ◽

I Hussain ◽

J Greenfield

Keyword(s):

Intracranial Hypotension ◽

Spontaneous Intracranial Hypotension ◽

Bed Rest ◽

Structural Defects ◽

Csf Leak ◽

History Of ◽

Surgical Cure ◽

Thoracic Discectomy ◽

Herniated Discs

Abstract The hallmark symptom of spontaneous intracranial hypotension (SIH) is orthostatic headaches which manifests secondary to cerebrospinal fluid (CSF) hypovolaemia. Well-recognised aetiologies include trauma which includes procedures such as lumbar punctures and spinal surgery. More recently, structural defects such as bony osteophytes and calcified or herniated discs have been attributed to mechanically compromising dural integrity consequently resulting in CSF leak and symptom manifestation. A thorough literature review noted only a handful of such cases. We report the case of a thirty-two-year-old Asian female who presented with a one-month history of new-onset progressively worsening orthostatic headaches. Workup included MRI of the thoracic spine which revealed an epidural collection of CSF consequently prompting a dynamic CT-myelogram of the spine which not only helped to confirm severe cerebral hypotension but also suggested the underlying cause as being a dorsally projecting osteophyte-complex at level T2-3. Conservative and medical management including bed rest, analgesia, mechanical compression, and epidural blood patches failed to alleviate symptoms and a permanent surgical cure was eventually sought. The surgery involved T2-T3 laminectomy and osteophytectomy and at a 3-month follow-up, complete resolution of symptoms was noted.

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Comparison of Pulsed Radiofrequency, Oxygen-Ozone Therapy and Epidural Steroid Injections for the Treatment of Chronic Unilateral Radicular Syndrome

Medicina ◽

10.3390/medicina57020136 ◽

2021 ◽

Vol 57 (2) ◽

pp. 136

Author(s):

Pavel Ryska ◽

Jiri Jandura ◽

Petr Hoffmann ◽

Petr Dvorak ◽

Blanka Klimova ◽

...

Keyword(s):

Pain Relief ◽

Analogue Scale ◽

Pulsed Radiofrequency ◽

Ozone Therapy ◽

Ct Guided ◽

The Third ◽

Vas Score ◽

Radicular Syndrome ◽

Epidural Steroid

Background and objectives: For the treatment of chronic unilateral radicular syndrome, there are various methods including three minimally invasive computed tomography (CT)-guided methods, namely, pulsed radiofrequency (PRF), transforaminal oxygen ozone therapy (TFOOT), and transforaminal epidural steroid injection (TFESI). Despite this, it is still unclear which of these methods is the best in terms of pain reduction and disability improvement. Therefore, the purpose of this study was to evaluate the short and long-term effectiveness of these methods by measuring pain relief using the visual analogue scale (VAS) and improvement in disability (per the Oswestry disability index (ODI)) in patients with chronic unilateral radicular syndrome at L5 or S1 that do not respond to conservative treatment. Materials and Methods: After screening 692 patients, we enrolled 178 subjects, each of whom underwent one of the above CT-guided procedures. The PRF settings were as follows: pulse width = 20 ms, f = 2 Hz, U = 45 V, Z ˂ 500 Ω, and interval = 2 × 120 s. For TFOOT, an injection of 4–5 mL of an O2-O3 mixture (24 μg/mL) was administered. For the TFESI, 1 mL of a corticosteroid (betamethasone dipropionate), 3 mL of an anaesthetic (bupivacaine hydrochloride), and a 0.5 mL mixture of a non-ionic contrast agent (Iomeron 300) were administered. Pain intensity was assessed with a questionnaire. Results: The data from 178 patients (PRF, n = 57; TFOOT, n = 69; TFESI, n = 52) who submitted correctly completed questionnaires in the third month of the follow-up period were used for statistical analysis. The median pre-treatment visual analogue scale (VAS) score in all groups was six points. Immediately after treatment, the largest decrease in the median VAS score was observed in the TFESI group, with a score of 3.5 points (a decrease of 41.7%). In the PRF and TFOOT groups, the median VAS score decreased to 4 and 5 points (decreases of 33% and 16.7%, respectively). The difference in the early (immediately after) post-treatment VAS score between the TFESI and TFOOT groups was statistically significant (p = 0.0152). At the third and sixth months after treatment, the median VAS score was five points in all groups, without a statistically significant difference (p > 0.05). Additionally, there were no significant differences in the Oswestry disability index (ODI) values among the groups at any of the follow-up visits. Finally, there were no significant effects of age or body mass index (BMI) on both treatment outcomes (maximum absolute value of Spearman’s rank correlation coefficient = 0.193). Conclusions: Although the three methods are equally efficient in reducing pain over the entire follow-up, we observed that TFESI (a corticosteroid with a local anaesthetic) proved to be the most effective method for early post-treatment pain relief.

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PHL 417: a zirconium-rich pulsating hot subdwarf (V366 Aquarid) discovered in K2 data

Monthly Notices of the Royal Astronomical Society ◽

10.1093/mnras/staa3123 ◽

2020 ◽

Vol 499 (3) ◽

pp. 3738-3748

Author(s):

R H Østensen ◽

C S Jeffery ◽

H Saio ◽

J J Hermes ◽

J H Telting ◽

...

Keyword(s):

Heavy Metal ◽

Helium Abundance ◽

The Sun ◽

The Third ◽

Short Period ◽

Standard Models ◽

Hot Subdwarfs ◽

Amplitude Mode ◽

Rare Group

ABSTRACT The Kepler spacecraft observed the hot subdwarf star PHL 417 during its extended K2 mission, and the high-precision photometric light curve reveals the presence of 17 pulsation modes with periods between 38 and 105 min. From follow-up ground-based spectroscopy, we find that the object has a relatively high temperature of 35 600 K, a surface gravity of $\log g / {\rm cm\, s^{-2}}\, =\, 5.75$ and a supersolar helium abundance. Remarkably, it also shows strong zirconium lines corresponding to an apparent +3.9 dex overabundance compared with the Sun. These properties clearly identify this object as the third member of the rare group of pulsating heavy-metal stars, the V366-Aquarii pulsators. These stars are intriguing in that the pulsations are inconsistent with the standard models for pulsations in hot subdwarfs, which predicts that they should display short-period pulsations rather than the observed longer periods. We perform a stability analysis of the pulsation modes based on data from two campaigns with K2. The highest amplitude mode is found to be stable with a period drift, $\dot{P}$, of less than 1.1 × 10−9 s s−1. This result rules out pulsations driven during the rapid stages of helium flash ignition.

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Percutaneous needle aspiration and sclerotherapy with rolitetracycline in the treatment of hydrocele

Urologia Journal ◽

10.1177/039156039205900416 ◽

1992 ◽

Vol 59 (4) ◽

pp. 63-64

Author(s):

M. De Siati ◽

D. Grassi ◽

E Marzoli ◽

N. Franzolin

Keyword(s):

Needle Aspiration ◽

The Third ◽

One Year

Thirty-one patients with unilateral or bilateral hydrocele were treated by percutaneous needle aspiration and subsequent sclerotherapy with rolitetracycline. Thirty patients were considered cured after a follow-up of one year. In 20 pts. the procedure proved to be definitive after the first sitting, in 6 cases the treatment was repeated twice and in 4 cases three times. Only in 1 a recurrence was observed after the third treatment. No complications related to the procedure were recorded.

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