PARAPLEGIA AFTER A FROZEN ELEPHANT TRUNK PROCEDURE Successful reversal by immediate spinal liquor drainage

We report a patient who presented with paraplegia after ascending aorta and arch replacement using the frozen elephant trunk technique. Immediate postoperatively cerebrospinal fluid drainage allowed successful reversal of spinal chord injury. Early awakening of patients following a frozen elephant technique is mandatory because it allows recognition and treatment of this complication by prompt cerebrospinal liquor drainage.

Dural tear from diagnostic lumbar puncture followed by long-term morbidity: a case report

Background Lumbar punctures are performed in different medical settings and are a key procedure in the diagnosis of several neurological conditions. Complications are rare and generally self-limiting. There are no reports of symptomatic accumulation of fluid in the epidural space after lumbar puncture in adults and there are no studies on long-term outcome after post dural puncture headache (PDPH). Case A lumbar puncture was performed in a 29 y.o. slender woman with unspecific symptoms to rule out neuro-infection. Next day MRI showed substantial accumulation of CSF in the epidural space from C2 to the sacrum dislocating the spinal chord in the spinal canal. The condition was ameliorated by epidural blood-patching. At 5 months she was still impaired by severe orthostatic headache. Conclusions The only plausible explanation for the massive CSF leak was a dural tear occurring during multiple attempts of lumbar puncture. Anterior dislocation of the spinal chord due to CSF leak is not a recognised complication to lumbar puncture. This complication was followed by long-term disability in our case. The diagnosis can be made by MRI. A difficult procedure with several attempts and use of traumatic technique may increase risk of this complication.

Playing the Spinal Chord: Tantric Musicology and Bengali Songs in the Nineteenth Century

Across the nineteenth century, Bengali songbook editors applied musicological theory to their tantric religious practices. Responding to the new possibilities of musical publishing, these editors developed innovative techniques of relating the body to music by tying together tantric tropes with music theory and performance practice. Theories about the affective potential and poetic connotations of rāgas were brought into conversation with understandings of the yogic body, cakras, and the visualization of goddesses. These different theories, stemming from aesthetics and yogic philosophy, were put into effect through lyrical composition and the ways in which songs were set to music and edited for printed anthologies. This article considers different examples of tantric musical editorial, and explores how esoteric knowledge was applied in innovative ways through the medium of printed musical literature.

Phantom Limbs

Phantom limbs pose a philosophical problem about the location of pains. The work of Descartes first used them to make a philosophical point about the brain in relation to the body. They have traditionally been thought of as being due to nerve endings on the pathway to the original limb being activated. However, it was subsequently discovered that the phenomenon occurs even when the spinal chord is severed, suggesting that it is rather a question of brain activity, part of a neurosignature through which the brain indicates the body is one’s own. More recent resarch suggests involvement not only of the sensory systems but also the parietal cortex and the limbic system, which is concerned with emotion and motivation.

Lipid Mictrotubes as a Nutrient Reservoir or Enzyme Delivery Vehicle in Engineered Cartilage

Tissue-engineered cartilage using a hydrogel scaffold is capable of achieving native compressive properties and glycosaminglycan (GAG) content [1]. However, these tissues are limited in their collagen production and closer inspection of the localized mechanical properties demonstrates that mature constructs consist of a stiffer periphery region surrounding a softer core [1, 2]. Nutrient diffusion becomes increasingly more challenging as the cells in the construct periphery deposit extracellular matrix. Altering the scaffold porosity by adding microscopic porogens can improve the nutrient diffusion into the center of the construct [3]. Furthermore, chondroitinase ABC (chABC) has been shown to improve collagen production of mature engineered cartilage (i.e. tissue cultured for 2–4 weeks before chABC digestion). Lipid microtubes, designed to slowly release chABC for spinal chord injury repair can be incorporated into our agarose hydrogel scaffold in a chABC-loaded or unloaded form. The objective of this study was to explore the use of lipid microtubes in our scaffold as a tubular porogen and as a vehicle to deliver chABC throughout the scaffold to improve nutrient diffusion and collagen production into our engineered constructs.