Search

Background To report cases of extraspinal mimics of cauda equina syndrome (CES) to enable prompt diagnosis and treatment in the future. CES results from compression of spinal nerve roots. Current practice mandates lumbosacral magnetic resonance imaging (MRI) scanning to diagnose CES. However, it may not reveal compression or provide an explanation for the presentation. We present 3 cases of suspected CES who went on to have intracranial pathology. Methods Retrospective review of all patients presenting with CES-type features who were subsequently found to have causative intracranial pathology over a 6-month period. Results Three cases were found, and these are hereby presented. Case Presentation: Case 1: A 57-year-old lady presented with urinary retention and bilateral leg weakness. She underwent an MRI spine which showed no evidence of CES. She was diagnosed with haemorrhagic intracranial metastases. Case 2: A 52-year-old lady presented with lower back and right buttock pain, with right-sided leg numbness, saddle hypoesthesia, and bowel and bladder incontinence. MRI spine showed no cauda equina compression. MRI neuraxis revealed a subdural haematoma. Case 3: A 69-year-old lady presented with a 6-day history of urinary incontinence, right foot drop, and leg weakness. MRI spine was negative for CES. She was diagnosed with an intraparenchymal haematoma of posterior left frontal lobe. Conclusions Negative lumbosacral MRI will not exclude extraspinal mimics of CES and, although rare, these cases should be considered.

Background Context Defects in the annulus fibrosus (AF) remain a challenge in the surgical treatment of lumbar disc herniations with persistent defects, allowing potential re herniation of nucleus pulposus (NP) tissue. A cervical porcine model was chosen to simulate human lumbar intervertebral disc (IVD). Purpose The aim of this study was to determine the technical feasibility of closure of the AF of the IVD using a novel minimally invasive Kerrison-shaped suture application device. Study Design Ex vivo biomechanical and in vivo porcine device evaluations were performed. Methods Ex vivo biomechanical evaluation: 15 porcine spinal units were explanted and subjected to mock discectomy. The annular defect was closed using 2-0 non-absorbable (ultra-high molecular-weight polyethylene, UHMWPE) suture and Dines knot. The knot was backed up with two, three, or four throws. The spinal unit was subject to 4000 cycles of flexion/extension with 1500 N of axial load, and assessed for knot slippage. In vivo porcine device evaluation: three pigs (53–57 kg) were anesthetized and underwent a ventral surgical approach to the cervical spine. The AF of two discs was incised, and simulated partial NP discectomy was performed. The defect was closed at one level using the AnchorKnot device to apply the suture with a Dines knot and four throws. The pigs were observed for 4 weeks before euthanasia, allowing 7T magnetic resonance imaging (MRI) and histological evaluation. Results A Dines knot with four throws experienced no slippage after 4000 cycles. This configuration was tested in vivo. Clinically, the neurological examination in treated pigs was normal following surgery. Histological and MRI assessment confirmed sustained defect closure at 4 weeks. There was no reaction to the suture material and no NP extrusion at any of the sutured levels. Conclusions This study demonstrates that it is technically feasible to perform AF defect closure in a porcine model. This novel device achieved AF defect closure that was maintained through 4 weeks in vivo.

Objective: The SURE-AVR registry was established to collect real-world clinical and haemodynamic performance of LivaNova aortic valve prostheses in a prospective, International setting. We report t...

Mannose-binding lectin (MBL) deficiency (or the common opsonic defect) has been reported as a risk factor for several immunologically controlled conditions, including infection and graft rejection. However, the effects of MBL deficiency on acute rejection after heart transplantation are unknown. Ninety heart transplant recipients were included in this study. Plasma MBL quantification was performed using a commercially available enzyme-linked immunoassay (ELISA). Acute rejection was diagnosed via endomyocardial biopsy and histologic assessment. MBL concentration was controlled for demographics, immunosuppression and anti-viral therapy. Individuals with dysfunctional MBL had significantly fewer rejection episodes (6.3 +/- 3.8%) than those with functional MBL (12.9 +/- 11.6%) (p = 0.016). We found no significant difference between MBL concentrations among those with (1,232 +/- 58 ng/ml) and those without (1,216 +/- 161 ng/ml) GCAD (p = 0.841). There was also no significant difference between the incidence of GCAD in those with "normal" concentrations (p = 0.782). Heart transplant recipients with MBL deficiency had fewer acute graft rejection episodes compared to patients with functional MBL. This suggests the lectin pathway of complement activation is an important process in graft rejection. Furthermore, functional MBL may indicate a greater likelihood of rejection.

Background Natural killer (NK) cells have the capacity to recognize and respond to alloantigen, yet their role in lung transplant rejection is not well defined. The aim of this study was to correlate NK cell numbers and immunophenotype in peripheral blood and tissue with graft function after lung transplantation. Methods NK cell subsets were immunophenotyped in peripheral blood ( n = 41). Lung tissue was stained for NK cells via CD16 and morphologic assessment ( n = 30). Results Peripheral blood NK cells were activated in patients with chronic rejection, but the overall number of cells was lower in these patients when compared with stable patients. Furthermore, there was significantly more CD16 + NK cells in the lung compartment of patients with bronchiolitis obliterans syndrome compared with stable patients ( p = 0.001). Conclusions In patients with chronic rejection, peripheral blood NK cells are activated but their numbers decrease, while the number of NK cells in the lungs increases. This suggests NK cells systemically activate and migrate to the lung during the progression of chronic rejection after lung transplantation.

Introduction Survival following lung transplantation is less than 50% at 5 years, mainly due to immune-mediated chronic rejection. Recently a novel subset of T cells, CD4−veCD8−ve CD30+ve, so-called double negative (DN) CD30+ve T cells, has been described and shown to be responsible for tolerance in an animal model of skin transplantation. Methods We investigated 18 lung transplant recipients for the presence of DN CD30+ve T cells in resting peripheral blood and also following in vitro stimulation of recipient peripheral blood mononuclear cells (PBMCs) with donor spleen cells. Results Small percentages (0.2% to 6%) of DN T cells are detectable in resting PBMCs of human transplant patients ( n = 18), but these did not correlate with allograft function, acute rejection episodes, HLA mismatch, or CMV status. On repeated stimulation of recipient PBMCs (two exposures) in vitro by donor spleen cells (2:1 ratio stimulators to responders) the percentage of DN CD30+ve T cells within the lymphocyte pool correlated with preservation of allograft lung function (both for FEV 1 , P = .009, and FEF 25–75 , P = .036) and was inversely correlated with grade of chronic rejection. On repeated exposure of recipient PBMCs to donor spleen cells with a 1:1 ratio the percentage of DN CD30+ve T cells correlated with the number of acute rejection episodes of grade 2 or greater. The total number of HLA mismatches correlated with the percentage DN CD30+ve T cells present after primary stimulation of recipient PBMCs with donor spleen cells (1:1 ratio). The number of mismatches at the B locus inversely correlated with the percentage of DN CD30+ve T cells after primary stimulation of recipient PBMCs with donor spleen cells (1:1 ratio; P = .031, n = 18). Conclusion Percentages of DN CD30+ve T cells present following repeated stimulation of recipient PBMCs by donor spleen cells correlated with preservation of graft function following lung transplantation.

INTRODUCTION: Following lung transplantation, cytomegalovirus (CMV) has both direct and indirect adverse effects on the allograft. Natural killer cells mediate immune responses to CMV. This can be both dependent and independent of MHC class I expression. However, their role during CMV infection following lung transplantation is unknown. In this study, the immunophenotypic characteristics of NK cells were correlated with CMV infection following lung transplantation. METHODS: Seventy lung transplant recipients were included in the study. NK cells were characterised via flow cytometric analysis of CD3, CD16, CD56, CD107a, CD107b, and CD161. CMV infection was determined using an established quantitative PCR technique on peripheral blood. RESULTS: The number of peripheral blood NK cells with CD16, CD56 and CD161 phenotypes decreased in patients with CMV infection. However, there were no correlations between CMV infection and NK cell activation determined via LAMP expression. CONCLUSIONS: This study reports comparative differences in the peripheral blood NK cell repertoire in lung transplant recipients with CMV infection versus those without. However, NK cell activity did not alter with CMV infection, suggesting that CMV infection alone does not induce an NK cell response.

Background Due to the increasing demand for suitable cardiac donor organs, acceptance criteria need to be re-evaluated. We retrospectively analyzed the effect of donor age on survival following cardiac transplantation. Method Three hundred thirty-five cardiac transplant recipients and corresponding donor data were reviewed using SPSS. Results Seventy-two recipients had early posttransplant angiography or postmortem data available. The mean donor age of recipients with evidence of graft coronary artery disease (32.5 ± 11.7 years) was significantly higher than that of recipients free of transplant coronary artery disease (TCAD) (24.8 ± 9.4 years; P = .003). Recipient of organs from donors aged less than 50 years were less likely to develop TCAD than those of donors aged over 50 years (odds ratio 0.333; 95% CI 0.239–0.465; P = .044). TCAD also occurred much earlier posttransplantation in recipients of organ from donors over 50 years (mean time 6.5 years; median 5.0 years) than those of donors under 50 years (mean time 12.7 years; median 14.0 years). Conclusion We observed no increase in mortality associated with cardiac donors over 50 years. However, increased donor age was associated with an increased incidence of TCAD.

Five patients with multiple myeloma who had an autologous bone marrow/stem cell transplant were studied to assess the cause of the erectile dysfunction by assessing markers of gonadal function and cavernosal vascular measurements by flow Doppler study.