Search

BACKGROUND Guillain-Barré syndrome (GBS) is a rare disorder that typically presents with ascending weakness, pain, paraesthesias, and numbness, which mimic the findings in lumbar spinal stenosis. Here, we report a case of severe lumbar spinal stenosis combined with GBS. CASE SUMMARY A 70-year-old man with a history of lumbar spinal stenosis presented to our emergency department with severe lower back pain and lower extremity numbness. Magnetic resonance imaging confirmed the diagnosis of severe lumbar spinal stenosis. However, his symptoms did not improve postoperatively and he developed dysphagia and upper extremity numbness. An electromyogram was performed. Based on his symptoms, physical examination, and electromyogram, he was diagnosed with GBS. After 5 d of intravenous immunoglobulin (0.4 g/kg/d for 5 d) therapy, he gained 4/5 of strength in his upper and lower extremities and denied paraesthesias. He had regained 5/5 of strength in his extremities when he was discharged and had no symptoms during follow-up. CONCLUSION GBS should be considered in the differential diagnosis of spinal disorder, even though magnetic resonance imaging shows severe lumbar spinal stenosis. This case highlights the importance of a careful diagnosis when a patient has a history of a disease and comes to the hospital with the same or similar symptoms.

BACKGROUND Empty sella syndrome is a condition in which the pituitary gland shrinks or flattens. Patients with empty sella syndrome often present with headache, hypertension, obesity, visual disturbances, cerebrospinal fluid (CSF) rhinorrhoea, or endocrine dysfunction. Herein, we report a rare case of empty sella syndrome discovered after the patient experienced postoperative hypotension and respiratory failure. CASE SUMMARY A 60-year-old man was admitted for further workup of left shoulder pain. He was assessed by the orthopaedics team and booked for internal fixation of the left clavicle. General anaesthesia with a nerve block was administered. His blood pressure continued to decrease post-operation. Endocrine tests were performed, with the results supporting a diagnosis of hypopituitarism with hypocortisolism and hypothyroidism. Brain magnetic resonance imaging demonstrated that the sella was enlarged and filled with CSF, confirming a diagnosis of empty sella syndrome. The patient was started on endocrine replacement therapy. The patient regained consciousness and spontaneous breath finally. CONCLUSION This case highlights the importance of considering pituitary hormone insufficiency in the context of respiratory and hemodynamic failure during the perioperative period.

Background The objective of this study was to investigate the potency of platelet-rich plasma (PRP) combined with bone marrow mesenchymal stem cells (BMSCs) to promote tendon–bone healing in a rabbit model. Methods In the in vitro study, the effects of PRP on osteogenic induction of BMSCs were analysed. Later, PRP with or without BMSCs was used in the rabbit model of anterior cruciate ligament reconstruction. Specimens were harvested 8 weeks postoperatively to evaluate tendon–bone healing by histology, radiology, and biomechanical testing. Results The in vitro study revealed that collagen I, osteocalcin, and osteopontin expression was higher in BMSCs co-cultured with PRP for 14 days. The in vivo study revealed a more mature tendon–bone interface using light microscopy, a more newly formed bone at the bone tunnel walls detected by micro-computed tomography, and a significantly higher failure load as assessed by biomechanical testing in the BMSC + PRP group than in the control and PRP groups. Conclusions These results indicate that the combination of PRP and BMSCs promotes tendon–bone healing and has potential for clinical use. Electronic supplementary material The online version of this article (doi:10.1186/s13018-016-0433-7) contains supplementary material, which is available to authorized users.

Background Previous studies suggest that string capsule endoscopy is feasible, safe, accurate, highly acceptable, and likely to be proven as a more cost-effective technique than conventional EGD. However, this technique needs proper high-level disinfection, and the string attachment is not easy to perform. We developed a modified esophageal capsule endoscopy, called sleeve string capsule endoscopy (SSCE). Objective To assess the feasibility and safety of SSCE in the evaluation of esophageal diseases. Design A pilot study. Setting Outpatient setting in a tertiary hospital, Shanghai, China. Patients Two healthy volunteers and 8 patients with suspected esophageal diseases were enrolled. Interventions The OMOM capsule endoscope was enclosed in a small, transparent, thin, latex sleeve, with a string attached to the caudal end. Both the sleeve and the string were for single use and were discarded after completion of the procedure. Two healthy volunteers without previous EGD and 8 patients who had undergone EGD swallowed the capsules. Pictures of the esophagus were viewed in real time. Main Outcome Measurements Discomfort associated with the procedure, quality, and diagnostic value of the pictures were documented. In addition, patient preference between SSCE and conventional EGD was recorded. Results SSCE was successfully carried out in the 10 subjects. The procedures were easy and safe to perform. No sleeves and strings were disrupted or broken, and no capsule was lost. The mean overall discomfort score during SSCE in the 8 patients was 2.88 (range 2-5). Pictures generated during SSCE were generally of high quality and produced identical diagnoses to those obtained by EGD in all 8 patients. In addition, all the 8 patients preferred SSCE to EGD. Limitations This was a single-center nonrandomized study with a small sample size. Conclusions SSCE was a feasible, easy-to-operate, and safe method for the diagnosis of esophageal diseases without the need for disinfection. SSCE appears to possess the same diagnostic capacity as that of EGD.

To investigate the relationship between oxytocin (OT) and male infertility, serum OT baseline concentration and oxytocin receptor (OTR) gene expression in fertile and infertile men were investigated.Twenty obstructive azoospermia patients, twenty five idiopathic asthenozoospermia patients, twenty idiopathic oligozoospermia patients and twenty healthy subjects were taken into consideration. Serum OT baseline concentration was determined by radioimmunoassay. Moreover, serum concentration of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone (T) were determined by chemoluminescence to evaluate the correlation with OT. OTR gene promotor and OTR mRNA expressions were determined by polymerase chain reaction and reverse transcriptase-polymerase chain reaction, respectively. OTR protein expression was also performed by Western Blot.Serum OT baseline concentrations in infertile groups were significantly higher than in fertile group (F0.05/2(2,82) = 8.29, p 0.001). Serum baseline concentration of OT was not correlated with that of LH, FSH and T. There was no significant difference in gene sequences of OTR gene promotor and OTR mRNA when comparing infertile patients with fertile. Human OTR was in the form of oligomers and monomers, and the oligomers were in the majority containing tetramers and hexamers. Monomer expression was significantly higher in idiopathic asthenozoospermia and idiopathic oligozoospermia than that in obstructive azoospermia and control group (F0.05/2(2,82) = 115.50, p 0.001). There was no significant difference in oligomer expression between different groups, but 20% of idiopathic asthenozoospermia cases showed a decrease.Significantly different OT baseline concentrations and OTR expressions between fertile and infertile men strongly suggest that OT/OTR system is likely to be linked with male infertility, providing new insights into the pathogenesis and treatment of male infertility.

Background It remains unclear whether conservative treatment should be used to treat the common undisplaced femoral neck fractures that develop in the elderly. Herein, we systematically review the rates of union and avascular necrosis after conservative and surgical treatment of undisplaced femoral neck fractures. Methods We searched the EMBASE, PubMed, OVID, Cochrane Library, Web of Science, and Scopus databases for randomized controlled trials or observational studies that assessed the outcomes of conservative or surgical treatments of undisplaced femoral neck fractures. No language or publication year limitation was imposed. Statistical analyses were performed with the aid of the chi-squared test. We evaluated the quality of each publication and the risk of bias. Results Twenty-nine studies involving 5071 patients were ultimately included; 1120 patients were treated conservatively and 3951 surgically. The union rates were 68.8% (642/933) and 92.6% (635/686) in the former and latter groups, respectively (p