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PubMed1995

Omphalocele-exstrophy-imperforate-anus-spina bifida (OEIS) complex in a male prenatally exposed to diazepam.

A male clinically affected by the OEIS complex was studied. His mother, aged 30 years, has an affective disorder and ingested 30 mg of Diazepam daily, from 3 months previous to the gestation and during the entire pregnancy. At birth, a closure during the entire pregnancy. At birth, a closure defect of the anterior abdominal wall, exstrophy of hemibladders, exposure of intestinal epithelium, abnormal pelvis, imperforate anus, and bifid penis were noted. Birth weight was 3600 g and other measurements were not recorded. Colostomy was performed in the postnatal period followed by partial closure of the abdominal wall defect, and iliac osteotomies. At six years, 6 months of age, physical examination showed somatometric measurements around the third percentile (height 109 cm, weight 17 kg, cephalic circumference 48.5 cm). Clinically he presented mild mental retardation, functional colostomy, incomplete closure of the vesical exstrophy, imperforate anus, bifid penis and scrotum, descended testes, diastasis of pubis, lumbosacral scoliosis and shortening of the left leg (clinical photograph of the external features is not included as we were not able to obtain authorization to do so). Radiological studies (Figure 1) revealed wide separation of the ischiopubic bones; lumbosacral region with rotoscoliosis, platyspondyly and dysraphism; left coxa valga, and right coxa vara. The abdominal ultrasonographic studies showed unilateral renal agenesis (left). Chromosomal analysis (GTG bands) in peripheral blood lymphocyte cultures demonstrated a normal 46,XY constitution. Exposure to other substances, particularly alcohol, were excluded with the study of the mother's medical history and through information obtained from relatives.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Drug-Induced↗

PubMed1976

Spina bifida, exencephaly, and cranial bleb produced in hamsters by the solanum alkaloid solasodine.

Solasodine, one of the spirosolone structured solanum alkaloids, was gavaged to hamsters at 1184 - 1628 mg/kg once on the 7th or 8th day of gestation. About one-third of all litters from surviving, pregnant dams had one or more deformed offspring. There were 50 abnormals among 727 offspring from 84 dams at sacrifice. Abnormalities included 9 spina bifida, 13 major exencephaly, 25 cranial bleb, 2 hare lip, and 1 anophthalmic types. There were 5 abnormals among 1948 total offspring from 192 control dams. Malformation incidence in controls was 1/10 that in solasodine-gavaged animals. Solasodine gavage also resulted in a large increase in resorptions. Spina bifidas had a protuberance of the skin and other soft tissue in the dorsal mid-line of the lumbosacral region of the fetus. Exencephalics had a prominent dorsocranial defect that fully exposed the brain. Cranial blebs consisted of a soft protuberance of the skin in the mid-line of the interparietal region. The solasodine analogs tomatidine and diosgenin were not teratogenic at dose levels twice as high as the teratogenic dose of solasodine.

Abnormalities, Drug-Induced↗

PubMed1994

Cardiovascular and behavioral responses to nicotinic agents administered intrathecally.

We have examined the role of the spinal nicotinic receptors in mediating cardiovascular and behavioral responses in conscious rats. Intrathecal administration of nicotinic agonists to the lumbosacral region of the spinal cord caused a dose-dependent increase in systolic blood pressure, heart rate and a nociceptive (behavioral) response. The order of potencies for the pressor response was l-nicotine > or = cytisine > N-methylcarbamylcholine > or = dimethylphenylpiperazinium > d-nicotine. However, cytisine was the most potent in producing the heart rate increase and nociceptive response. Unlike the other agonists, cytisine also exhibited marked desensitization of the three responses upon repeated administration. The effects of nicotine were antagonized in a dose-dependent fashion by mecamylamine, hexamethonium, alpha-lobeline, dihydro-beta-erythroidine and methyllycaconitine. By contrast, cytisine-induced responses were blocked effectively by mecamylamine and methyllycaconitine, but not by alpha-lobeline or dihydro-beta-erythroidine. However, when alpha-lobeline or dihydro-beta-erythroidine antagonism of the pressor response to cytisine was monitored during the initial minute following intrathecal administration, both antagonists significantly inhibited the response. The competitive ganglionic blocker, trimethaphan, or the elapid alpha-toxin, alpha-bungarotoxin, when administered intrathecally, had no effect on nicotine- or cytisine-elicited responses. The cardiovascular responses to intrathecal nicotine and cytisine have two components. The first is likely mediated through direct sympathetic output and desensitizes rapidly to cytisine, the second is coupled indirectly to the nociceptive response and shows a diminished capacity for rapid desensitization. Agonist and antagonist specificities indicate that the spinal nicotinic receptor differs from those in ganglia and those characterized in brain to date. Although antagonist specificity of the blockade of nicotine and cytisine elicited responses differ, this may be due to the unique desensitization capacity of cytisine rather than an action mediated by distinct receptor subtypes.

Aconitine↗

PubMedDate not supplied

Lipomyelomeningocele: a 9-year review.

Fourteen infants and children, 6 males & 8 females, with lipomyelomeningoceles were reviewed from October 1982 to December 1991 at Taichung Veterans General Hospital. The age at diagnosis ranged from 3 days to 5 years. The chief problems included mass on the back, urinary distention, weakness of lower limbs and poor bowel control. The cutaneous lesions over the lumbosacral region were subcutaneous lipoma, dimples and hemangioma. There were several associated anomalies, such as occult spina bifida, syringomyelia, sacrococcygeal dysgenesis, high-types imperforate anus, genitourinary anomalies, congenital heart disease, talipes equinovarus and annular pancreas. Among the 12 cases who were operated on, 8 had preoperative neurological deficits, but there was only little postoperative improvement in 2. It is important to recognize at an early stage the defect underlying skin lesions and its associated anomalies, rather than to be concerned about cosmetic factors. Early surgical repair before the appearance of neurological deficits is recommended.

Child, Preschool↗

PubMed1993

[Intramedullary meningeal melanocytoma].

A primary benign melanotic tumour was resected twice in the thoracic spinal cord of a 49-year-old woman. The patient had complained of low back pains, obstipation and mictional urgency for two years. She developed a partial Brown-Sequard's syndrome at th10-th12 level. The tumour showed the histological and immunohistochemical features of a meningeal melanocytoma. The following up was marked by tumoral seeding in the lumbosacral region and later in the cerebral hemispheres, which lead to death 4 years after the diagnosis. This is a survey of the clinical and morphological characteristics of meningeal melanocytoma and demonstrates the risk of secondary dissemination of this primary benign tumour.

Brain Neoplasms↗

PubMed1993

Intradural recurrence with chondrosarcoma of the spine. A case report and review of the literature.

Known for its resistance to chemotherapy and radiation therapy, chondrosarcoma remains largely a surgically managed tumor predisposed to local recurrence and late distant metastasis. A 42-year-old man with known thoracic chondrosarcoma developed progressive low back pain, lower extremity weakness, and urinary incontinence. Magnetic resonance imaging and computed tomographic myelography demonstrated multiple filling defects throughout the lumbosacral region. Surgical excision of these lesions disclosed intradural, extramedullary drop metastases of the chondrosarcoma. The spread of neoplasms within the dural space is uncommon, accounting for less than 5% of spinal metastases, and has not previously been reported for chondrosarcoma.

Adult↗

PubMed1993

Stability of the lumbar spine and method of instrumentation.

We have carried out a biomechanical study to investigate the effect on flexion, extension, and rotation of seven systems of fixation on five cadaveric lumbar spines. Pedicle fixation proved the most effective method to restrict these movements. Facet screw fixation was also successful. Harrington distraction rods, the Hartshill rectangle and the Luque technique, although restricting slight flexion and extension, exerted little control over rotation. We conclude that pedicular fixation and facet joint fixation provide the greatest overall stability and might, therefore, be the best systems to consider for multilevel fusions in the lumbosacral region.

Adult↗

PubMedDate not supplied

Oxidative and antioxidative activity in the patients with disseminated demyelinating disease of central nervous system.

Considering the basic pathologic process and current knowledge of the physiopathologic mechanisms in the active phase of disseminated demyelinating disease of central nervous system, the increase of oxidative processes was assumed in the patients with that disease in the phase of clinical impairment. The aim of the research was to study some indices of oxidative processes and activity of antioxidative enzymes in such patients. The research was performed on blood samples (erythrocyte hemolysate and plasma) and cerebrospinal fluid of 30 patients with disseminated demyelinating disease of central nervous system during the clinical impairment and during the increase of immunologic activity in intrathecal space. The patients were of younger age, in the acute phase or with the shorter disease duration (up to 3 years). Control group was formed of 12 patients examined for lesions of intervertebral disks in lumbosacral region. The research results demonstrated the increase of superoxide anion production, the elevation of lipid peroxidation followed by the increase of superoxide dismutase and glutathione reductase activation. It was concluded that the signs of simultaneous increase of oxidative processes and antioxidative activity, but also the oxidative impairment of lipid structures existed in the studied patients during the acute phase.

Adult↗

PubMed1997

The role of transitional vertebrae in spondylolysis and spondylolytic spondylolisthesis.

Transitional lumbar vertebrae include lumbarization and sacralization of the lumbosacral region. This study was performed to evaluate the relationship of transitional vertebra to spondylolytic spondylolisthesis such as the incidence and degree of slippage and to ascertain the clinical relevance for treatment. The study included 182 cases with 33 cases (18.1%) of transitional vertebra, 12 cases of lumbarization, and 21 cases of sacralization. The remaining 149 cases constituted the control group. The degree of the anterior slippage of the vertebral body was measured by Meyerding's grading and the percentage of the anterior slippage was measured by Taillard's method. In the patients with lumbarization and the isthmic defects in the fourth lumbar spine, the average slip of L4 was 14.5%. While patients with sacralization and the isthmic defects in L4, the average slip of L4 was 19.3%. The average slip of L4 was 11.4% in the control group. In patients with lumbarization and the isthmic defects in the fifth lumbar vertebra, the average slip of L5 was 12.5%. While in patients with sacralization and the isthmic defects in L5, the average slip of the L5 vertebra was 9.5%. The average slip of L5 was 16.2% in the control group. The patients with sacralization and the isthmic defects in L4 showed more anterior slippage than the patients with the isthmic defect in L4 without transitional vertebrae. The patients with sacralization and the isthmic defects in L5 showed less anterior slippage than the patients with isthmic defects in L5 without transitional vertebrae. From this it can be concluded that more aggressive treatment is recommended in the patients with sacralization and isthmic defects in L4, whereas more conservative treatment is recommended in the patients with sacralization and the isthmic defects in L5.

Adult↗

PubMed1998

[Method of resection and spondylocorporoplasty of lumbar and sacral vertebrates in experiments].

For a considerable reduction of injuries caused by resection and spondylodesis of the lumbosacral region of the spine, the authors have developed a procedure of conservation of vascular extravertebra and neural nets by employing 10 cadavers. With this the transabdominal approach is used to form an aperture in SI and partially LV corpus vertebralis, by removing all pathological substances of the healthy spongious substance of the bone. The formed cavity is filled by two autografts, bone bits, antibiotics and hemostatic sponge. The two autografts are formed as a cross and their ends are clung to the edge of the entrance aperture of the bone. Stitches are placed to the periosteum and the strata of the abdominal wall.

Adult↗

PubMed1998

[An increased risk of spinal injury in high performance gymnasts during pubertal growth?].

Elite womens gymnastics has generally been described to induce vertebral overload injuries, especially in the pubertal growth phase. This paper describes the results of a 4-year prospective longitudinal and transversal investigation of German elite womens gymnasts with respect to the spine. The main results are: 1) Pathological changes are detectable by clinical investigation before X-ray abnormalities can be found. 2) A sensitive test is the spine springing test. 3) Functional abnormalities can be detected especially in the lumbosacral region. 4) There were no spondylolyses. 5) Osteochondrotic lesions are frequent. They are concentrated in the dorsolumbar region.

Adolescent↗

PubMed1997

[Bilithiasis (cholenephrolithiasis)].

The study covers 232 patients with chronic calculous cholecystitis, operated in the Surgical Clinic of the Military Hospital--Plovdiv over the period 1991 through August 1995. Bilithiasis (cholenephrolithiasis) is diagnosed in 26 cases (11.2 per cent). This is a condition running a clinical course characterized by pain in the right subcostal and lumbosacral regions, accompanied by nausea and vomit in 57.7 per cent. Eighteen patient sustain renal crisis. Palpatorily, pain is established in the right subcostal region, and positive succussio renalis--in twelve patients. In nine patients there is evidence of albuminuria and leukocyturia (34.6 per cent). In 26 cases the echographic study reveals presence of concretions in the gallbladder, and in all of them-renal calculi too (left kidney--9, right kidney--9, and bilaterally--8 patients). Intraoperatively, concretions in the gallbladder are found in all patients, with hydrops and empyema of the gallbladder documented in five, and vesicoduodenal fistula in one (23 per cent), whereas in the patients free of urolithiasis they amount to 10.8 per cent which points to a reciprocal aggravation of the two pathological conditions. The early, as well as the long-term results of the operative management applied are estimated as very good.

Adult↗

PubMed1998

Case of the month: June 1998--2 year old boy with lumbosacral mass.

We report the case of a boy aged 2 years with spina bifida and a lipomyelomeningocele which contained ectopic immature renal tissue. He presented with a swelling over the lumbosacral region, incontinence, and bilateral leg weakness. Histopathologic examination revealed adipose tissue in which a focus of fibrous tissue contained neuroglial elements, striated muscle fibres and clusters of glomeruloid structures surrounded by immature tubules. The differential diagnosis of teratoma and lipomyelomeningocele with nephrogenic rests is discussed with reference to possible pathogenesis.

Child, Preschool↗

PubMed1950