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Meningiomas combined with meningioangiomatosis (MA-M) present similarly to more invasive lesions because of their appearance on neuroimaging. These lesions are especially rare in pediatric patients and suggestive imaging can help identify... more
Meningiomas combined with meningioangiomatosis (MA-M) present similarly to more invasive lesions because of their appearance on neuroimaging. These lesions are especially rare in pediatric patients and suggestive imaging can help identify them for differential diagnosis. An 11-year-old male child who presented with diplopia and a headache was found to have an edematous invasive appearing temporal lobe mass on magnetic resonance imaging. Despite the lesion’s appearance, it was completely resected and found to be a benign MA-M upon histopathologic examination. The present case demonstrated a rare meningioma with meningioangiomatosis that appeared to be a higher grade or invasive lesion upon initial imaging in a pediatric patient. A review of the literature was performed on patients who presented similarly. Despite the rarity of this condition in children, neuroimaging should be carefully examined prior to surgical resection of similar masses in preparation for highly vascular tissue, ...
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Osteochondroma is described as a capped benign bony neoplasm that forms on the outer surface of bone. These tumors affect nearly 6 million people per year. While osteochondromas most often involve the appendicular skeleton, a significant... more
Osteochondroma is described as a capped benign bony neoplasm that forms on the outer surface of bone. These tumors affect nearly 6 million people per year. While osteochondromas most often involve the appendicular skeleton, a significant portion involve the spine with many cases located in the cervical spine. When osteochondromas involve the spine, they can present with a variety of symptoms including pain, radiculopathy and myelopathy which may necessitate surgical treatment. Spinal osteochondromas can be classified into two types: multiple osteochondromas in the context of patients with multiple hereditary exostosis (MHE), and solitary osteochondromas or solitary exostosis (SE). Previous reviews have only captured portions of the available literature on cervical osteochondromas and generally focus on either SE or those associated with MHE. The purpose of our review was to provide an extensive review of all previously reported cervical osteochondromas and to compare osteochondroma characteristics, clinical presentation and outcomes in the context of MHE and SE.
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The management of spine tumors is multimodal and personalized to each individual patient. Patients often require radiation therapy after surgical fixation. While titanium implants are used most commonly, they produce significant artifact,... more
The management of spine tumors is multimodal and personalized to each individual patient. Patients often require radiation therapy after surgical fixation. While titanium implants are used most commonly, they produce significant artifact, leading to decreased confidence in target-volume coverage and normal tissue sparing. Carbon-based materials have been found to have minimal effects on dose-perturbation in postoperative radiation therapy while demonstrating biostability and biocompatibility that is comparable to titanium implants. We conducted a systematic review on carbon-based screw and rod fixation systems in the treatment of spinal tumors utilizing Pubmed and Web of Sciences databases. We reviewed clinical studies with regards to safety of spine fixation with carbon fiber reinforced (CFR) implants, biomechanical studies, as well as radiation and dosimetric studies. The radiolucency of CFR-PEEK implants has potential to benefit spine tumor patients. Clinical studies have demonstrated no increase in complications with implementation of CFR-PEEK implants, and these devices appear to have sufficient stiffness and pullout strength. However, further trials will be necessary in order to determine if there is a clinically significant impact on local tumor control.
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Spontaneous spinal subdural hematomas (SSDHs) are rarely encountered in clinical practice. In this paper, we report a case of a 70-year-old female who presented to the Emergency Department with symptoms of mid-epigastric pain radiating to... more
Spontaneous spinal subdural hematomas (SSDHs) are rarely encountered in clinical practice. In this paper, we report a case of a 70-year-old female who presented to the Emergency Department with symptoms of mid-epigastric pain radiating to her mid-scapular region. Her workup demonstrated mildly elevated cardiac troponin I levels and electrocardiogram (ECG) leads V3-V5 ST-depressions. She was subsequently treated through the non-ST elevation myocardial infarction (NSTEMI) protocol and given an antiplatelet agent. The next morning, she developed bilateral lower extremity paresthesias, progressive left lower extremity weakness, and urinary retention. Magnetic resonance imaging (MRI) of the spine demonstrated a hematoma in the thoracic region resulting in spinal cord compression. The patient underwent surgical decompression. After the decompression of the thoracic spinal cord, the patient’s neurological symptoms gradually improved and she regained lower extremity function. This report br...
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OBJECTIVE Glioblastoma multiforme is a primary brain malignancy with significant morbidity and mortality. The current standard of treatment for GBM is surgery followed by radiotherapy and Temozolomide. Despite an established treatment... more
OBJECTIVE Glioblastoma multiforme is a primary brain malignancy with significant morbidity and mortality. The current standard of treatment for GBM is surgery followed by radiotherapy and Temozolomide. Despite an established treatment protocol, there exists heterogeneity in outcomes due to patients not receiving all treatments. We analyzed patients in different healthcare models to investigate this heterogeneity. METHODS A retrospective analysis was performed at 2 hospitals in San Bernardino County, California for patients with newly diagnosed GBM from 2004 to 2019. Patients less than 18 years of age, history of low-grade glioma, undergone prior treatment, and those lost to follow up were excluded. RESULTS 57 patients were included in our study. Chemotherapy was started at 41 ± 30 and 77 ± 68 days in the HMO and county model, respectively (p = 0.050); radiation therapy was started at 46 ± 34 and 85 ± 76 days in the HMO and county models, respectively (p = 0.036). In individuals who underwent both chemotherapy and XRT, the difference in time to XRT was no longer significant (p = 0.060). Recurrence time was 309 ± 263 and 212 ± 180 days in the HMO and county groups, respectively (p = 0.379). The time to death was 412 ± 285 and 343 ± 304 days for HMO and county models, respectively (p = 0.334). CONCLUSION Our study demonstrates a statistically significant difference in time to adjuvant therapies between patients within a county hospital and a managed health care organization. This information has the potential to inform future policies and care coordination for patients within the county model.
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Biomarkers play an increasing role in medicinal biology. They are used for diagnosis, patient management, drug target identification, drug responses, and disease prognosis. We have discovered that calpain-1 and calpain-2 play opposite... more
Biomarkers play an increasing role in medicinal biology. They are used for diagnosis, patient management, drug target identification, drug responses, and disease prognosis. We have discovered that calpain-1 and calpain-2 play opposite functions in neurodegeneration, with calpain-1 activation being neuroprotective, while prolonged calpain-2 activation is neurodegenerative. This notion has been validated in several mouse models of acute neuronal injury, in particular in mouse models of traumatic brain injury (TBI) and repeated concussions. We have identified a selective substrate of calpain-2, the tyrosine phosphatase, PTPN13, which is cleaved in brain following TBI. One of the fragments generated by calpain-2, referred to as P13BP, is also found in the blood after TBI both in mice and humans. In humans, P13BP blood levels are significantly correlated with the severity of TBI, as measured by GCS scores and loss of consciousness. The results indicate that P13BP represents a novel blood biomarker for TBI.
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Background:Subgaleal hematoma (SGH) is generally documented within the neonatal period and is rarely reported as a result of trauma or hair braiding in children. While rare, complications of SGH can result in ophthalmoplegia, proptosis,... more
Background:Subgaleal hematoma (SGH) is generally documented within the neonatal period and is rarely reported as a result of trauma or hair braiding in children. While rare, complications of SGH can result in ophthalmoplegia, proptosis, visual deficit, and corneal ulceration secondary to hematoma extension into the orbit. Although conservative treatment is preferential, expanding SGH should be aspirated to reduce complications associated with further expansion.Case Description:A 12-year-old African-American female with no recent history of trauma presented with a chief complaint of headache along with a 2-day history of enlarging 2–3 cm ballotable bilateral frontal mass. Hematological workup was negative. The patient’s family confirmed a long history of hair braiding. The patient was initially prescribed a period of observation but returned 1-week later with enlarging SGH, necessitating surgical aspiration.Conclusion:SGH is rare past the neonatal period, but can be found in pediatri...
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Background:Tardive tremor (TT) is an underrecognized manifestation of tardive syndrome (TS). In our experience, TT is a rather common manifestation of TS, especially in a setting of treatment with aripiprazole, and is a frequent cause of... more
Background:Tardive tremor (TT) is an underrecognized manifestation of tardive syndrome (TS). In our experience, TT is a rather common manifestation of TS, especially in a setting of treatment with aripiprazole, and is a frequent cause of referrals for the evaluation of idiopathic Parkinson disease. There are reports of successful treatment of tardive orofacial dyskinesia and dystonia with deep brain stimulation (DBS) using globus pallidus interna (GPi) as the primary target, but the literature on subthalamic nucleus (STN) DBS for tardive dyskinesia (TD) is lacking. To the best of our knowledge, there are no reports on DBS treatment of TT.Case Description:A 75-year-old right-handed female with the medical history of generalized anxiety disorder and major depressive disorder had been treated with thioridazine and citalopram from 1980 till 2010. Around 2008, she developed orolingual dyskinesia. She was started on tetrabenazine in June 2011. She continued to have tremors and developed P...
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Background: Solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is a rare tumor which originates from the walls of capillaries and has historically been thought to be able to occur anywhere in the body that blood vessels are found. It... more
Background: Solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is a rare tumor which originates from the walls of capillaries and has historically been thought to be able to occur anywhere in the body that blood vessels are found. It is rarely found in the sellar region. Case Description: InS this report, we present the first case of this tumor occurring in the sellar region of a pediatric patient. This 12-year-old male presented with progressive vision loss which prompted surgical resection after a sellar lesion was discovered on imaging. The initial transsphenoidal approach resulted in subtotal resection and the patient experienced reoccurrence within 3 months. He underwent an orbitozygomatic craniotomy to achieve gross total tumor resection. Conclusion: We conducted a literature review of intracranial SFT/HPC in the pediatric population and found it to be an extremely rare occurrence, with <30 cases reported. The incidence of SFT/HPC occurring in the sellar region for any a...
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Context Opioids may be prescribed for the short-term management of acute-onset back pain in the setting of trauma or for long-term management of chronic back pain. More than 50% of regular opioid users report taking them for back pain.... more
Context Opioids may be prescribed for the short-term management of acute-onset back pain in the setting of trauma or for long-term management of chronic back pain. More than 50% of regular opioid users report taking them for back pain. Objective To investigate whether surgical intervention reduces opioid requirements by patients taking opioids for back pain and whether there is a difference between county and managed care hospitals in this postoperative reduction of opioid requirement. Methods A retrospective medical record review of 118 patients who underwent elective lumbar fusion at 4 hospitals (2 county hospitals and 2 managed care hospitals) was conducted. Opioid requirements before and after surgical intervention and at the 30-day outpatient follow-up were evaluated. Results Forty medical records were included in the study. An overall decrease in opioid use was found in the postoperative follow-up phase after lumbar fusion in both the county and managed care hospitals. This re...
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Introduction: Intracranial hemorrhage (ICH) accounts for significant morbidity and mortality in the United States. Many studies have looked at the benefits of surgical intervention for ICH. Recent results for Minimally Invasive Surgery... more
Introduction: Intracranial hemorrhage (ICH) accounts for significant morbidity and mortality in the United States. Many studies have looked at the benefits of surgical intervention for ICH. Recent results for Minimally Invasive Surgery Plus Recombinant Tissue-type Plasminogen Activator for Intracerebral Hemorrhage-II trials have shown promise for a minimally invasive clot evaluation on improving perihematomal edema. Often rural or busy county medical centers may not have the resources available for immediate operative procedures that are nonemergent. In addition, ICH disproportionally affects the elderly which may not be stable for general anesthetics. This study looks at a minimally invasive bedside approach under conscious sedation for evacuation of ICH. Materials and Methods: Placement of the intraparenchymal hemorrhage drain utilizes bony anatomical landmarks referenced from computed tomography (CT) head to localize the entry point for the trajectory of drain placement. Using th...
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We present a case of a nail gun injury penetrating the right maxillary sinus and frontal lobe with complaints of headache and right eye blindness. After surgical removal and treatment, there were no neurological deficits aside from the... more
We present a case of a nail gun injury penetrating the right maxillary sinus and frontal lobe with complaints of headache and right eye blindness. After surgical removal and treatment, there were no neurological deficits aside from the persistence of right eye blindness that the patient initially presented with. Our report describes the patient’s clinical course, the multidisciplinary medical and surgical management, along with the clinical workup and important mental health considerations for patients presenting with intracranial nail gun injuries.
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The glycemic index is used to compare the extent to which the blood glucose level increases following the consumption of foods containing digestible carbohydrate and is considered to be zero, or not measurable, if the food, such as... more
The glycemic index is used to compare the extent to which the blood glucose level increases following the consumption of foods containing digestible carbohydrate and is considered to be zero, or not measurable, if the food, such as protein, is carbohydrate-free. We have found that after overnight fasting, the consumption of several varieties of meat caused significant increases in blood glucose levels. We consider these possibly to be because of gluconeogenesis from the digested protein. It is a curious feature that in two instances the response was inversely related to the amount of meat consumed, over the range from 26 to 78 g of protein. © 2010 IUBMB IUBMB Life, 62(6): 481–483, 2010