Left Horn Research Articles

Ventricles of brain: A morphometric study by computerized tomography

Introduction: As the human brain ages, characteristic structural changes occur that are considered to be normal and are expected. Thus the thorough knowledge of the age related normal changes that occur in the brain is required before any abnormal findings are analyzed. As ageing advances, the brain undergoes many gross and histopathological changes with regression of the brain tissue leading to the enlargement of the ventricles. To understand these changes the knowledge of normal morphometry and size of normal ventricular system of brain is important. Materials & Methods: For the present study 358 (Males - 207 and Females - 151) individuals Computerized Tomography (CT) images of brain studied. Measurements of fourth ventricle, third ventricle and lateral ventricle were noted down from CT images and it was statistically analyzed. Results: After analysis it was observed that the height and width of the fourth ventricle was larger in males as compared to females. The length of the third ventricle was observed to be greater in females than in males. The width of the third ventricle it was observed to be greater in males than in females. Antero-posterior extent of the left frontal horn (males = 26.26 ± 2.94, 95% CI 25.86 - 26.66 mm and females = 26.53 ± 3.38, 95% CI 25.99 - 27.08 mm) was greater than that of the right ones (males = 25.00 ± 3.18, 95% CI 24.57 - 25.44 mm and females = 25.34 ± 3.50, 95% CI 24.78 - 25.90 mm). Conclusion: Advances in sensitive imaging techniques like the Computerized Tomography helps in dramatic expansion of our understanding of the normal structure of brain. The present study has defined the morphometric measurements of the lateral ventricles, third ventricle, and fourth ventricle of the brain which has clinical correlations in diagnosis and for further line of treatment.

Upper terminal of the inferior vena cava and development of the heart atriums: a study using human embryos.

In the embryonic heart, the primitive atrium is considered to receive the bilateral sinus horns including the upper terminal of the inferior vena cava (IVC). To reveal topographical anatomy of the embryonic venous pole of the heart, we examined horizontal serial paraffin sections of 15 human embryos with crown-rump length 9-31 mm, corresponding to a gestational age of 6-7 weeks or Carnegie stage 14-16. The IVC was often fixed to the developing right pulmonary vein by a mesentery-like fibrous tissue. Rather than the terminal portion of the future superior vena cava, the IVC contributed to form a right-sided atrial lumen at the stage. The sinus venosus or its left horn communicated with the IVC in earlier specimens, but in later specimens, the left atrium extended caudally to separate the sinus and IVC. In contrast, the right atrium consistently extended far caudally, even below the sinus horn, along the IVC. A small (or large) attachment between the left (or right) atrium and IVC in adult hearts seemed to be derived from the left (or right) sinus valve. This hypothesis did not contradict with the incorporation theory of the sinus valves into the atrial wall. Variations in topographical anatomy around the IVC, especially of the sinus valves, might not always depend on the stages but partly in individual differences.

Initial Presentation Of Multiple Myeloma As Intraparenchymal Brain Mass

Case presentation38 year old African female presented with complaints of severe headache which had started couple of weeks prior to presentation and was progressively becoming worse. Patient underwent a CT scan of the head which revealed a 3.2 X 3.3 X 3.7 cm lobulated hyperdense periventricular mass in the left temporoparietal area with surrounding vasogenic edema with mass effect on the adjacent left lateral ventricle and 0.6 cm midline shift to the right with uncal herniation and effacement of left cerebral peduncle with dilatation of left temporal horn. MRI of the brain revealed a 3.1 X 2.6 X 3.6 cm lobulated mass in left lateral ventricle trigone. Radiologically, differential diagnoses included intraventricular meningioma, lymphoma, choroid plexus papilloma or metastasis. Patient underwent left craniotomy for tumor resection. Patient had an uneventful post-operative recovery and the resected tumor was high grade malignant neoplasm with plasmablastic features and immunohistochemical stains revealed that the tumor cells were positive for CD138, CD30, MUM-1, Bcl-2, vimentin and lambda light chains and were negative for kappa light chains, CD3, CD20, PAX-5, CD79a, GFAP, cytokeratin, AE1/AE3, synaptophysin, chromogranin, EMA, S-100, Melan-A, CD45, CD56 and EBV(EBER-ISH). Ki-67 was about 80%. Serum protein electrophoresis (SPEP) was sent that showed an M-spike of 3.3 g/dl that was IgG lambda. A bone marrow biopsy showed 100 % infiltration with plasma cells. Patient underwent a CT chest/abdomen/pelvis and a PET/CT scan which revealed multiple scattered subcutaneous masses throughout the body and an asymptomatic mass near spinal cord at C1. Patient was treated with VTD-PACE regimen (bortezomib, thalidomide, decadron, cisplatin, liposomal doxorubicin, cyclophosphamide, and etoposide). She received two cycles of VTD-PACE chemotherapy regimen with excellent response to the treatment. Her M-spike protein which prior to treatment was 3.3 g/dl disappeared after second cycle of chemotherapy and her subcutaneous lesion also dramatically improved on repeat PET/CT scan. The C1 dural lesion also had significant improvement after the chemotherapy. Her IgG also decreased from 5070 mg/dl to 791 mg/dl. She was referred for autologus stem cell transplant. She was subsequently started on weekly cyclophosphamide, bortezomib and decadron. DiscussionMalignancies of plasma cells comprise 1% of malignant neoplasms which includes multiple myeloma, solitary plasmacytomas (including solitary bone plasmacytoma and extramedullary plasmacytomas) and immunoglobulin deposition syndromes. Central nervous system (CNS) involvement of multiple myeloma itself is not a common entity. Fassas et al. published data of 18 cases over a course of 10 years. Gozzetti et al. published their data of 50 patients in 2012. Of these 50 patients, 76% had osteo-dural or primary dural multiple myeloma (OD-DMM) and 24% had central nervous system myelomatosis. They found that patients treated with novel agents had better outcome than patients treated with conventional drugs. Cases with initial presentation of intracranial plasmacytomas are even rarer. Patients with CNS myeloma have poor prognosis with median survival being around 4- 5 months. Our patient had excellent response with two cycles of VTD-PACE regimen with negative M-spike, normalization of IgG and decrease in size of subcutaneous nodules and C1 spinal lesion. She has survived for 5 months without autologus transplant and is currently on weekly cyclophosphamide, bortezomib and decadron. Disclosures:No relevant conflicts of interest to declare.

Abstract 543: Local Uterine Ang-(1-7) Infusion Augments Expression of Cannabinoid Receptors and Differentially Alters Endocannabinoid Metabolizing Enzymes in the Decidualized Uterus of Pseudopregnant Rats

Endocannabinoids (ECs) are important contributors to implantation and decidualization and are suppressed in early pregnancy. Elevated levels of anandamine (AEA), the endogenous ligand for the CB 1 and CB 2 receptor (R), interfere with receptivity of the blastocyst. Ang-(1-7) is present in the decidualized zones of the implantation site (IS) at early pregnancy and is down-regulated in the IS in normal pregnancy. We determined the effects of intra-uterine Ang-(1-7) on the EC system in the decidualized uterus. Ovariectomized rats were sensitized for the decidual cell reaction by steroid treatment. Decidualization was induced by infusion of phosphate buffered saline into the left horn (infused); the right horn was non-infused. Ang-(1-7) (24 μg/kg/hr) or vehicle was given into one of the two uterine horns. CB 1 R mRNA was reduced by decidualization but increased in the presence of Ang-(1-7) . CB 2 R mRNA was increased by decidualization and by Ang-(1-7) ( Figure). The enzyme metabolizing AEA, fatty acid amide hydrolase (FAAH), was reduced by decidualization (1.0 ± 0.07 vs. 0.13 ± 0.03 U, p<0.01) and remained reduced by Ang-(1-7), whereas the enzyme metabolizing 2-arachidonylglycerol, monoacyl glycerol lipase (MAGL), was unchanged by decidualization (1.06 ± 0.11 vs. 1.34 ± 0.13 U, ns) and increased by Ang-(1-7) (1.32 ± 0.19 vs. 2.27 ± 0.23 U, p<0.01). These findings report for the first time that Ang-(1-7) augments the expression of CB 1 R, CB 2 R and MAGL in the decidualized uterus. The effects of Ang-(1-7) to disrupt regulation of the EC system may interfere with the early events of decidualization, including alterations in angiogenesis, apoptosis, permeability, and receptivity.

Virtual Autopsy in Hanging

The aim of the study was to compare postmortem computed tomographic (CT) imaging findings from a case of hanging with the autopsy findings. The CT showed a good match with autopsy findings especially for bone, soft tissue, and spinal injuries. The CT images of the injuries of the neck obtained by CT scan clearly showed the ligature mark, the hemorrhagic suffusion in the soft tissue (thickening of derma) and in the muscles (sternocleidomastoid) of the neck. Furthermore, CT 3-dimensional reconstruction showed brain edema, fracture of the left posterior horn of the hyoid bone, and a grade 1 retrolisthesis of C5 on C6. This last finding was not detected by autopsy because of the anterior approach that is frequently used in necropsy technique. Nevertheless, the CT virtual autopsy did not show vascular findings (like Amussat mark) because a barium mixture was not injected in the body.

Elements of functional genital asymmetry in the cow

Asymmetry in the cow affects ovarian function and pregnancy. In this work we studied ovarian and uterine asymmetry. Synchronised animals, in which in vitro-produced embryos (n=30-60) had been transferred on Day 5 to the uterine horn ipsilateral to the corpus luteum (CL), were flushed on Day 8. Ovulatory follicle diameter, oestrus response and total protein flushed did not differ between sides. However, a corpus luteum in the right ovary led to plasma progesterone concentrations that were higher than when it was present in the left ovary. Fewer embryos were recovered from the left than the right horn. Among 60 uterine proteins identified by difference gel electrophoresis, relative abundance of nine (acyl-CoA dehydrogenase, very long chain; twinfilin, actin-binding protein, homologue 1; enolase 1; pyruvate kinase isozymes M1/M2 (rabbit); complement factor B Bb fragment ; albumin; fibrinogen gamma-B chain; and ezrin differed (P<0.05) between horns. Glucose concentration was higher, and fructose concentration lower, in the left horn. In a subsequent field trial, pregnancy rates after embryo transfer did not differ between horns (51.0±3.6, right vs 53.2±4.7, left). However, Day 7 blood progesterone concentrations differed (P=0.018) between pregnant and open animals in the left (15.9±1.7 vs 8.3±1.2) but not in the right horn (12.4±1.3 vs 12.4±1.2). Progesterone effects were independent of CL quality (P=0.55). Bilateral genital tract asymmetry in the cow affects progesterone, proteins and hexoses without altering pregnancy rates.

Ventricular Enlargement and its Clinical Correlates in the Imaging Cohort From the ADCS MCI Donepezil/Vitamin E Study

We analyzed the baseline and 3-year T1-weighted magnetic resonance imaging data of 110 amnestic mild cognitive impairment (MCI) participants with minimal hippocampal atrophy at baseline from the Alzheimer's Disease Cooperative Study group MCI Donepezil/Vitamin E trial. Forty-six subjects converted to Alzheimer disease (AD) (MCIc), whereas 64 remained stable (MCInc). We used the radial distance technique to examine the differences in lateral ventricle shape and size between MCIc and MCInc and the associations between ventricular enlargement and cognitive decline. MCIc group had significantly larger frontal and right body/occipital horns relative to MCInc at baseline and significantly larger bilateral frontal, body/occipital, and left temporal horns at follow-up. Global cognitive decline measured with AD Assessment scale cognitive subscale and Mini-Mental State Examination and decline in activities of daily living (ADL) were associated with posterior lateral ventricle enlargement. Decline in AD Assessment scale cognitive subscale and ADL were associated with left temporal and decline in Mini-Mental State Examination with right temporal horn enlargement. After correction for baseline hippocampal volume, decline in ADL showed a significant association with right frontal horn enlargement. Executive decline was associated with right frontal and left temporal horn enlargement.

An Unusual Case of Cervical Diverticulum Identified by Presence of 3 Cavities at Diagnostic Hysteroscopy

Herein is presented the case report of a patient who had severe dysmenorrhea since menarche, known right unicornuate uterus with a left rudimentary horn, and recurrent hematometra. Previous hysteroscopic drainage of the hematometra temporarily alleviated the symptoms. At subsequent hysteroscopy, 3 cavities were identified, 2 corresponding to the uterine horns and the other to a cervical diverticulum. Hysteroscopic metroplasty with drainage of the rudimentary horn hematometra provided long-term relief of the symptoms. The diagnosis was verified at diagnostic laparoscopy.

Oestrogen, Progesterone and Oxytocin Receptors and COX‐2 Expression in Endometrial Biopsy Samples from the Induction of Ovulation to Luteolysis in Llamas (Lama glama)

Endometrial expression of oestrogen (ERα), progesterone (PR) and oxytocin receptor (OR) and cyclooxygenase-2 (COX-2) was evaluated from the induction of ovulation to luteolysis in llamas. Ovarian activity was daily assessed by ultrasonography in five females. Ovulation was induced immediately after the detection of an ovulatory follicle by a GnRH injection (Day 0). Endometrial samples were obtained by transcervical biopsies from the left and right horns on day 0 and days 4, 8, 10 and 12 post-GnRH. Blood samples were collected daily for progesterone and estradiol-17β determinations by RIA. An immunohistochemical technique was used to study receptors population and COX-2 expression which were then evaluated by two independent observers. The expression of ERα and PR was highest on day 0 in the luminal epithelium and stroma in association with high plasma estradiol-17β concentrations. Thereafter, a decrease in ERα population was registered on day 4 and a new increase of its expression was observed between days 8 and 12 in those cell types. Conversely, PR population was gradually down-regulated until its lowest expression was reached on day 10 post-GnRH in the luminal epithelium. Content of OR was similar throughout the study in all cell types. The expression of COX-2 was highest from day 8 to 12 post-GnRH in the luminal epithelium, in relation to the time of maximal PGF2α release. Both steroid receptors populations and COX-2 expression were similar between horns. Meanwhile, OR expression was higher in the right than in the left uterine horn. In summary, this study showed that the loss of endometrium sensitivity to progesterone by days 8-10 post-induction of ovulation and the concomitant increase of COX-2 expression could play a key role in the mechanism of luteolysis and somehow be related to the short corpus luteum lifespan of llamas.

The aromatase inhibitor letrozole reduces adhesion formation after intraperitoneal surgery in a rat uterine horn model

To investigate, in an experimental animal study, the effects of letrozole and tamoxifen in the reduction of adhesion formation following abdominopelvic surgery. Thirty female Wistar albino rats were included and divided into three groups. One group received 500 μg/d tamoxifen and a second group received 1 mg/kg/d letrozole through an enteric tube. A third group did not receive any drugs and served as the control group. On the fifth day, a laparotomy was performed and the right uterine horn was injured by monopolar cautery. The left uterine horn was incised with a scalpel and sutured. The preventive therapy protocols were continued for 7 days after surgery. On the 14th day after first surgery the animals were sacrificed, and the intraperitoneal macroscopic adhesion formation and microscopic adhesion features were evaluated. The Kruskal-Wallis test was used to compare the scores of the macroscopic adhesion scores and histologic features among the three groups, followed by a post hoc Mann-Whitney test. The total histological score was analyzed with a one-way ANOVA, followed by post hoc Bonferroni correction tests. p values ≤0.05 were considered statistically significant. The level of significance was set at p≤0.016 for the post hoc tests. The letrozole and tamoxifen groups had significantly lower adhesion scores for the right uterine horn than the control group (p=0.005 and p=0.013, respectively). For the left horn, however, only the letrozole group had a lower macroscopic adhesion score than the controls (p=0.011). The total histological score was significantly lower in the letrozole group than in the control group (p=0.014), but no differences were found between the tamoxifen group and the control group (p=0.954). Inflammation, fibroblastic activity, collagen formation and vascular proliferation were significantly lower in the letrozole group compared with the control group (p<0.05). The foreign body reactions were similar among the three groups (p>0.05). Tamoxifen administration did not result in any significant effects on the histological scores (p>0.05). Letrozole resulted in a significant decrease in postoperative macroscopic adhesion formation and the total histological scores, but tamoxifen did not demonstrate a similar effect on the histological scores.

Chronology of early embryonic development and embryo uterine migration in alpacas

The objectives were to: (1) describe the chronology of early embryonic development from ovulation to entry into the uterus; and (2) to determine the timing of embryo migration to the left uterine horn when ovulation occurred from the right ovary. The experiment was conducted in Peru. Females (n = 132) were randomly assigned to 15 experimental groups. All females were mated to an intact male, given 50 μg GnRH im (Cystorelin) and ovulation time determined by transrectal ultrasonography, conducted every 6 hours, starting 24 hours postmating. Animals were slaughtered at a specific intervals postovulation and reproductive tracts were recovered and subjected to oviductal and uterine flushing for females slaughtered between 1 and 6 days postovulation (dpo; Day 0 = ovulation) and uterine flushing for females slaughtered from 7 to 15 dpo for recovery of oocytes/embryos. Season of mating did not influence the interval from mating to ovulation (winter: 29 ± 6 hours vs. summer: 30 ± 6 hours; P = 0.49). Ovulation rates for females mated during winter and summer were 92% versus 100%, respectively (P = 0.05). Fertilization rates for winter and summer mated females were 72% and 82% (P = 0.29). Unfertilized ova were not retained in the uterine tube. All embryos collected were in the uterine tube ipsilateral to the side of ovulation between 1 and 5 dpo. Embryos reached the uterus on 6 dpo. Embryos began to elongate on 9 dpo; at this time, 83% of embryos derived from right-ovary ovulations were collected from the left uterine horn. Embryos occupied the entire uterine cavity by 10 dpo. In conclusion, we characterized early embryo development and location of embryo during its early developmental stages in alpaca. This was apparently the first report regarding chronology of embryo development and migration to the left horn in alpaca which merits further investigation regarding its role in maternal recognition of pregnancy.

Ventricular Pneumocephalus with Meningitis after Lumbar Nerve Root Block

Lumbar nerve root block is a common modality used in the management of radiculopathy. Its complications are rare and usually minor. Despite its low morbidity, significant acute events can occur. Pneumocephalus is an accumulation of air in the intracranial space. It indicates a violation of the dura or the presence of infection. The object of this report is to describe the case of a patient with intraventricular pneumocephalus and bacterial meningitis after lumbar nerve root block. A 70-year-old female was brought into emergency department with severe headache and vomiting which developed during her sleep. She had received lumbar nerve block for her radiculopathy one day before her presentation. Cranial computed tomography scan revealed a few hypodense lesions in her left lateral ventricle frontal horn and basal cistern indicating ventricular pneumocephalus. Five hours later, she developed sudden hearing loss. Cerebrospinal fluid analysis showed bacterial meningitis, and she was treated with high dose steroid and antibiotics. However, her impaired hearing as a sequela from meningitis was persistent, and she is still in follow-up. Intracranial complications of lumbar nerve root block including meningitis and pneumocephalus can occur and should be considered as high-risk conditions that require prompt intervention.

Neuroblastoma with a Solitary Intraventricular Brain Metastasis Visualized on I‐123 MIBG Scan

Although metastatic skull lesions of neuroblastoma are not uncommon, brain involvement is infrequent and prompt diagnosis is of utmost importance in such cases. Previous studies have shown that Meta-Iodo-Benzyl-Guanidine (MIBG) scans were not always reliable in detecting central nervous system metastases, however most published reports referred to the Iodine-131 ((131)I)-MIBG scans. Herein, we report an intraventricular metastasis of neuroblastoma diagnosed using an Iodine-123 ((123)I)-MIBG scan, which is increasingly being used in clinical practice and reported as a more accurate method for detecting metastatic lesions. An unusual case of metastatic neuroblastoma to the left lateral ventricle of the brain is presented. Planar (123)I-MIBG scintigraphy showed faint tracer activity close to the midline without asymmetric extensions or abnormal activity in the skull bones. A subsequent brain MR scan revealed an enhancing mass within the left frontal horn consistent with a metastatic lesion. The patient underwent tumor resection with pathology showing neuroblastoma. Our case shows that (123) I-MIBG scintigraphy can be useful in detecting intraventricular brain metastases of neuroblastoma. Although the (123)I-MIBG scintigraphy has been reported to have a significantly superior sensitivity in monitoring asymptomatic patients with neuroblastoma compared with (131)I-MIBG scans, bone marrow histology, bone scan, CT, and urinary catecholamine levels, further studies may be necessary to evaluate its sensitivity in detecting brain lesions.

111 FUNCTIONAL AND MOLECULAR GENITAL ASYMMETRY IN THE COW

Bilateral asymmetry in the cow affects ovarian function, uterine horn morphology, pregnancy, and embryonic sex. However, many aspects and molecular mechanisms of such laterality remain obscure. The objective of this work was identifying new traits of ovarian and uterine asymmetry, as based on oestrus and ovarian monitoring, P4 concentrations, early embryo development, flushing performance, and pregnancy outcomes after embryo transfer (ET). In addition, proteins identified in previous work by difference gel electrophoresis and mass spectrometry (DIGE-MS) in uterine fluid (UF) were reanalyzed in a horn-of-origin basis (n = 16 and n = 14 flushes from left and right horns, respectively; Muñoz et al. 2012 J. Proteome Res. 11, 751–766; Gómez et al. 2011 Reprod. Fert. Dev. 24, 152). Studies were performed in experimental herd and on field. Data were analyzed by Proc GLM of SAS/STAT (Version 9.2; SAS Inst. Inc., Cary, NC) and REGWQ test for means. In experimental herd, we analyzed ovarian and uterine asymmetry within animals (n = 25) monitored through different reproductive cycles (n = 109). Animals synchronised with progestagen + PGF2α were alternatively transferred with IVP embryos (n = 30–60) or vehicle (sham transfer) on Day 5 to ipsilateral horn. On Day 8, embryos and/or diluted UF were recovered by flushing with 30 or 45 mL PBS. Nonsignificant differences (P &gt; 0.7) were obtained in ovulatory follicle diameters 48 h after PGF2α injection, onset oestrus time and recoverable total protein by flushing between animals ovulating in the left or in the right ovary. However, cows bearing the corpus luteum (CL) in the right ovary (i.e. right) had higher (26.3 ± 1.5) Day 8 P4 concentration than those showing a CL in the left ovary (i.e. left) (21.6 ± 1.8) (P = 0.03). Fluid recovery (%) was lower in the left (47.0 ± 6.3) than in the right (64.4 ± 5.0) horn when 30 mL were infused (P = 0.035); in contrast, 45 mL infused did not differ between horns (61.6 ± 4.1 v. 67.9 ± 4.1). Less total embryos were recovered from the left (14.6 ± 4.7) than the right (31.0 ± 3.7) horn (P &lt; 0.02), although the relative proportions of viable embryos were conserved. Among 76 proteins analyzed, concentrations of VLCAD, KPYM, CFB, ALB, FGG, EZR, and ACTB were higher (P ≤ 0.05), while TWF1 and ENO1 were lower in the left horn. On field experiments (n = 184 ET in 286 synchronised animals from 39 farms; ≥3 ET per farm) confirmed on Day 7 the above differences in P4 (right: 8.3 ± 0.43 v. left: 6.1 ± 0.55; P = 0.0058). Pregnancy rates after ET did not differ between horns (51.0 ± 3.6, right v. 53.2 ± 4.7, left). However, P4 concentrations differ (P = 0.018) between pregnant and open animals in the left (15.9 ± 1.7 v. 8.3 ± 1.2) but not in the right horn (12.4 ± 1.3 v. 12.4 ± 1.2), respectively. Genital asymmetry in the cow has physical concerns (flushing and recoveries), while changes in P4 and/or proteins could operate to hold similar pregnancy rates between horns. Project AGL2009-10059 (MICINN). MM, BT and EC are sponsored by RYC08-03454, Cajastur and FPU2009-5265, respectively.

Contrast-Enhanced Ultrasound Ventriculography

During external ventricular drainage (EVD) weaning, cranial computed tomography (cCT) is necessary to evaluate ventricle width. Because intrahospital transfer of critically ill patients is associated with higher mortality, bedside techniques are necessary to evaluate ventricle width. Transcranial sonography is able to show the ventricles in patients with sufficient temporal acoustic window. Contrast-enhanced ultrasound (CEUS) is able to overcome the limitations of insufficient insonation. We demonstrate the feasibility of bedside transcranial CEUS ventriculography to measure ventricles and verify the passage of cerebrospinal fluid (CSF) through the foramen of Magendie into the subarachnoid space during EVD weaning in critically ill patients. Six patients were examined by transcranial and transnuchal CEUS. Harmonic imaging with low mechanical index was used. One milliliter of an ultrasound contrast agent was administered via EVD line. Comparison with the cCT scans at the time of discharge was used to confirm CEUS-ventriculography results. Ventricles were visualized in all patients. CSF transmission via the foramen of Magendie was demonstrated in 5 patients. Mean ventricle width (centimeters) was 0.67 (CEUS) vs 0.73 (cCT) (standard deviation 0.43, 0.45, P = .116) [third ventricle], 0.88 vs 1.02 (0.28, 0.22, P = .055) [fourth ventricle], 1.40 vs 1.37 (0.56, 0.54, P = .620) [left lateral ventricle], 1.37 vs 1.37 (0.55, 0.54, P = .952) [right lateral ventricle], 2.33 vs 2.23 (0.51, 0.58, P = .169) [left anterior horn], and 2.25 vs 2.07 (0.56, 0.64, P = .204) [right anterior horn]. Mean duration for CEUS ventriculography was 3:15 minutes. CEUS ventriculography is an effective bedside procedure in critically ill patients with EVD. CEUS allows measurement of ventricle width, ventricle communication, and CSF transfer to the subarachnoidal space through the cisternal foramina.

7T MRI of spinal cord injury

A man with 25 years of mild left neck, arm, and leg paresthesias had initial MRI in 1996 identifying a left C3-4 dorsal horn cavernous hemangioma. In 1997, hemorrhage (C3-7) and resection induced left arm > leg proprioceptive loss and clumsiness. Three months after surgical resection, left upper-body pain recurred; 2 years later, disabling colocalizing itch recurred.(1) In 2012, ultra-high-resolution 7T MRI (figure) localized hemosiderin to specific dorsal horn laminae and detected rostral (C1-3) hypersignal invisible on conventional MRIs, most likely representing Wallerian degeneration.(2) These new imaging findings demonstrate the benefit of high-field spinal cord MRI and generate the hypothesis that his late-onset central itch might be related to delayed white matter degeneration.

Effects of electrical stimulation of sciatic nerve on synaptic plasticity of spinal dorsal horn, hippocampal CA1 region and spinal c-fos, hippocampal CA1 region expression in neonatal rats

To explore the response to nociceptive stimuli in spinal cord of neonatal rat and observe the electrical stimulation of sciatic nerve on synaptic plasticity of spinal dorsal horn, hippocampal CA1 region and spinal c-fos, hippocampal CA1 region expression in neonatal rats. The rats were divided into neonatal and adult groups. The evoked potentials of left spinal dorsal horn from T13-L1 and right hippocampal CA1 region were recorded. After conditional electric stimulations, the potential amplitudes were recorded. When the incubation period reached 120 min, D-AP5 was added to spinal cord of rats and resulting changes in field potential and c-fos expression were recorded. Long-term potentiation (LTP) in neonatal rats was mainly evoked by A-type nerve fibers whereas LTP in adult rats was mainly evoked by C-type nerve fibers. C-fos expression was significantly increased in superficial, deep layers of spinal dorsal horn, ventral horn and hippocampal CA1 region in neonatal rats. Pain signals change with age.

MULLERIAN DUCT ANOMALIES;

Background: Müllerian duct anomalies (MDAs) occur with an incidence estimated to be 4.3%. A unicornuate uterus with orwithout a rudimentary horn; is a type of mullerian duct abnormality with a frequency of 0.4%. Rudimentary horn pregnancies are rare obstetriccomplication and may cause difficulty in diagnosis and subsequent management. Objective: To alert about Mullerian duct abnormalitiesespecially unicornuate uterus with or without rudimentary horn. Design: Case series. Setting: Study was conducted in the department ofGynecology and obstetrics unit1, Allied Hospital Faisalabad. Duration of study: Cases detected during September 2006-0ctober 2011.Subjects and methods: All admitted cases of MDA whether obstetric or gynecological were included. We calculated cases of unicornuateUterus with or without rudimentary horn, also included cases of rudimentary horn pregnancy with or without rupture. Results: There were120cases of MDA out of which 8 (6.6%) were of unicornuate uterus. Out of 8 unicornuate uteri, 7/8 (87.5%) were with rudimentary horn and1/8(12.5%) without rudimentary horn. Left rudimentary horn in 4/8 patient (50%), right in 3/8 (37.5%) without horn1/8 (12.5%).Out of 7 rudimentaryhorn 1/7 gynecologic and 6/7 were obstetric, 5/7 (71.42%) ruptured in second trimester, and1/7 (14.28%) term pregnancy. In 1/7 (14.28%) hornnot removed because tubal ligation was done. Unilateral renal agenesis was present in 3/8 patient (37.5 %). Ovaries were preserved in 3/7patients (66%). Conclusions: There must be high index of suspicion for Mullerian duct abnormalities especially rudimentary horn for achievinggood success in diagnosis and management.

An unusual skin lesion derived from postmortem ecchymoses in a donor skin graft site

A 42-year-old female patient was found dead hanging in a shower room in a psychiatric hospital. The woman had suffered from a persecutory type of paranoid disorder over a long period. Six weeks prior to death, she attempted suicide by injecting gasoline into the cubital vein of her left arm. Clinical records showed that a skin graft, which was taken from the left femoral region, was transplanted to the left antecubital fossa, replacing the necrotic skin adjacent to the site where the gasoline was injected. According to the inquest records and police investigations, the body had been suspended for at least 7 h before it was discovered. Medico-legal autopsy, which was commenced 2.5 days after death, revealed early putrification of the corpse, which measured 161 cm and weighed 71.5 kg. Non-blanchable livor mortis with numerous postmortem ecchymoses involved most of the skin of the legs. The external examination of the body showed signs of her previous medical treatment, which was performed in the hospital when she had injected gasoline, in the form of a linear scar (29 cm in length) on the anterior side of the left upper to forearm and a triangular scar (5 9 4.5 cm) in the left antecubital fossa. Autopsy revealed the cause of death to be hanging, which was evidenced by the following findings: ligature mark measuring 1.5 cm in width around the neck; hemorrhage at the periosteal origin of the right sternocleidomastoid muscle; fracture of the left upper horn of the thyroid cartilage; hemorrhages under the anterior longitudinal ligament of the lumbar vertebral column (‘‘Simon’s bleedings’’). However, the most notable finding was a rectangular (8 9 4 cm) dark purple, bruise-like skin lesion surrounded by dense postmortem ecchymoses on the anterior side of the left thigh (Fig. 1). Histopathology of this lesion showed subepidermal blistering and interstitial extravasation of erythrocytes in the dermis, but without any surrounding inflammatory cellular response or thrombosis (Fig. 2).

Two cases of desmoplastic non⁃infantile astrocytoma with review of the literature

Objective To investigate clinical pathological characteristics, diagnosis and differentiation of desmoplastic non ⁃ infantile astrocytoma (DNIA). Methods & Results Two female patients with DNIA aged 5 and 10 years old, respectively. The patient of case 1 had repeated unconsciousness with limbs twitch, MR image showed a mass in the inner part of the left temporal horn, the tumor was located in the underside of cortex of temporal lobe, about 3.00 cm × 3.50 cm × 3.50 cm in size with yellow in color and medium blood supply, the boundaries of the tumor were fairly clear and the mass was completely dissected. The patient of case 2 had recurrent headache with vomiting, MR image showed a large cystic solid mass in the right frontal temporal lobe⁃lateral ventricle. The tumor was located at 1 cm under the subcortex and drew off yellow cyst fluid about 80 ml. The tumor was about 11.00 cm × 10.00 cm × 10.00 cm in size with yellow in color and brittle texture and abundant blood supply, adhesion to the brain tissue and was completely dissected. Histology showed obvious interstitial fibrosis associated with neoplastic astrocytes with primary neuroepithelium. Immunohistochemical staining indicated that the expression of both tumor cells was positive for vimentin, GFAP, S⁃100, Nestin, and negative for CK, EMA, NeuN, the expression of primary cells was positive for Syn; Ki ⁃ 67 labeling index was 6% and 10% , respectively. Histochemical staining showed that the tumor cells were surrounded by reticular fibers. Patients were followed up for 18 and 52 months, respectively, both had no recurrence and metastasis. Conclusion DNIA is a rare supratentorial neuroepithelial tumor. The prognosis is generally good. It needs to be differentiated from other tumors, especially malignant glioma. DOI：10.3969/j.issn.1672⁃6731.2012.03.015