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Day: June 16, 2018

[Merkel cell carcinoma of the vulva – case report and the literature review].

By London Spine
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[Merkel cell carcinoma of the vulva – case report and the literature review].

Ginekol Pol. 2013 May;84(5):385-9

Authors: Jońska-Gmyrek J, Bobkiewicz P, Gmyrek L, Zółciak-Siwińska A, Lindner B, Staniaszek J

Abstract
UNLABELLED: Merkel cell carcinoma (MCC) is a rare malignant neoplasm, mostly affecting the skin (97% of cases). It is usually found in elderly people, in the sun-exposed areas of the skin. About 50-60% of MCC cases are located on the head and the neck, less often on the extremities and the torso, and extremely rarely in the genital area. Ultraviolet radiation may be the main factor responsible for the development of the tumors but viral etiology is also debated. Due to extremely rare incidence of MCC in the area of the vulva, proper management remains a challenging task.
AIM: To present a case of an aggressive MCC of the vulva and a review of the literature.
MATERIAL AND METHODS: A previously healthy 72-year-old patient presented at the Oncology Center of the Maria Sklodowska-Curie Institute, Warsaw, in June 2010. Four months previously the patient noticed a painless lump in the vestibular region of the vagina. She received anti-inflammatory treatment at her local gynecological clinic, with no success. In February the patient underwent removal of the vulvar tumor Histopathological examination confirmed anaplastic carcinoma. Microscopic evaluation revealed the tumor diameter to be 15mm. Surgical margins were free of neoplastic infiltration. The patient did not receive adjuvant therapy due to the results from the histopathological protocol. The disease recurred after three months. Radical vulvectomy and bilateral inguinal femoral lymphadenectomy were performed in May 2010. Histopathological examination confirmed microcellular carcinoma with no metastases to the lymph nodes and complete resection of the tumor (RO). The disease recurred in the next two months: a 50-mm tumor was found in the right inguinal lymph nodes. The decision to verify all histopathological material obtained during all procedures performed so far was made. Immunohistochemical evaluation confirmed MCC. Adjuvant radiotherapy was recommended. The area of the vulva, pelvic and inguinal lymph nodes were irradiated. One month after therapy completion the patient complained of pain in the lumbar area. An ultrasound examination of the abdomen revealed a tumor (9 cm in diameter) in the para-aortic region but it was not histopathologically verified due to extremely poor overall condition of the patient. As the condition of the woman deteriorated systematically the patient was referred to a hospice facility where she died 9 months since the primary diagnosis.
CONCLUSIONS: MCC of the vulva is a rare neoplasm with an aggressive course. Clinical and histopathological diagnostic difficulties and consequently lack of standardized management, result in low survival rates.

PMID: 23819406 [PubMed – in process]

Endplate calcification and cervical intervertebral disc degeneration: the role of endplate marrow contact channel occlusion.

By London Spine

Endplate calcification and cervical intervertebral disc degeneration: the role of endplate marrow contact channel occlusion.

Folia Morphol (Warsz). 2015;74(1):84-92

Authors: Tomaszewski KA, Adamek D, Konopka T, Tomaszewska R, Walocha JA

Abstract
BACKGROUND: The aim of this study was to determine the fundamental relationships between cervical intervertebral disc (IVD) degeneration, endplate calcification, and the patency of endplate marrow contact channels (MCC).
MATERIALS AND METHODS: Sixty cervical IVDs were excised from 30 human cadavers. After sectioning the specimens underwent micro computed tomography (microCT) – from all images the number, calibre, diameter and distribution of endplate openings were measured using ImageJ. Next, the specimens were scored for macroscopic degeneration (Thompson’s classification), and subsequently underwent histological analysis for both IVD and endplate degeneration (Boos’s classification) and calcification.
RESULTS: The study group comprised 30 female and 30 male IVDs (mean age ± SD: 51.4 ± 19.5). Specimen’s age, macroscopic and microscopic degeneration correlated negatively with the number of MCCs (r = -0.33-(-0.95); p < 0.0001), apart from the MCCs > 300 μm in diameter (r = 0.66-0.79; p < 0.0001). The negative relationship was strongest for the MCCs 10-50 μm in diameter.
CONCLUSIONS: There is a strong negative correlation between the number of endplate MCCs, and both macroscopic and microscopic cervical IVD and endplate degeneration. This could further support the thesis that endplate calcification, through the occlusion of MCCs, leads to a fall in nutrient transport to the IVD, and subsequently causes its degeneration.

PMID: 25792401 [PubMed – in process]

Multiple sites for generation of ectopic spontaneous activity in neurons of the chronically compressed dorsal root ganglion.

By London Spine

Multiple sites for generation of ectopic spontaneous activity in neurons of the chronically compressed dorsal root ganglion.

J Neurosci. 2007 Dec 19;27(51):14059-68

Authors: Ma C, LaMotte RH

In a chronically compressed dorsal root ganglion (CCD) in the rat, a model of foraminal stenosis and radicular pain in human, a subpopulation of neurons with functional axons exhibits spontaneous activity (SA) that originates within the ganglion. Intracellular electrophysiological recordings were obtained from the somata of neurons of the compressed ganglion both in vitro and in vivo. The SA was classified into two types according to the presence (type I) or absence (type II) of subthreshold membrane potential oscillation. Neurons with type I SA had significantly higher somal excitability than those with type II SA. In most cases, depolarization of the membrane potential by current injection increased the discharge rates of type I–but not type II SA. Both types occasionally coexisted in the same neuron. Several lines of evidence suggested that the origin of SA in the DRG was most likely the soma for type I SA and the axon for type II. Therefore CCD neurons have multiple sites for generation of action potentials other than the terminal endings. In vivo recordings revealed the same two types of SA in a subpopulation of neurons with functionally characterized peripheral receptive fields. Thus, SA might not only produce spurious sensory input to the afferent pathways but also add to or block impulse transmission generated by natural stimulation of peripheral receptors. SA originating in the compressed ganglion is likely to interfere with sensory transmission in nociceptive and non-nociceptive neurons, thereby contributing to radicular pain, paresthesias, hyperalgesia and allodynia.

PMID: 18094245 [PubMed – indexed for MEDLINE]

Chronic Whiplash Associated Disorders (WAD): Responses to Nerve Blocks of Cervical Zygapophyseal Joints.

By London Spine
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Chronic Whiplash Associated Disorders (WAD): Responses to Nerve Blocks of Cervical Zygapophyseal Joints.

Pain Med. 2016 Dec;17(12):2162-2175

Authors: Persson M, Sörensen J, Gerdle B

Abstract
OBJECTIVE: This study explores the prevalence of facet joint pain in chronic Whiplash Associated Disorder (WAD).
DESIGN: Forty-seven patients with chronic WAD were scheduled for medial branch blocks of the cervical spine.
METHODS: The patient’s localization of the pain together with established pain maps guided to the first level of zygapophyseal joint to be tested. The joint was anesthetized by injecting bupivacaine (0.5 ml; 5 mg/ml) to the medial branches of the cervical dorsal rami above and below the joint. If a positive response was noted, the schedule continued with a double-blinded sequence with a placebo (saline) and bupivacaine. If a negative response was noted, other joint levels were anesthetized until all joints from C2 to C7 were tested. The responses were assessed using a visual analog scale (VAS) in a predefined protocol.The study was carried through with a definition of a positive response to a diagnostic block as a VAS decrease ≥50% compared with baseline during a minimum of 3 hours after the block. All other responses were regarded as negative. The data were also analyzed using a definition of a positive response as a VAS decrease ≥80%, and figures from this analysis are presented as the main result of the study.
RESULTS: The study yielded 29% true positive responders, 60% non-responders, and 11% placebo responders.
CONCLUSIONS: A substantial amount of patients with chronic WAD have their persistent pain emanating from cervical zygapophyseal joints.

PMID: 28025352 [PubMed – indexed for MEDLINE]