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A 7-year-old boy was sitting in the back seat of a car wearing a lap seatbelt when the car was involved in a head-on collision with another vehicle. Radiographs revealed mild scoliosis, anterior column compression of L3 and enlargement of both the intervertebral foramen and interspinous distance between L2 and L3. Computed tomography revealed bilateral L2-L3 facet joint disruption with fracture of the L2 spinous process. Magnetic resonance imaging revealed rupture of the posterior ligamentous complex. An open reduction and posterior fusion with autologous bone graft using 5-mm-wide ultra-high molecular weight polyethylene tape sublaminar wiring was performed. Three months after surgery, bony fusion of L2-L3 was observed. At 6 months after surgery, the patient was asymptomatic and had resumed previous activities. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The pathogenesis of ossification of the posterior longitudinal ligaments (OPLL) has not been clarified. We here report dizygotic twin sisters with OPLL of the cervical spine and propose a new pathogenesis of OPLL. This is the first report of dizygotic twins with OPLL. The twins suffered from schizophrenia, which might be related to the pathogenesis of OPLL. In addition, we investigated the occurrence of OPLL in 30 patients with schizophrenia who had been admitted to a mental hospital. OPLL of the cervical spine was found in six (20%) of them, with an incidence almost five times higher than the incidence of OPLL among the general population in Japan. Schizophrenia may have a increased susceptibility to OPLL. [ABSTRACT FROM AUTHOR]

Objectives: Nucleoside reverse transcriptase inhibitors (NRTIs) used in HIV antiretroviral therapy can inhibit human telomerase reverse transcriptase. We therefore investigated whether in utero or childhood exposure to NRTIs affects leukocyte telomere length (LTL), a marker of cellular aging. Methods: In this cross-sectional CARMA cohort study, we investigated factors associated with LTL in HIV -1-infected (HIV+) children (n = 94), HIV-1-exposed uninfected (HEU) children who were exposed to antiretroviral therapy (ART) perinatally (n = 177), and HIV-unexposed uninfected (HIV2) control children (n = 104) aged 0-19 years. Univariate followed by multivariate linear regression models were used to examine relationships of explanatory variables with LTL for: a) all subjects, b) HIV+/HEU children only, and c) HIV+ children only. Results: After adjusting for age and gender, there was no difference in LTL between the 3 groups, when considering children of all ages together. In multivariate models, older age and male gender were associated with shorter LTL. For the HIV+ group alone, having a detectable HIV viral load was also strongly associated with shorter LTL (p = 0.007). Conclusions: In this large study, group rates of LTL attrition were similar for HIV+, HEU and HIV2 children. No associations between children's LTL and their perinatal ART exposure or HIV status were seen in linear regression models. However, the association between having a detectable HIV viral load and shorter LTL suggests that uncontrolled HIV viremia rather than duration of ART exposure may be associated with acceleration of blood telomere attrition. [ABSTRACT FROM AUTHOR]

A 49-year-old woman presented with severe swelling and pain of the left little finger, which had exacerbated rapidly, in October 2006. The patient had a history of hepatocellular carcinoma and metastatic lung cancer. She had undergone partial hepatectomy for the hepatocellular carcinoma in September 2001 and pulmonary resection for metastatic lung cancer in November 2005. Roentgenogram of the hand on admission showed complete destruction of the distal phalanx of the left little finger. The final pathological result of the tissue obtained by disarticulation was an extrahepatic metastasis of hepatocellular carcinoma. Extrahepatic metastasis from primary hepatocellular carcinoma to the hand is very rare and only four cases have been reported in the literature. All the patients with extrahepatic metastases from the primary hepatocellular carcinoma to the hand had poor prognoses, but the patient presented in this article exhibited an unusual clinical course. The patient is still alive 1 year after the diagnosis of extrahepatic bone metastasis of the distal phalanx. [ABSTRACT FROM AUTHOR]

Study Design: A case report of dorsally sequestered cervical disc herniation. Objective: To present an unusual case of dorsally sequestered cervical disc herniation and to briefly review the literature on this condition. Summary Of Background Data: There have been few reports of migration of cervical disc herniation to the posterior surface of the spinal canal. Methods: A 72-year-old man experienced a sudden episode of weakness of both lower extremities after playing golf, which gradually progressed, resulting in inability to walk without aid. Magnetic resonance imaging revealed a well-defined, oval mass lesion on the left dorsal aspect of the spinal canal, which compressed the dural sac at the level of C7. The mass lesion was isointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images, and contrast-enhanced magnetic resonance imaging demonstrated peripheral enhancement of the mass lesion. Results: The patient underwent surgery consisting of decompressive laminoplasty of C6 to C7, partial laminectomy of T1, and removal of the mass lesion. Histologically, the mass lesion was diagnosed as a dorsally sequestered disc herniation. After surgery, the weakness of both lower extremities gradually resolved, and the patient was able to walk without assistance at 2 weeks after surgery. Conclusion: It is important to appropriately differentiate dorsally sequestered disc herniation from other epidural mass lesions such as extradural tumor before operation and essential to perform early and sufficient surgical decompression of the spinal cord to prevent poor postoperative course in cases of acute onset and rapid progression of the paralysis caused by disc herniation. [ABSTRACT FROM AUTHOR]