Spinal Spot Sign.

INTRODUCTION A marker predictive of hematoma expansion in the central nervous system could aid the selection of patients for hemostatic or surgical treatment. CASE REPORT Here, we present a 83-year-old patient with acute spinal subdural hematoma with paraparesis progressing to paraplegia. A contrast extravasation within the intraspinal hematoma was visualized on spinal MR indicating active bleeding (spinal spot sign). A second acquisition of contrast-enhanced MR images showed progression of contrast extravasation helping to different active bleeding from spinal arteriovenous malformations/fistula. CONCLUSIONS A "spinal spot sign" may be important for treatment decisions, notably in patients with incomplete neurological deficits at the time of imaging.

EACTS expert consensus statement for surgical management of pleural empyema

Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce hospital costs, morbidity and mortality. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research. The European Association for Cardio-Thoracic Surgery (EACTS) Thoracic Domain and the EACTS Pleural Diseases Working Group established a team of thoracic surgeons to produce a comprehensive review of available scientific evidence with the aim to cover all aspects of surgical practice related to its treatment, in particular focusing on: surgical treatment of empyema in adults; surgical treatment of empyema in children; and surgical treatment of post-pneumonectomy empyema (PPE). In the management of Stage 1 empyema, prompt pleural space chest tube drainage is required. In patients with Stage 2 or 3 empyema who are fit enough to undergo an operative procedure, there is a demonstrated benefit of surgical debridement or decortication [possibly by video-assisted thoracoscopic surgery (VATS)] over tube thoracostomy alone in terms of treatment success and reduction in hospital stay. In children, a primary operative approach is an effective management strategy, associated with a lower mortality rate and a reduction of tube thoracostomy duration, length of antibiotic therapy, reintervention rate and hospital stay. Intrapleural fibrinolytic therapy is a reasonable alternative to primary operative management. Uncomplicated PPE [without bronchopleural fistula (BPF)] can be effectively managed with minimally invasive techniques, including fenestration, pleural space irrigation and VATS debridement. PPE associated with BPF can be effectively managed with individualized open surgical techniques, including direct repair, myoplastic and thoracoplastic techniques. Intrathoracic vacuum-assisted closure may be considered as an adjunct to the standard treatment. The current literature cements the role of VATS in the management of pleural empyema, even if the choice of surgical approach relies on the individual surgeon's preference.

Urinary tract endometriosis in patients with deep infiltrating endometriosis: prevalence, symptoms, management, and proposal for a new clinical classification

OBJECTIVE To analyze the prevalence of urinary tract endometriosis (UTE) in patients with deep infiltrating endometriosis (DIE) and to define potential criteria for preoperative workup. DESIGN Retrospective study. SETTING University hospital. PATIENT(S) Six hundred ninety-seven patients with endometriosis. INTERVENTION(S) Excision of all endometriotic lesions. MAIN OUTCOME MEASURE(S) Correlation of preoperative features and intraoperative findings in patients with UTE. RESULT(S) Out of 213 patients presenting DIE, 52.6% suffered from UTE. In patients with ureteral endometriosis, symptoms were not specific. Among the patients with bladder endometriosis, 68.8% complained of urinary symptoms compared to 7.9% in the group of patients without UTE. In patients with rectovaginal endometriosis, the probability of ureterolysis showed a linear correlation with the size of the nodule. We found that 3 cm in diameter provided a specific cutoff value for the likelihood of ureteric involvement. CONCLUSION(S) The prevalence of UTE has often been underestimated. Preoperative questioning is important in the search for bladder endometriosis. The size of the nodule is one of the few reliable criteria in preoperative assessment that can suggest ureteric involvement. We propose a classification of ureteral endometriosis that will allow the standardization of terminology and help to compare the outcome of different surgical treatment in randomized studies.

Radiolarian biostratigraphy in the central Indian Ocean

Identifiable radiolarians of stratigraphic importance were recovered at eight of the sites drilled on Leg 115. The assemblages range in age from Holocene to middle Eocene (Dictyoprora mongolfieri Zone, about 48 Ma). Faunal preservation is particularly good in two stratigraphic intervals: the Holocene through upper Miocene (0-9 Ma), and the lowermost Oligocene to middle Eocene (35-48 Ma). Fluctuating rates of silica accumulation at these drill sites during the Cenozoic reflect changing tectonic and paleoceanographic conditions. In particular, the gradual closure of the Indonesian and Tethyan seaways and the northward migration of the Indian subcontinent severely restricted zonal circulation and silica accumulation in tropical latitudes during the late Oligocene through middle Miocene. By the late Miocene the Indian subcontinent had moved sufficiently north of the equator to allow trans-Indian zonal circulation patterns to become reestablished, and biosiliceous sedimentation resumed. The composition of the radiolarian assemblages in the tropical Indian Ocean is closely comparable with that of the 'stratotype' sequences in the equatorial Pacific. However, there are some notable exceptions in Indian Ocean assemblages: (1) the scarcity of the genera Pterocanium and Spongaster in the Neogene; (2) the absence of the stratigraphically important Podocyrtis lineage, P. diamesa -> P. phyxis -> P. ampla, in the middle Eocene; and (3) the scarcity of taxa of the genus Dorcadospyris, with the exception of D. ateuchus. The succession of radiolarian events was tabulated for those stratigraphic intervals where the assemblages were well preserved. We identified 55 events in the middle Eocene to earliest Oligocene, and 31 events in the late Miocene to Holocene. The succession of events is closely comparable with that of the tropical Pacific. However, there are exceptions that appear to be real, rather than artifacts of sample preservation, mixing, and core disturbance.

Radiolarians from the Southwest Pacific

Radiolarians are very rare in all Leg 90 sites. They are relatively more frequent only in Neogene sediments from Sites 586 and 594, and in Eocene sediments at Site 592. In this chapter radiolarian abundances are recorded as comparative percentages for 92 Neogene morphotypes at Site 586B. Relative abundances only are estimated at Sites 592 and 594, where preservation is poor to moderate. A tentative correlation of radiolarian events at Hole 586B and Site 594 shows that only a few species can be found in both tropical and subantarctic areas. New evolutionary lineages are proposed. 1. Middle Miocene eucyrtids like Eucyrtidium teuscheri group evolved into a widespread species (E. teuscheri teuscheri) ranging from middle Miocene to Holocene and a temperate species (E. teuscheri orthoporus) ranging from middle Miocene to early Pleistocene. 2. Phormostichoartus pitomorphus appears to be a temperate descendant of the cosmopolitan P. fistula and disappears in early Pleistocene time. 3. The discovery of Lamprocyrtis daniellae n.sp. calls into question the lineage L. heteroporos -> L. nigriniae. 4. The evolution of Lamprocyclas maritalis from an ancestor group (L. aff. maritalis) is located in the early part of the Pterocanium prismatium Zone.

Radiolarian biostratigraphy in sediments of ODP Site 202-1237

Site 1237 is located on Nazca Ridge ~140 km off the coast of Peru and thus within the offshore region of the Peru-Chile Current. A total of 83 samples were used to provide an initial radiolarian biostratigraphic framework for Site 1237; radiolarians are present to Sample 202-1237B-19H-2, 58-60 cm (186.45 meters composite depth [mcd]) and are of good to fair abundance and preservation. Site 1237 is influenced by both subtropical and northward-transported southern latitude waters, has 55 ash layers within the uppermost 166 m, and has minimal to gross reworking. Shipboard paleomagnetic results showed that the upper 200 m spanned the last 12 m.y., and in the upper 100 mcd, the paleomagnetic inclination pattern could be directly correlated to the geomagnetic polarity timescale (GPTS). Tropical biostratigraphy was used to establish the zonal boundaries for Site 1237, and the paleomagnetic and radiolarian stratigraphy were well correlated.

Relative abundances of selected radiolarian species in sediments of ODP Leg 199 sites

During Ocean Drilling Program (ODP) Leg 199, sediments were recovered from eight sites in the Central Pacific. Late Oligocene and early Miocene radiolarians are common to abundant and moderately well preserved in Cores 199-1218A-8H through 11H and 199-1219A-5H through 9H. More than 110 radiolarian species were encountered during this study. Of these species, 100 are identifiable forms and the rest are undescribed or unfamiliar forms. This report presents the relative abundances of described forms from the upper Oligocene to lower Miocene sediments.