This case report draws attention to the upper sympathetic trunk lesion as a complication of video-assisted thoracic spine surgery. A 39-year-old man developed an upper sympathetic trunk lesion after ...right-sided thoracoscopic fracture stabilization of T5 and T6. Dizziness and reduced perspiration persisted at the most recent follow-up 8 months after surgery. This rare complication can be overlooked and remain undiagnosed. Diagnosis is based on clinical symptoms and neurologic examination. There are no treatment options. Symptoms can be bothersome for the patient and may persist. In the upper thoracic spine, the course of the sympathetic trunk lies in close proximity of the vertebral bodies; thus, care must be taken to avoid it when resecting the posterior parts of the vertebral body.
The pathophysiology of HE has not yet been clarified. At present the main mechanisms under discussion are the combined effects of different toxins, such as ammonia, mercaptans, phenols and short- and ...medium-chain fatty acids, as well as a change particularly in GABAergic and glutamatergic neurotransmission. In this chapter the current views on the importance of these individual factors in the pathophysiology of HE are discussed; possible connections between changes in neurotransmission and the effect of different neurotoxins are presented. In addition, possible therapies resulting from recent knowledge of the pathophysiology of this disease are discussed, such as the use of Bz receptor antagonists.
Recent studies suggest a role of cutaneous human papillomaviruses (HPV) in non-melanoma skin cancer (NMSC) development. In this study viral DNA loads of six frequent HPV types were determined by ...quantitative, type-specific real-time-PCR (Q-PCR) in actinic keratoses (AK, n=26), NMSC (n=31), perilesional tissue (n=22), and metastases of squamous cell carcinomas (SCC) (n=8) which were previously shown to be positive for HPV5, 8, 15, 20, 24, or 36. HPV-DNA loads in AK, (partially microdissected) NMSC, and perilesional skin ranged between one HPV-DNA copy per 0.02 and 14,200 cell equivalents (median: 1 HPV-DNA copy per 344 cell equivalents; n=48). In 32 of the 79 HPV-positive skin biopsies and in seven of the eight metastases viral loads were even below the detection limit of Q-PCR. Low viral loads in NMSC were confirmed by in situ-hybridization showing only a few HPV-DNA-positive nuclei per section. Viral loads in SCC, basal cell carcinomas, and perilesional tissue were similar. But, viral loads found in AK were significantly higher than in SCC (p=0.035). Our data suggest that persistence of HPV is not necessary for the maintenance of the malignant phenotype of individual NMSC cells. Although a passenger state cannot be excluded, the data are compatible with a carcinogenic role of HPV in early steps of tumor development.
In light of evidence that the prosodic prominence of objects facilitates acquisition of the head + complement order of English vs the opposite order in German, the rhythmic activation principle of ...Marina Nespor et al (1996) predicts target-consistent (1) placement & (2) prosody of German objects from the beginning of the two-word stage. These predictions are tested by examining longitudinal corpora of German transitive infinitive constructions in normally developing & language-impaired children (N = 3 & 4, respectively); although results confirm (1), a clear discrepancy between word order & prosody is found in all Ss, as (2) is unequivocally noncanonical & is accompanied by noncanonical prosody in noun compounds in a subset of the corpora (N = 5). It is suggested that the interaction of the underlying trochaic prominence pattern with stress shift rules creates input opacity that delays access to a full prosodic representation, forcing a resort to radically underspecified representation under the learnability maxim "avoid irreversible wrong decisions." 13 Tables, 2 Figures, 40 References. J. Hitchcock
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