Biomedical subjects

Paul Klimo

Publications and source records attributed to Paul Klimo.

21 records · Page 2Linked to original sources

PubMed2003

Nerve sheath tumors involving the sacrum. Case report and classification scheme.

Nerve sheath tumors that involve the sacrum are rare. Delayed presentation is common because of their slow-growing nature, the permissive surrounding anatomical environment, and nonspecific symptoms. Consequently, these tumors are usually of considerable size at the time of diagnosis. The authors discuss a case of a sacral nerve sheath tumor. They also propose a classification scheme for these tumors based on their location with respect to the sacrum into three types (Types I-III). Type I tumors are confined to the sacrum; Type II originate within the sacrum but then locally metastasize through the anterior and posterior sacral walls into the presacral and subcutaneous spaces, respectively; and Type III are located primarily in the presacral/retroperitoneal area. The overwhelming majority of sacral nerve sheath tumors are schwannomas. Neurofibromas and malignant nerve sheath tumors are exceedingly rare. Regardless of their histological features, the goal of treatment is complete excision. Adjuvant radiotherapy may be used in patients in whom resection was subtotal. Approaches to the sacrum can generally be classified as anterior or posterior. Type I tumors may be resected via a posterior approach alone, Type III may require an anterior approach, and Type II tumors usually require combined anterior-posterior surgery.

Accidents, Traffic↗

PubMed2003

Congenital partial aplasia of the posterior arch of the atlas causing myelopathy: case report and review of the literature.

STUDY DESIGN: A case report of a patient with a congenital anomaly of the posterior arch of the atlas and review of the literature are reported. OBJECTIVE: To describe a unique presentation of cervical myelopathy caused by a mobile isolated bone fragment in an otherwise healthy young male. The description is supplemented by a video showing the repeated trauma the bone fragment caused to the dorsal spinal cord with neck extension. SUMMARY OF BACKGROUND DATA: Congenital anomalies of the posterior arch of C1 are well described and are almost always asymptomatic and found incidentally. Neurologic symptoms, either of a chronic nature or developing acutely following head or neck trauma, have been described in patients with isolated posterior arch tubercles (Types C or D). METHODS: A 17-year-old male developed sensory deficit in his distal lower extremities acutely that progressed over several weeks proximally and into his left upper extremity. He also described a Lhermitte sign, only with extension of his neck and an episode of temporary quadriparesis with a minor fall. Plain radiographs and a computed tomography scan of his neck revealed a congenital deformity of the posterior arch of the atlas. Magnetic resonance imaging showed T1 and T2 signal abnormality within the posterior spinal cord at the level of C1 to C2. RESULTS: The patient underwent flexion and extension movements under fluoroscopy, which showed the posterior tubercle moving anteriorly and compressing the spinal cord every time he extended his neck. The fragment was resected, and, intraoperatively, dense fibrous tissue was found to be bridging the bony defect. After surgery, his sensory deficits almost completely resolved, and he no longer had a Lhermitte phenomenon. CONCLUSION: This case illustrates a symptomatic congenital deformity of the posterior arch of the atlas due to a mobile, isolated fragment. These anomalies are exceedingly rare. To date, only 17 patients, including ours, have been described in the literature as having myelopathy related to an isolated posterior tubercle. Of these, only two patients had documented movement of this tubercle before our report. Recognizing the anomaly is crucial because treatment is relatively simple, produces resolution of symptoms, and prevents major neurologic deficits from occurring after trauma.

Adolescent↗

PubMed2002

Brief chemotherapy and involved-region irradiation for limited-stage diffuse large-cell lymphoma: an 18-year experience from the British Columbia Cancer Agency.

PURPOSE: To evaluate clinical outcome of patients with limited-stage diffuse large-cell lymphoma (DLCL) treated with three cycles of chemotherapy followed by involved-region irradiation (IRRT). PATIENTS AND METHODS: Adults with limited-stage DLCL were treated with brief doxorubicin-containing chemotherapy regimens between 1980 and 1998. IRRT was administered 3 to 4 weeks after the third chemotherapy treatment in a dose equivalent to 30 Gy in 10 fractions. RESULTS: Three hundred and eight patients (median age, 64 years) were included, and 299 experienced complete remission. After a median follow-up of 86 months, 64 patients developed progressive disease, and 104 patients died (43 from lymphoma, three from toxicity, and 58 from other causes). Actuarial overall and progression-free survival (PFS) rates were, respectively, 80% and 81% at 5 years and 63% and 74% at 10 years. For subgroups identified using the Miller modification of the International Prognostic Index (IPI), the overall survival rates at 5 and 10 years were, respectively, 97% and 89% (no factors), 77% and 56% (one or two factors), and 58% and 48% (three or four factors), and the 5-year and 10-year PFS rates were, respectively, 94% and 89% (no factors), 79% and 73% (one or two factors), and 60% and 50% (three or four factors). Men with testicular presentation, had a definitely inferior outcome. CONCLUSION: Long-term outcome with three cycles of doxorubicin-based chemotherapy and IRRT confirms that this is a successful approach for the majority of patients with limited-stage DLCL. Subgroups with worse prognoses can be identified, and these patients should be offered alternative treatment approaches.

Adolescent↗