Solid Variant of Aneurysmal Bone Cyst of Thoracic Spine

Solid Variant of Aneurysmal Bone Cyst of Thoracic Spine SOLID VARIANT OF ANEURYSMAL BONE CYST (S-ABC) OF THORACIC SPINE: A Case Report Abstract Introduction: The solid variant of aneurysmal bone cyst (ABC) has been seen on occasional basis, and till date very few cases involving the spine has been reported. The utmost difficulty is in diagnosing it with X-rays without using biopsy or surgery methods. In this case report, we present a very rare tumor of thoracic spine which was presented to us in an emergency situation and was managed by 360 degree decompression via posterior only approach and stabilization. Case Report: A 16-year-old young boy, presented to us with a sudden onset of weakness in both the lower extremities leading to paraplegia. He also had a history of back and chest pain since a year. Collapse of T5 vertebrae on plain radiograph was observed. The patient was taken to the operating room on emergency basis with an initial plan of a total en-block spondylectomy of T5. However, intraoperatively, histology favored solid-ABC variant rather than spindle cell tumor, Giant Cell Tumor. Thus Initial plan was revised to 360 degree decompression and without resecting body en-block via posterolateral approach. Results: After surgery, there was not only complete resolution of sensory and motor functions but also his chest and back pain was resolved.ÂÂ   The diseased vertebral body was re-constituted with new bone formation and healing was seen at 18 months, postoperatively. Conclusion: This case report concludes that solid ABC should be kept as a differential diagnosis for tumour of spine. Intraoperative frozen sections shall be useful as well. However,early diagnosis and appropriate surgical plays the most important role in successful management of ABC. Keywords: Aneurysmal Bone Cyst, ABC, Osteolytic lesion, Palliative Surgery. INTRODUCTION The solid variant of aneurysmal bone cyst (ABC) is generally very rare to see and accounts for 3.4% to 7.5% of all aneurysmal bone cysts [1]. It is an expansile cystic lesion which can occur in any part of the bone and most often affects individuals in their second decade of life [2,3]. Jaffe and Lichtenstein were the first ones to describe ABC as its own entity in 1942, when they noted a peculiar blood-containing cyst of large size. [4]. Although benign, an ABC can grow rapidly and destruct the bone. Its expansile nature can cause lot of swelling, pain, deformity, disruption of growth plates, pathologic fractures and neurologic symptoms depending on location [2,3]. As many as 69% of primary ABCs demonstrate a characteristic clonal t(16;17) genetic translocationwhich can lead to upregulation of the TRE17/USP6 oncogene [5,6]. However, the diagnosis of ABC is quite difficult without biopsy or surgery. There is a distinct solid variant of ABC which was first described by Sanerkin et al., in 1983 [7]. This solid variant may be easily misdiagnosed as a spindle cell tumor, especially osteosarcoma [1]. ABCs are generally treated with surgery. However, asymptomatic ABCs may also exist which is characterized by clinically insignificant destruction of the bone. In such cases, close monitoring alone of the lesion is sufficient enough. However, the diagnosis must be first confirmed and the lesion should not be increasing in size. In case monitoring alone is selected as the management plan [8]. CASE REPORT A 16-year-old young boy, presented to us with a sudden onset of weakness in both the lower extremities leading to paraplegia. He also had a history of back and chest pain since a year. A good rectal tone without any perineal anesthesia was seen in rectal examination and the post-void residual urine volume was negligible. His premedical history was unremarkable. Laboratory findings were all within normal limits. Plain radiograph revealed collapse of T5 vertebrae in figure 1. CT axial images showed expansile and lyrics lesion in vertebral body, left pedicle and transverse process. T2-weighted Sagittal and axial MRI T2 weighted images of thoracic spine showing hyperintence signals in T5 vertebral body, left pedicle and transverse process with pathological fracture (Figure 2). Attempt to establish preoperative tissue biopsy couldnt be done because of the urgency of decompression. The patient was taken to the operating room on emergency basis with an initial plan of a total en-block spondylectomy of T5. However, intraoperatively, histology favored solid-ABC variant rather than Giant Cell Tumor. Thus Initial plan was revised to palliative surgery with 360 degree decompression and without resecting body en-block via posterolateral approach as shown in figure 3. The vertebral column was reconstructed in a 360ÂÂ ° manner with an expandable titanium cage and pedicle screw fixation (Figure 3). Results After surgery, there was not only complete resolution of sensory and motor functions but also his chest and back pain was resolved.ÂÂ   The diseased vertebral body was re-constituted with new bone formation and healing was seen at 18 months, postoperatively (figure 4). Discussion ABCs are benign, but locally aggressive and highly vascular tumors which has recurrence rates after curettage of equal to or less than 50 % [9]. However, Malghem had reported in his study about the spontaneous healing in three patients [10]. ABCs are found to have a predilection for the lumbar spine in the case series presented by Boriani [11]. Although CT and MRI are preferred diagnostic methods, it may be noted that in the literature, biopsy is the utmost necessary for confirmation, due to similarity of many bone lesions in appearance. Biopsy will show the proliferating round or oval cells, generally mixed with randomly distributed multi-nucleated giant cells, regions of reactive fibroblastic proliferation and region of tumor with the blood filled microcystic component [12]. Depending on the proliferative component, the solid variant of ABC may be histologically misdiagnosed for other benign or malignant tumor-like lesions of the bone [1]. The pathological differential diagnosis should always be kept in mind while thinking of ABC. They include solitary bone cyst, giant cell tumor, hemangioma, osteosarcoma, and chondroblastoma [13]. Treatment of ABC is also very controversial which includes arterial embolization, curettage with or without bone grafting, complete excision, intra-lesional drug injections (steroid and calcitonin) and radiation [14]. However,early diagnosis and appropriate surgical plays the most important role in successful management of ABC [15]. Whether surgical management results in a better outcome and recurrence rate than a more conservative or palliative one (for example, curettage alone) remains controversial and to be seen in future studies. Conclusion This case report concludes that ABC should be kept as a differential diagnosis for tumour of spine. Intraoperative frozen sections shall be useful as well. An effective spinal decompression and stabilization of ABC can be achieved by partial or subtotal excisions. However,early diagnosis and appropriate surgical plays the most important role in successful management of ABC. References Bertoni F, Bacchinin P, Capanna R, Ruggieri P, Biagini R, Ferruxxi A, Bettelli G, Picci P, Campanacci M: Solid variant of aneurysmal bone cyst. Cancer 1993, 71:729-734. Clayer M. Injectable form of calcium sulphate as treatment of aneurysmal bone cysts. ANZ J Surg. 2008 May. 78(5):366-70. Burch S, Hu S, Berven S. Aneurysmal bone cysts of the spine. Neurosurg Clin N Am. 2008 Jan. 19(1):41-7. Jaffe HL, Lichtenstein L. Solitary unicameral bone cyst with emphasis on the roentgen picture, the pathologic appearance and the pathogenesis. Arch Surg. 1942. 44:1004-25. Panoutsakopoulos G, Pandis N, Kyriazoglou I, Gustafson P, Mertens F, Mandahl N. Recurrent t(16;17)(q22;p13) in aneurysmal bone cysts. Genes Chromosomes Cancer. 1999 Nov. 26(3):265-6. Lau AW, Pringle LM, Quick L, Riquelme DN, Ye Y, Oliveira AM, et al. TRE17/ubiquitin-specific protease 6 (USP6) oncogene translocated in aneurysmal bone cyst blocks osteoblastic maturation via an autocrine mechanism involving bone morphogenetic protein dysregulation. J Biol Chem. 2010 Nov 19. 285(47):37111-20. Sanerkin NG, Mott MG, Roylance J: An unusual intraosseous lesion with fibroblastic, osteoclastic, osteoblastic, aneurysmal and fibromyxoid elements: solid variant of aneurysmal bone cyst. Cancer 1983, 51:2278-2286. Tedesco N. Medscape, Aneurysmal Bone Cyst. Available from: http://emedicine.medscape.com/article/1254784-overview#a11. Accessed on 24th January, 2017. Ruiter DJ, Van Rijssel TG, Van Der Velde EA. Aneurysmal bone cysts: a clinicopathological study of 105 cases. Cancer. 1977;39:2231-2239. doi: 10.1002/1097-0142(197705)39:53.0.CO;2-Q. Malghem J, Maldague B, Esselinckx, Noel H, De Nayer P, Vincent A. Spontaneous healing of aneurysmal bone cysts: a report of three cases. J Bone Joint Surg Br. 1989;71B:645-650. Boriani S, De Iure F, Campanacci L, et al. Aneurysmal bone cyst of the mobile spine: report on 41 cases. Spine. 2001;26:27-35. doi: 10.1097/00007632-200101010-00007. Saccomanni R. Aneurysmal bone cyst of spine: a review of literature. Arch Orthop Trauma Surg. 2008;128:1145-1147. doi: 10.1007/s00402-007-0477-6. Hay MC, Paterson D, Taylor TK. Aneurysmal bone cysts of the spine. J Bone Joint Surg Br. 1978;60:406-411. Tsai JC, Dalinka MK, Fallon MD, Zlatkin MB, Kressel HY. Fluid-fluid level: a nonspecific finding in tumors of bone and soft tissue. Radiology. 1990;175(3):779-782. Garg S, Mehta S, Dormans JP. Modern surgical treatment of primary aneurysmal bone cyst of the spine in children and adolescents. J Pediatr Orthop. 2005;25(3):387-392. doi: 10.1097/01.bpo.0000152910.16045.ee. Figures and Legends Figure 1. Radiograph showing collapse of T5 Vertebra (AP and LAT XRAY of thoracic spine showing pathological fracture and collapse of T5) FIGURE 2. CT (Top Left) MRI (Bottom left and Right). Figure 2. Intraoperative AP and Lat X-ray of thoracic spine showing pedicle screw fixation and cage Figure 4. Post-surgery MRI showing new bone formation

The My Lai Massacre Essay -- History Innocent Murder Historical Essays

The My Lai Massacre   Ã‚  Ã‚  Ã‚  Ã‚  On March 16, 1968, in the Quang Ngai region of Vietnam, specifically My Lai, the United States military was involved in an appalling slaughter of approximately 500 Vietnamese civilians. There are numerous arguments as to why this incident even had the capacity to occur. Although some of the arguments seem valid, can one really make excuses for the slaughter of innocent people? The company that was responsible for the My Lai incident was the Charlie Company and throughout the company there were many different accounts of what happened that reprehensible day. Therefore there are a few contradictions about what had occurred, such as what the commanding officers exact instructions for the soldiers were. Even with these contradictions the results are obvious. The question that must be posed is whether these results make the American soldiers involved that day â€Å"guilty†. There is the fact that the environment of the Vietnam War made it very confusing to the s oldiers exactly who the enemy was, as well as providing a pent up frustration due to the inability to even engage in real combat with the enemy. If this is the case though, why did some soldiers with the same frustrations refuse the orders and sit out on the action, why did some cry while firing, and why then did one man go so far as to place himself between the Vietnamese and the firing soldiers? If these men who did not see the sense in killing innocents were right with their actions, then how come the ones who did partake were all found not guilty in court? The questions can keep going back and forth on this issue, but first what happened that day must be examined. Captain Earnest Medina was in charge of giving orders to the Charlie Company and in the early evening of March 15th a meeting was called. CPT Medina told the company that the next morning they would be moving into My Lai and attacking Vietcong forces there. He told them that all the civilians would be at the market or would have already been moved out by the time that the soldiers arrived to carry out their planned attack. He said all that would be left in the village would be the Vietcong of the 48th battalion and Vietcong sympathizers. It was never clear what CPT Medina had said to do in the event of coming across civilians. Medina claimed in court that he had told the GI’s not to kill women and children, to us... ... landing on the president for putting the soldiers out in the jungles of an un-winnable war. In conclusion, there are just too many people and too many things to place blame easily for this disturbing event. So the easy road was taken, just do not let this happen again. The military took time out to think about their training of soldiers. "Commanders sent troops in the Desert storm operation into battle with the words, â€Å"No My Lais—you hear?† (Linder) History is said to be good for one reason- to learn from past mistakes so they will not be repeated, and that is a very good lesson to learn from My Lai and one that all hope was, in fact, learned. Works Cited Chafe, William H. The Unfinished Journey: America Since World War II. New York: Oxford University Press, 1999. Goff, Richard, et al. The Twentieth Century: A Brief Global History. Boston: McGraw-Hill, 1998. Linder, Doug. â€Å"An Introduction to the My Lai Courts Martial.† Famous American Trails: The My Lai Courts Martial, 1970. 15 Nov. 1999 <http://www.law.umkc.edu/ faculty/projects/ftrials/mylai/Myl_intro.html>. Olson, James S., and Randy Roberts. My Lai: A Brief History With Documents. Boston: Bedford, 1998

Quantitative Analysis of Salicylates by Visible Spectroscopy

Introduction: The purpose of this lab was to learn how to use a spectrophotometer to measure the amount of light absorbed by different concentrations of salicylic acid, compare those concentrations to our unknown sample and to use the data collected to compile a graph showing the levels of absorbance of the different concentrations. Methods and materials: In this lab we used a spectrophotometer, a test tube filled with water to be used as a blank, six test tubes with different concentrations of salicylic acid ranging from 0 mg/dL to 5 mg/dL and one test tube with an unknown concentration of salicylic acid.We set the spectrophotometer to a wavelength of 540 nm. We adjusted the transmittance to 0%. Next we placed the test tube with the water into the spectrophotometer and adjusted the transmittance dial to 100%. We removed the test tube containing the water and replaced it with the first concentration of 0 mg/dL. We recorded the absorbance and repeated the test for a total of 5 reading s. We did this for each concentration. We then calculated the average of each concentration’s absorbance readings and plotted the averages onto the graph.Once we had gathered the data for our known concentrations we then repeated the procedure for our unknown concentration. We again took the average and plotted that on the absorbance curve to determine the concentration of the unknown. Observations and Data: Calibration Standard| Absorbance Reading 1| Absorbance Reading 2| Absorbance Reading 3| Absorbance Reading 4| Absorbance Reading 5| AverageAbsorbance Reading| 0 mg/dL| 0. 007| 0. 010| 0. 007| 0. 005| 0. 006| 0. 07| 0. 5 mg/dL| 0. 032| 0. 036| 0. 037| 0. 041| 0. 038| 0. 037| 1. 5 mg/dL| 0. 098| 0. 100| 0. 098| 0. 099| 0. 096| 0. 098| 2. 5 mg/dL| 0. 150| 0. 149| 0. 153| 0. 154| 0. 150| 0. 151| 3. 5 mg/dL| 0. 234| 0. 239| 0. 237| 0. 250| 0. 229| 0. 238| 5. 0 mg/dL| 0. 286| 0. 287| 0. 288| 0. 292| 0. 291| 0. 289| Unknown A| 0. 241| 0. 238| 0. 239| 0. 241| 0. 241| 0. 239| Base d on the data from the known concentrations I found our unknown to be a concentration of 3. mg/dL. Conclusions: We used a spectrophotometer to determine the concentration curve for the known samples then used both the spectrophotometer and the concentration curve to determine the concentration of the unknown sample. This technique can be used by toxicologists to determine the amount of drugs in a person’s blood. This can be helpful if there was an overdose or if the district attorney needed to know the concentration of drugs in someone’s system.

The Art of Public Speaking

Public speaking is an oral presentation in which a speaker addresses an audience, and until the 20th century, public speakers were usually referred to as orators and their discourses as orations.   A century ago, in his Handbook of Public Speaking, John Dolman observed that public speaking is significantly different from a theatrical performance in that it is  not a conventionalized imitation of life, but life itself, a natural function of life, a real human being in real communication with his fellows; and it is best when it is most real. Unlike its predecessor oration, public speaking involves an interplay of not only body language and recitation, but on conversation, delivery and feedback. Public speaking today is more about the audiences reaction and participation than an orations technical correctness. Six Steps to Successful Public Speaking According to John. N Gardner and A. Jerome Jewlers Your College Experience, there a six steps to creating a successful public speech: Clarify your objective.Analyze your audience.Collect and organize your information.Choose your visual aids.Prepare your notes.Practice your delivery. As language has evolved over time, these principals have become even more apparent and essential in speaking well in a public capacity. Stephen Lucas says in Public Speaking that languages have become more colloquial and speech delivery more conversational as more and more citizens of ordinary means took to the rostrum, audiences no longer regarded the orator as a larger-than-life figure to be regarded with awe and deference. As a result, most modern audiences favor straightforwardness and honesty, authenticity to the oratory tricks of old. Public speakers, then, must strive to convey their objective directly to the audience they will be speaking in front of, collecting information, visual aids, and notes that will best serve the speakers honesty and integrity of delivery. Public Speaking in the Modern Context From business leaders to politicians, many professionals in modern times use public speaking to inform, motivate, or persuade audiences near and far, though in the last few centuries the art of public speaking has moved beyond the stiff orations of old to a more casual conversation that contemporary audiences prefer. Courtland L. Bovà ©e notes in Contemporary Public Speaking that while basic speaking skills have changed little, styles in public speaking have. Whereas the early 19th century carried with it the popularity of the recitation of classic speeches, the 20th century brought a change in focus to elocution. Today, Bovà ©e notes, the emphasis is on extemporaneous speaking, giving a speech that has been planned in advance but is delivered spontaneously. The internet, too, has helped change the face of modern public speaking with advents of going live on Facebook and Twitter and recording speeches for later broadcast to a global audience on Youtube. However, as Peggy Noonan puts it in What I Saw at the Revolution, Speeches are important because they are one of the great constants of our political history; for two hundred years they have been changing — making, forcing — history.