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1.  Spontaneous epidural hematoma of thoracic spine presenting as Brown-Séquard syndrome: report of a case with review of the literature 
Background
Spontaneous spinal epidural hematoma (SSEH) is an uncommon clinical entity. It produces a severe neurological deficit and prompt decompression is usually the first choice of treatment. Brown-Séquard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm, but rarely caused by SSEH.
Methods
Case report and literature review.
Findings
A previously healthy man presented with Brown-Séquard syndrome below T5–T6 cord segment secondary to spontaneous epidural hematoma. He opted for conservative treatment, which was followed by rapid resolution.
Conclusions
Although Brown-Séquard syndrome as a presenting feature of SSEH is rare, it does exist in exceptional case, which should be taken into consideration for differential diagnosis. Prompt surgical decompression is an absolute surgical indication widely accepted for patient with progressive neurological deficit. However, SSEH presenting with incomplete neurological insult such as Brown-Séquard syndrome might have a benign course. Successful non-operative management of this problem does not make it a standard of care, and surgical decompression remains the standard treatment for SSEH.
doi:10.1179/107902611X13069205199468
PMCID: PMC3152816  PMID: 21903018
Spinal epidural hematoma; Brown-Séquard syndrome; Thoracic vertebra; Spinal cord; Methylprednisolone; Paraparesis
2.  2-tert-Butyl 4-methyl 3,5-dimethyl-1H-pyrrole-2,4-dicarboxyl­ate 
In the title mol­ecule, C13H19NO4, except for two C atoms of the tert-butyl group, the non-H atoms are almost coplanar (r.m.s. deviation = 0.2542 Å). In the crystal, mol­ecules are linked into centrosymmetric dimers by two inter­molecular N—H⋯O hydrogen bonds, forming an R 2 2(10) ring motif.
doi:10.1107/S1600536812020120
PMCID: PMC3379292  PMID: 22719490
3.  2,2′-Dichloro-N,N′-[1,3-phenyl­enebis(methyl­ene)]diacetamide 
The complete mol­ecule of the title compound, C12H14Cl2N2O2, is generated by a crystallographic twofold axis with two C atoms of the central benzene ring lying on the axis. In the crystal, N—H⋯O hydrogen bonds link the mol­ecules into chains parallel to the c axis.
doi:10.1107/S1600536812008653
PMCID: PMC3343915  PMID: 22589996
4.  Ossification process involving the human thoracic ligamentum flavum: role of transcription factors 
Arthritis Research & Therapy  2011;13(5):R144.
Introduction
Ossification of the ligamentum flavum (OLF) of the spine is associated with serious neurologic compromise, but the pathomechanism of this process remains unclear. The objective of this study was to investigate the pathomechanism of the ossification process, including the roles of various transcriptional factors in the ossification of human thoracic ligamentum flavum.
Methods
Sections of the thoracic ligamentum flavum were obtained from 31 patients with OLF who underwent posterior thoracic decompression, and from six control patients free of OLF. Cultured ligamentum flavum cells (n = 6, each) were examined with real-time reverse transcription-polymerase chain reaction (RT-PCR) analysis for Sry-type high-mobility group box 9 (Sox9), runt-related transcription factor 2 (Runx2), muscle segment homeobox 2 (Msx2), Osterix, distal-less homeobox 5 (Dlx5), and AP-1. The harvested sections were examined with hematoxylin-eosin, the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) method, and immunohistochemistry for the transcriptional factors.
Results
Compared with the control, the OLF showed disorganization of the elastic fiber bundles and abundant hypertrophic chondrocytes in the ossification front. TUNEL-positive chondrocytes were found near the ossified plaques. The mRNA expression levels of Sox9, Runx2, Msx2, and AP-1 in cultured cells from the ligamentum flavum of OLF patients were significantly different from those of the control. OLF samples were strongly immunoreactive to Sox9, Runx2, and Msx2 at proliferating chondrocytes in the fibrocartilage area. Hypertrophic chondrocytes were positive for Runx2, Osterix, Dlx5, and AP-1.
Conclusions
The ossification process in OLF seems to involve chondrocyte differentiation under the unique expression of transcriptional factors. Accumulation of hypertrophic chondrocytes was evident around the calcified area at the ossification front, and we suggest that the differentiation of these cells seems to be concerned with the ossification process.
doi:10.1186/ar3458
PMCID: PMC3308072  PMID: 21914169
5.  3-Methyl-4-{[(3-{[(3-methyl-5-oxo-1-phenyl-4,5-dihydro-1H-pyrazol-4-yl­idene)(phen­yl)meth­yl]amino­meth­yl}benz­yl)amino](phen­yl)methyl­idene}-1-phenyl-1H-pyrazol-5(4H)-one 
The complete mol­ecule of the title compound, C42H36N6O2, is generated by a crystallographic twofold axis with two C atoms of the central phenyl group lying on the axis. In the independent part of the mol­ecule, one amino group is involved in an intra­molecular N—H⋯O hydrogen bond, and the two adjacent phenyl rings are twisted from the plane of the pyrazolone ring with dihedral angles of 6.82 (3) and 88.32 (6)°. The crystal packing exhibits no classical inter­molecular contacts.
doi:10.1107/S1600536811027000
PMCID: PMC3213468  PMID: 22091047
6.  Nontraumatic Acute Paraplegia Associated With Cervical Disk Herniation 
Background:
Acute paraplegia is a true emergency. It is often the result of trauma but is rarely reported in association with cervical disk herniation in patients without antecedent injury.
Methods:
Case report.
Findings:
This 75-year-old man presented with acute paraplegia due to severe compression of the spinal cord by herniation of the C4-C5 cervical disk. He underwent emergency diskectomy and anterior fusion. Postoperatively, his neurologic functions improved gradually.
Conclusions:
Cervical disk herniation should be considered in the differential diagnosis of nontraumatic acute paraplegia. Pre-existing narrowed canal is an important predisposing factor and excessive neck movements are believed to be triggering factors. Immediate early decompressive surgery is recommended to avoid irreversible progression of neurologic deficit.
PMCID: PMC2964031  PMID: 21061902
Paraplegia, acute, nontraumatic; Cervical vertebrae; Intervertebral disk displacement; Spinal cord compression; Rehabilitation, physical

Results 1-6 (6)