Meningiomas of the spine are the most common benign intradural extramedullary lesions and account for 25%–46% of all spinal cord tumors in adults. The goal of treatment is complete surgical resection while preserving spinal stability. Usually, these lesions occur in the thoracic region and in middle-aged women. Clinical presentation is usually nonspecific and the symptoms could precede the diagnosis by several months to years, especially in older people, in whom associated age-related diseases can mask the tumor for a long time. We report a series of 30 patients, aged 70 years or more, harboring intradural extramedullary spinal meningiomas. No subjects had major contraindications to surgery. A minimally invasive approach ( hemilaminectomy and preservation of the outer dural layer) was used to remove the tumor, while preserving spinal stability and improving the watertight dural closure. We retrospectively compared the outcomes in these patients with those in a control group subjected to laminectomy or laminotomy with different dural management. In our experience, the minimally invasive approach allows the same chances of complete tumor removal, while providing a better postoperative course than in a control group.

Interaction of the CD4 co-receptor with major histocompatibility complex (MHC) class II molecules during antigen presentation results in enhancement of antigen receptor signaling. The synergism between the two receptors is believed to result from the juxtaposition of the CD4-associated tyrosine kinase p56lck with the cytoplasmic domains of CD3 complex components. Here, we report that cross-linking of CD4 on the surface of Jurkat cells using monoclonal antibodies results in activation of the CD3-associated kinase p59fyn. Co-cross-linking of CD4 and CD3 results in synergistic activation of p59fyn. The p59fyn kinase is also hyperactive in a Jurkat cell line stably transfected with a constitutively active p56lck mutant, indicating that p56lck mediates CD4 activation of p59fyn. In support of this hypothesis, expression of a dominant inhibitory mutant of p59fyn blocks CD4 signals involved in gene activation. In addition, the p59fyn dominant inhibitor mutant blocks gene-activating signals induced by expression of a constitutively active mutant of p56lck. Overexpression of the regulatory kinase p50csk, which attenuates TcR signaling by inactivation of p59fyn, inhibits signaling from the constitutively active form of p56lck. Taken together, these data suggest that CD4/p56lck enhancement of TcR signaling is, at least in part, mediated by activation of p59fyn, and may be regulated by p50csk.

Background:Various methods of fixation have been described for custom made hydroxyapatite cranial implants. Their poor malleability limits most of the common used fixation techniques because of the high risk of cranioplasty's fracturing or higher exposure to infections. We present our experience with a new fixation technique, based on an appositely premodified hydroxyapatite implants.Methods:In a 2-year time period, 12 patients underwent cranioplasty by a modified custom made porous hydroxyapatite implant. Once the three-dimensional computer model of the prostheses was performed, three semicircular extensions placed at strategic positions were drawn and the final prosthesis was realized. At surgery, holes fitting the extensions were drilled into the skull borders and the implant was easily embedded inside the defect. Small titanium meshes overlying the extensions were fixed by screws to the surrounding bone.Results:A minimal increase of operative times was recorded, with drilling and fixation requiring additional 30 and 15 minutes, respectively. Optimal contact between cranioplasty and skull borders was always observed at control computed tomography (CT) scans. Permanent rigid fixation was obtained in all cases, with good functional and aesthetic results at follow-up.Conclusions:Modifications of hydroxyapatite implants are obtained without additional costs. The minimal increase of operative times is largely counterbalanced by optimal fixation results. Finally, the bone drilling and the immediate proximity of bone to prosthesis might enhance the potential for osteogenesis and osteointegration.