Context The relevance of hyponatremia has been acknowledged by guidelines from the United States (2013) and Europe (2014). However, treatment recommendations differ due to limited evidence. Objective In hyponatremia following pituitary surgery—caused by the syndrome of inappropriate antidiuretic hormone (SIADH) secretion—we compared fluid restriction with the pharmacological increase of water excretion by blocking the vasopressin 2 receptors with tolvaptan at a low and a moderate dose. Design Prospective observational study. Setting Neurosurgical Department of a University hospital with more than 200 surgical pituitary procedures per year. Patients Patients undergoing pituitary surgery and developing serum sodium below 136 mmol/L. The diagnosis of SIADH was established by euvolemia (daily measurement of body weight and fluid balance), inappropriately concentrated urine (specific gravity), and exclusion of adrenocorticotropic and thyroid-stimulating hormone deficiency. Intervention Patients were treated with fluid restriction (n = 40) or tolvaptan at 3.75 (n = 38) or 7.5 mg (n = 48). Main Outcome Measures Treatment efficacy was assessed by the duration of hyponatremia, sodium nadir, and length of hospitalization. Safety was established by a sodium increment below 10 mmol/L per day and exclusion of side effects. Results Treatment with 7.5 mg of tolvaptan resulted in a significant attenuation of hyponatremia and in a significant overcorrection of serum sodium in 30% of patients. The duration of hospitalization did not differ between treatment groups. Conclusions Tolvaptan at a moderate dose is more effective than fluid restriction in the treatment of SIADH. Overcorrection of serum sodium may be a side effect of tolvaptan even at low doses.

Koehler-Freiberg's disease is found to most commonly manifest itself in the metatarsal head of the second ray. Occasionally it is observed to occur in the metatarsal head of the third and less commonly it is seen to appear in the other rays of the foot. An investigation into probable causes of the disorder calls for consideration of the biomechanical conditions in the region of the metatarsophalangeal joints. A review of the literature pertaining to this matter has failed to reveal any detailed information in this respect and therefore a series of experiments have been conducted involving determination of a) the ground force under the metatarsophalangeal joints and under the toes in normal barefoot walking b) the direction of the flexor tendons and such others that cross the joint and that might play an important role in exerting force between the toes and the ground, c) the geometry of the articulating surfaces and d) the forces that act between the metatarsal head and the corresponding phalangeal joint surface. It is shown that the specific loading of the MP-II joint (due to forces acting across the joint) could amount to nearly twice that to which MP-I is subjected to. This might explain the more frequent occurrence of osteonecrosis of the second metatarsal head as compared to that observed within the head of the first. Furthermore, the direction of the joint resultant force in the MP-II joint is seen to be more dorsally inclined than that in MP-I, which agrees well with clinical findings regarding the site of localized lesions. Lastly, a hypothesis which still requires closer investigation is presented to explain the development of the bone lesions that are known to occur just below the subchondral cortex.

We present a case of a 73-year old female with a giant spinal cord schwannoma WHO grade I at the level of C2/3. We performed the rare lateral approach to the upper spine, a forgotten invasive procedure modified by us for better tumor exposure. The tumor was removed completely with rapid neurological improvement. .

Age-related neurological complications are common and affect the quality of life. The present study was designed to investigate age-dependent changes in behavioral responses and the role of protective heat shock proteins (Hsp)s 70 and Hsp 90, which expression in the frontal cortex (FC) might be vulnerable to aging processes in rats. We report that 3-month-old rats exhibited the highest motor activity and lowest anxiety (increased distance, time and number of entries in the open arms of the elevated plus maze) compared to 14-and 18-month-old rats. Moreover, old rats showed a decreased level of Hsp 70 and Hsp 90 in the FC compared to young adult rats. These findings suggest that the aging process is accompanied by changes in emotional status that might be associated with a decreased function of protective chaperone proteins in the FC.

We present the case of a 3-year old female with a diffuse astrocytoma (WHO grade II, IDH Wild Type) of the thoracic cord. The patient is without tumor-progression after 1-year follow-up. Guidelines at this age group are missing. After reviewing the literature, surgical tumor removal is recommended, however chemo-or radiotherapy or combined after surgical removal is controversial. This decision seems to be simplified by tumor grade and progression, as well as the age of the patient resulting in better outcomes. Radiotherapy is not performed in children below 5 years old. Early neurological rehabilitation is mandatory.