Candida albicans osteomyelitis of the spine: progressive clinical and radiological features and surgical management in three cases

Candida albicans vertebral osteomyelitis is rare. Three cases are presented. Without antifungal treatment, they developed spinal collapse and neurological deterioration within 3–6 months from the onset of symptoms. There was a delay of 4.5 and 7.5 months between the onset of symptoms and surgery. All patients were managed with surgical debridement and reconstruction and 12-week fluconazole treatment. The neurological deficits resolved completely. The infection has not recurred clinically or radiologically at 5–6 years follow-up. Although rare, Candida should be suspected as a causative pathogen in cases of spinal osteomyelitis. Without treatment the disease is progressive. As soon as osteomyelitis is suspected, investigations with MRI and percutaneous biopsy should be performed followed by medical therapy. This may prevent the need for surgery. However, if vertebral collapse and spinal cord compression occurs, surgical debridement, fusion and stabilisation combined with antifungal medications can successfully eradicate the infection and resolve the neurological deficits

Magmatic and amagmatic seafloor generation at the ultraslow-spreading Gakkel ridge, Arctic Ocean

A high-resolution mapping and sampling study of the Gakkel ridge was accomplished during an international ice-breakerexpedition to the high Arctic and North Pole in summer 2001. For this slowest-spreading endmember of the global mid-ocean-ridgesystem, predictions were that magmatism should progressively diminish as the spreading rate decreases along the ridge, and thathydrothermal activity should be rare. Instead, it was found that magmatic variations are irregular, and that hydrothermal activity isabundant. A 300-kilometre-long central amagmatic zone, where mantle peridotites are emplaced directly in the ridge axis, liesbetween abundant, continuous volcanism in the west, and large, widely spaced volcanic centres in the east. These observationsdemonstrate that the extent of mantle melting is not a simple function of spreading rate: mantle temperatures at depth or mantlechemistry (or both) must vary significantly along-axis. Highly punctuated volcanism in the absence of ridge offsets suggests thatfirst-order ridge segmentation is controlled by mantle processes of melting and melt segregation. The strong focusing of magmaticactivity coupled with faulting may account for the unexpectedly high levels of hydrothermal activity observed