Transpedicular reduction and stabilization for postlaminectomy lumbar instability

Summary This study retrospectively reviewed the outcomes of 17 patients with postlaminectomy lumbar instability treated by transpedicular reduction and stabilization. The criteria of instability were defined strictly by both the clinical symptom of instability catch and the radiological findings that fulfilled Nachemson's criteria. Low back pain and/or sciatica that interfered largely with the patients' work or quality of life were the indications for this treatrment. All the operations were performed by one surgeon with the same spinal instrumentation system — AO internal fixator. The follow-up period was between 16 and 36 months (mean 24 months).Face to face questionnaire revealed that this treatment modality is encouraging. Fourteen patients (82%) had complete or nearly complete relief from all the pre-operative symptoms. Two (12%) had partial relief of the symptoms that required a subsequent discectomy or wider laminectomy. Only one case (6%) with osteoporosis remained unchanged after the operation. On the follow-up radiographs, sixteen patients (94%) showed good alignment and solid arthrodesis of the treated motion segment. These radiological findings correlated quite well with the absence of the clinical symptom of instability catch.A common, but acceptable, complication found in this series was a variable degree of low back stiffness secondary to the instrumentation. Fracture of the screw was found in one patient and pull out of the screw was found in another patient. However, they did not elicit detectable symptoms.Osteoporosis, concomitant disc herniation and persistent spinal stenosis at/or adjacent to the operated level were the three main factors that may contribute to unsatisfactory results secondary to this treatment. These problems remain to be resolved in thp future.     

Clinical importance of urethral pressure variations

The cause of female urethral instability is still controversial. With the help of this retrospective analysis of 1168 continuous long-term recordings of the intraurethral pressure at the maximum point of urethral pressure, the correlation between pressure variations (UPV) and simultaneous bladder instability was investigated. It could be stated that clinically important UPV (more than 15 cmH₂O) are found more often in women who suffer from signs of bladder instability (defined as low bladder compliance combined with uninhibited detrusor contractions and/or urinary leakage) than in patients without signs of unstable bladder.     

Kluger's “Fixateur interne” for spinal instability

Kluger's Fixateur Interne proved to be an excellent tool not only in spinal trauma for repositioning of impacted fractures and transpedicular stabilization of the dorsal column but also in other forms of thoracic or lumbar instability.After spinal tumor excision from a dorsal approach and vertebral replacement with methylmethacrylate additional stability through dorsal fixation was achieved with this device.Spondylodiscitis, symptomatic spondylolisthesis, spinal instability from degenerative disc disease as well as nonunion following previous surgery could be cured using Kluger's internal fixation. Rare complications, i.e. from broken screws or rods (5%) caused no problems, but some patients required a second operation for readjustment of malpositioned screws which were causing pain or neurological deficit.     

Detrusor sphincter dyssynergia,detrusor instability,and urethral sphincter spasticity as the urodynamic findings in the urethral syndrome: Role of treatment with a combined anticholinergic and alpha blocking agent,bladder drill,and antibiotics

The combined effect of isopropamide 5 mg plus trifluoperazine 1 mg (a combined anticholinergic and alpha-adrenergic antagonist) (Smith, Kline and French Canada Ltd, Ontario, Canada), antibiotics, and bladder drill was retrospectively assessed on 100 consecutive women, aged 16 to 47 years, presenting with the signs and symptoms of the urethral syndrome. Assessment included history, physical examination, routine bacterial and chlamydial cultures (cervical, urethral, vaginal, and urine), cystourethroscopy, and urodynamics. Urodynamic diagnoses included detrusor sphincter dyssynergia (n=84), detrusor instability (n =8), external urethral sphincter spasticity (n=4), and sensory urgency (n=1). Three patients with positive urine cultures were excluded. Urethrotrigonitis was visualized at cystourethroscopy in all patients. Only one case of chlamydial urethritis-cervicitis was identified by culture: 82% of patients had a history of prior antibiotic therapy for lower urinary tract symptoms and 21% were being treated with antibiotics at the time of their initial assessment.Following 1 month of treatment, 44 (45%) patients were cured of all symptoms, 49 (51%) were improved, 3 (3%) were unchanged and 1 (1%) was worse. Significant changes in uroflowmetry included a reduction in postvoid residual urine volume from 49 ± 28 ml to 14 ±21 ml (P=0.029) in the unstable bladder group and a conversion from intermittent to continuous uroflow patterns in the detrusor sphincter dyssynergia group (P <0.005, ²) and overall (P <0.005, ²). A statistically significant number of patients (P <0.025, ²) converted from increased to normal tracings on repeat perianal electromyography, suggesting that the pathophysiology of the urethral syndrome is urethral spasticity related to urethral inflammation rather than actual infection.We conclude that detrusor sphincter dyssynergia, bladder instability, and urethral sphincter spasticity are the common urodynamic findings in the urethral syndrome. A combination of anticholinergic and alpha blocking agent, antibiotics, and a bladder drill markedly improved (96%) symptoms in women with the urethral syndrome.     

Multiple mononeuropathy as the initial presentation of systemic lupus erythematosus — nerve biopsy and response to plasma exchange

Summary A total of 15 patients affected by idiopathic dystonia (7 with generalized and 8 with focal or segmental dystonia) were subjected to therapy with bromocriptine at low doses, pimozide and trihexyphenidyl. The symptoms were evaluated by giving a progressive score in relation to the intensity of the dystonic symptom to each of the body segments involved by the dystonia. Bromocriptine did not significantly modify the dystonia. Pimozide showed a slight nonsignificant improvement of the dystonic symptoms. Trihexyphenidyl was effective in the generalized dystonias, in agreement with previous reports in the literature. The variation in the pharmacological results could be due to the diversity of the dystonic syndromes, which comprise cases that are different in age at onset, site of dystonic symptoms, and evolution.

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Zusammenfassung Fünfzehn von idiopathischer — und zwar 7 von generalisierter und 8 von fokaler und segmentarischer — Dystonie befallenen Patienten unterzogen sich verschiedenen pharmakologischen Behandlungen mit kleinen Mengen Bromocriptine, Pymozide und Triesifenidile. Die Symptome wurden durch eine fortlaufende Punktzahl bezeichnet, so daß deren Schätzung von der Intensität des Symptoms Dystonie in jedem einzelnen befallenen Körperteil abhing. Die Dystonien wurden durch Bromocriptine nicht bedeutend geändert.Pymozide führte zu einer geringeren, doch unbedeutenden, Besserung der dystonischen Symptome.Triesifenidile wirkte auf die generalisierten Dystonien, in Übereinstimmung mit einigen Literaturangaben.Die Veränderlichkeit der pharmakologischen Ergebnisse wurde auf die Verschiedenheit der dystonischen Syndrome zurückgeführt, unter denen man Fälle versammelt, die sich durch Anfangsalter, Sitz der dystonischen Symptome und Entwicklungsart voneinander unterscheiden.

     

The rotational component in the dynamics of the C2–3 spinal segment

Summary The technique of the PA axial projection of the arches of the upper cervical vertebrae into the occipital foramen and the normal findings, are described. The influence of maximum forced anteflexion at the craniocervical junction and rotation of the head on the relations of atlas and axis is demonstrated. It seems that in this position rotation at atlasaxis level is restricted and partly transmitted to the C_2–3 segment. Thus, selective clinical examination of the rotational component of the dynamics at C_2–3 can be achieved and the pathological restrictions of movement can be assessed.     

宫颈癌患者基因组遗传不稳定性分析

目的 研究中国宫颈癌高发区宫颈癌患者基因组遗传不稳定性改变，为寻找宫颈癌相关内源因子提供依据。方法 从GenBank中选取8对微卫星DNA引物，采用PCR-变性PAGE-银染方法检测50例宫颈癌(来自高发区)活检组织及其对照(同病例血液)样品的杂合性丢失(LOH)和微卫星不稳定(MI)。结果 LOH总检出率为66％(33／50)，其中，D18S474(染色体18q21)LOH达40．5％；染色体3p21．2—3p21．3中微卫星位点D3S1478，LOH达31．7％；并且在原位癌与浸润癌中，LOH分布也有一定差异。MI在宫颈癌患者基因组中仅存在少数微卫星位点，总的发生率较低，为8％(4／50)。结论 除高危型人乳头瘤病毒(HPVhr)感染外，细胞内源基因的改变在宫颈癌发生发展过程中也起着重要作用。高频LOH位点18q21 D18S474、3p21．2-3p21．3 D3S1478可能存在潜在的宫颈癌抑癌基因。     

中国人乳腺癌患者线粒体基因体细胞性突变

 目的　探讨中国人乳腺癌线粒体DNA体细胞性突变特征。方法　对 5 4例中国人乳腺癌组织和匹配的正常组织的全线粒体基因进行PCR扩增和时相温度梯度凝胶电泳突变筛选分析 ,对显示在肿瘤和配对正常组织中具有不同类型电泳带型变化的片段进行测序以辨明其突变类型。结果　 5 4例肿瘤中有 2 0例 (37.0 4 % )具有体细胞性突变 ,总突变数为 39个 ,平均突变密度为 2 .35个 / 10 0 0碱基 ,D环区突变密度最高 ,其中 10个肿瘤具有 30 3～ 30 9位点的C插入或缺失突变 (18.5 1% )。结论　线粒体DNA体细胞性突变在中国人乳腺癌中是一个普遍现象 ,并可能在肿瘤的发生过程中扮演着重要的角色。     

微卫星不稳定散发性大肠癌的临床病理特征和DNA倍体研究

目的:探讨微卫星不稳定的散发性大肠癌的临床病理特征及微卫星不稳定表型和DNA倍体类型的关系。方法:对71例散发性大肠癌行BAT25和BAT26两个位点的微卫星不稳定检测和流式细胞术倍体分析,探讨微卫星不稳定状态和临床病理特征及DNA倍体类型的关系。结果:微卫星不稳定的阳性率为9.86%(7/71),微卫星不稳定表型和发病部位、组织学类型及分化程度相关(P<0.05),而与性别、年龄、淋巴结转移和分期无关。微卫星不稳定的散发性大肠癌中右半结肠癌和低分化腺癌的比例高于微卫星稳定者。68例患者检出二倍体和异倍体分别为18和50例,微卫星不稳定表型者5例为二倍体,因此和DNA倍体类型显著相关(P=0.012)。结论:微卫星不稳定的散发性大肠癌好发于右半结肠,具有低分化腺癌的倾向,多为二倍体。     

硫酸镍诱导的人支气管上皮细胞系癌变细胞基因组不稳定性分析

目的　检测硫酸镍对基因组不稳定性的影响,从而进一步探讨镍化合物致癌的分子机制。方法　采用随机扩增多态性DNA(random amplified polymorphic DNA, RAPD)技术对经硫酸镍在诱导人支气管上皮细胞系(16HBE)的恶变细胞中的基因组不稳定性进行分析。结果　本实验所选用的7条随机引物均能扩增出清晰、明显的条带,条带数在1~6条之间。7条引物中第1、4、7的3条引物扩增的片段在实验组和对照组之间无差异。其余4条引物均有明显差异,对于同一随机引物它们都具有特异的带型。结论　硫酸镍能诱发16HBE细胞基因组不稳定。