Anterior lumbar fusion using a hybrid interbody graft

Summary This is a radiographic report of 40 patients (20 men, 20 women) who underwent anterior lumbar interbody fusions (73 levels) utilizing a “hybrid” interbody graft composed of femoral cortical allograft (FCA) bone and iliac crest cancellous autograft bone. The average age at surgery was 38 years (range 17–64 years), and follow-up averaged 1.4 years (range 1.0–2.4 years). Nineteen of the patients had undergone previous lumbar surgery. Thirty-two patients (63 levels) underwent anterior fusion combined with some type of posterior fixation, and eight patients (10 levels) had no posterior fixation. Types of posterior fixation included: for 20 patients (36 levels) Steffee variable screw placement fixation, for 10 patients (23 levels) translaminar facet screws (TFS), for 1 patient (3 levels) Knodt rods and for 1 patient (1 level) facet screws. Based on the persistence of lucent lines at the graft-host interface, three patients (one level each) were felt to have non-unions at their latest follow-ups at 1.4, 1.5 and 2.0 years, respectively. Two of these patients had no posterior fixation, and the other had TFS fixation. The overall fusion rate was 96% (70 of 73 levels). The fusion rate for all levels treated with posterior fixation was 98% compared with 75% for those without fixation. Intervertebral disc heights (IVDH) were measured on all films and corrected for magnification with computer assistance. On average, the IVDH was increased postoperatively but returned to preoperative values at follow-up. IVDH loss was independent of the type of instrumentation used. No complications arose from the use of the hybrid graft. Incorporation of the allograft portion of the graft is slow and was felt to be complete in only 7 of the 73 levels at follow-up. We conclude that the hybrid interbody graft technique is a safe and reliable method for performing anterior lumbar interbody fusions and should be combined with some type of posterior fixation. Long-term follow-up will be required to assess the behaviour of the allograft until incorporation is complete.     

Non-Cartesian data reconstruction using GRAPPA operator gridding (GROG).

A novel approach that uses the concepts of parallel imaging to grid data sampled along a non-Cartesian trajectory using GRAPPA operator gridding (GROG) is described. GROG shifts any acquired data point to its nearest Cartesian location, thereby converting non-Cartesian to Cartesian data. Unlike other parallel imaging methods, GROG synthesizes the net weight for a shift in any direction from a single basis set of weights along the logical k-space directions. Given the vastly reduced size of the basis set, GROG calibration and reconstruction requires fewer operations and less calibration data than other parallel imaging methods for gridding. Instead of calculating and applying a density compensation function (DCF), GROG requires only local averaging, as the reconstructed points fall upon the Cartesian grid. Simulations are performed to demonstrate that the root mean square error (RMSE) values of images gridded with GROG are similar to those for images gridded using the gold-standard convolution gridding. Finally, GROG is compared to the convolution gridding technique using data sampled along radial, spiral, rosette, and BLADE (a.k.a. periodically rotated overlapping parallel lines with enhanced reconstruction [PROPELLER]) trajectories.     

Gd-DTPA动态增强MRI评价心肌微血管损伤

目的：探讨Gd-DTPA动态增强MRI评价心肌微血管损伤的可行性。方法：制作急性犬心肌梗死动物模型，在活体上用放射微球^99Tc—MAA测量心肌血流量，0．5％伊文蓝染色区分缺血心肌；心脏离体后用3％TTC染色区分梗死心肌，SP免疫组化染色观察心肌微血管并计算微血管体积分数。犬离体心脏左冠状动脉插管后作MRI平扫及Gd—DTPA动态增强扫描，测量正常、缺血和梗死心肌的信号强度，绘制时间-信号强度曲线。结果：在T1WI上，心肌信号强度无明显差异；在T2WI上，病变心肌信号强度较正常增高；Gd-DTPA灌注动态增强扫描，正常心肌时间-信号强度曲线呈下降形，危险心肌呈上升形，梗死心肌呈平直形，灌注晚期病变区呈明显环状强化。正常、危险和梗死心肌血流量、微血管体密度差异显著。结论：急性心肌梗死后心肌间质水肿、心肌含水量增加致T2WI信号增高。Gd-DTPA动态增强时间-信号强度曲线上升的斜率及峰值可以反映心肌微血管损伤及组织水肿的程度。     

重建钛板枢椎椎弓根螺钉及颗粒状植骨枕颈融合术

目的 探讨重建钛板螺钉及颗粒状自体松质骨植骨在枕颈融合中的应用。方法 2002年4月～2005年1月，选择枕颈区不稳定患者19例，年龄31～67岁；病程3个月～2年。其中枕寰枢椎复合畸形8例，陈旧性寰枢椎骨折脱位8例，类风湿性关节炎所致寰椎前脱位2例，枢椎齿状突肿瘤1例。JOA脊髓功能评分平均9．8分。使用重建钛板和枢椎椎弓根螺钉固定枕颈部，同时枕骨与枢椎后弓间颗粒状自体松质骨植骨。结果 术中、术后无并发症发生，切口Ⅰ期愈合。19例均获随访6个月～2年8个月，平均16个月，均获得了骨性融合。无神经血管损伤，无断钉、断板及内固定松脱。JOA脊髓功能评分平均达14．4分。结论 重建钛板枢椎椎弓根螺钉固定可靠，置入方便，自体颗粒状松质骨具有较高的融合率，在枕颈融合中效果满意。     

Cervifix内固定系统在枕颈融合术中的应用

目的 介绍Cervifix枕颈内固定系统在枕颈融合术中的应用并评价其疗效。方法 对6例由新鲜创伤和25例由陈旧性创伤、先天畸形、类风湿引起的枕颈失稳病例，采用Cervifix系统进行枕颈融合术；随访手术效果。结果 全部病例得到随访，随访时间9～37个月。3l例均获得骨性融合。内固定无松动，移位和断裂等并发症。脊髓神经功能有不同程度恢复。l例在术中发现有椎动脉损伤，术后无相关症状出现。所有病例未出现与内固定有关的神经脊髓损伤和脑脊液漏等并发症。结论 Cervifix系统固定可靠，器械安装方便，手术操作虽有一定难度，但仍是目前枕颈融合内固定的较好方法：     

Grading static versus dynamic images of contact lens complications

Background: This study was conducted to investigate grading performance when estimating the severity of static versus dynamic images of contact lens‐related ocular pathology. Methods: Thirty‐eight subjects used the Efron Grading Scales for Contact Lens Complications to grade the severity of ocular pathological changes depicted in static and dynamic (movie clip) computer‐displayed images of each of the following contact lens complications: bulbar conjunctival redness, limbal redness, papillary conjunctivitis, corneal staining, corneal infiltrates and meibomian gland dysfunction. The viewing of static and dynamic images was separated by seven weeks. Results: Grades assigned to dynamic images were 0.6 and 0.7 grading scale units higher than those assigned to static images for limbal redness and papillary conjunctivitis, respectively (p < 0.0001 for both). No difference was observed for the other four complications. There was an apparent trend for grading variability to be reduced (that is, observers grading in closer agreement) when grading dynamic versus static images. Conclusions: Absolute grades based on an assessment of signs of pathology represented in static images may, in some instances, underestimate the true severity of the condition.     

Value of polydirectional tomography in the assessment of the postoperative spine after anterior decompression and vertebral body autografting

With the growing number of orthopedic reconstructive spinal procedures, the use of bone grafting has steadily increased in the past decade. An understanding of the biology of bone grafting is essential for both the clinician and radiologist. Despite the advent of computed tomography and magnetic resonance imaging, conventional polydirectional tomography remains an important tool in the evaluation of vertebral body autografts. Trispiral or hypocycloidal tomography plays a valuable role in the assessment of bone graft fusion and possible complications, especially in the presence of metallic fixation devices. We present our imaging experience derived from 375 patients with cervical, thoracic, or lumbar anterior spinal fusion. True graft complications occurred in 27 patients (7%) and consisted of fracture (4%), malpositioning (3%), and infection (<1%).     

Uptake and intracellular distribution of idarubicin in secondary cultures of normal and neoplastic urothelium

This study analyzes the uptake and endocellular distribution of idarubicin (IDA) in normal and neoplastic urothelial secondary cultures in relation to the changes in concentration and time of exposure. The urothelial lines were isolated by Freshney's method from biopsy fragments taken from five patients with superficial bladder cancer. Pharmacological experiments were carried out on subcultures previously immunophenotypically characterized and did not exceed ten passages. The uptake and endocellular distribution of IDA was analyzed by densitometric image analysis on cells treated for 10, 20, 30 and 60 min and 2 h with scalar dosages from 10 ng/ml to 2430 ng/ml. Microscopic observations and densitometric analyzes revealed that in the cells treated with IDA, fluorescence was higher in the cytoplasm compared to the nucleus and increased with the change in dosage. Moreover, densitometric data showed that IDA uptake in the first 20 min was higher in the neoplastic cells, but after that period its behavior became heterogeneous at 30 and 60 min, while at 2 h there was an inversion of the trend. These results suggest that the in vitro cytotoxicity should be evaluated in order to verify whether the elevated uptake of IDA in the first 20 min of treatment is really correlated to a more elevated toxicity in the neoplastic cells with respect to the normal cells. This is presently under investigation.     

27例肾腺癌的图象细胞仪定量分析

测定２７例肾腺癌的ＤＮＡ含量，并联系肿瘤的分级等部分形态学指标，对透明细胞型和颗粒细胞型肿瘤进行比较分析。发现：透明细胞型肾腺癌的分化一般较好，ＤＮＡ以二倍体为主，预后相对较好；而颗粒细胞型肾腺癌的分化较差，ＤＮＡ以非二倍体为主，其预后较差。     

对构建特色医院文化的思考

21世纪的医院是文化的医院,21世纪医院的竞争是文化的竞争,谁能构建出具有特色的医院文化,谁就能赢得竞争主动权。构建特色医院文化,核心是形成共同的理想和精神支柱;关键是打造“学习型”医院组织;根本是树立以人为本、诚信求实的服务理念;目标是树立良好的医院形象;基础是加快医院信息化建设。