Die posteriore, lumbale, interkorporelle Fusion in unilateraler transforaminaler Technik

Zusammenfassung Operationsziel Beseitigung von schmerzhaften Wirbels?uleninstabilit?ten und Dekompression nervaler Strukturen durch interkorporelle Fusion. Wiederherstellung der Form und Wirbels?ulenfunktion. Indikationen Segmentale Instabilit?t(en) bei chronischen, therapieresistenten Lumboischialgien infolge von Diskushernie und-protrusion, Osteochondrose, Spondylolisthese oder Spinalstenose. Kontraindikationen Kyphotische und fixierte Fehlstellungen der Lendenwirbels?ule, anatomische Anomalien oder Vernarbungen im oder um das Foramen intervertebrale, Kreuzschmerzen ohne neurologische Symptome, ungünstige psychosoziale Bedingungen. Operationstechnik Einseitige ?ffnung des Foramen intervertebrale und Ausr?umung der Bandscheibe nach Teilresektion von Gelenkanteilen des kranialen und kaudalen Wirbelk?rpers. Bilaterale Distraktion zur Erweiterung des Bandscheibenfaches mit einem Schrauben-Stab-System. Implantation von autogenem Knochen und zwei metallischen Abstützk?rpern. Wiederherstellung der Segmentstabilit?t durch Kompression der dorsalen Instrumentation gegen die vorderen Abstützk?rper. Ergebnisse Von Oktober 1993 bis August 1996 wurden 191 Patienten operiert, 89 M?nner und 102 Frauen im Durchschnittsalter von 53 Jahren (zw?lf bis 82 Jahre). Diagnosen siehe Tabelle 1, fusionierte Segmente siehe Tabelle 2, intra- und postoperative Komplikationen siehe Tabelle 3. Postoperative Kontrollen nach drei, sechs und zw?lf, zum Teil nach 24 Monaten. Schmerzstatus nach Denis siehe Tabelle 5. Die besten Resultate wurden bei degenerativer Spondylolisthese und isthmischer Defektspondylolisthese erzielt. Beim Postnukleotomiesyndrom “nur” in 60% gute bis befriedigende Resultate.     

Separation of temperature sensitive and temperature insensitive components of the postsynaptic potentials in the frog motoneurons

Intracellular measurements were made in the in situ spinal cord of the frog at temperatures below 5 degrees C. Responses to volleys in the sciatic nerve, in the descending fibres and in the motor axons were studied. About 30% of the motoneurons responded to sciatic volleys with 1-3 ms segmental latency, which was short enough to assume electrotonic mediation of these responses. Another group of motoneurons responded with 6-8 ms latency, i.e. with the expected delay at chemical synapses at low temperature. Latency distribution of the sciatic-evoked postsynaptic potentials was clearly bimodal in contrast with that found at higher temperatures. Postsynaptic discharges occurred with rather long latency and they were attributed to chemically-mediated excitation. Some of the postsynaptic potentials to descending volleys also occurred with quite short latency, indicating possible electrotonic transmission from supraspinal centres to motoneurons. Latency distribution of the action potentials evoked from the motor axons was bimodal, corresponding to the different, i.e. antidromic and recurrent facilitatory, mechanism of these spikes. Calculated Q10 ratios for the sciatic-evoked reflex discharges and the afferent fibre volleys were about 2.3 and 1.8, respectively. We concluded that cooling helps to separate postsynaptic potentials according to their electrotonic and chemical mediation and that electrotonic excitation does not seem to have a primary role in the generation of postsynaptic discharges initiated by dorsal root volleys in the frog.     

Imatinib accelerates progenitor cell‐mediated liver regeneration in choline‐deficient ethionine‐supplemented diet‐fed mice

Severe chronic hepatic injury can induce complex reparative processes. Ductular reaction and the appearance of small hepatocytes are standard components of this response, which is thought to have both adverse (e.g. fibrosis, carcinogenesis) and beneficial (regeneration) consequences. This complex tissue reaction is regulated by orchestrated cytokine action. We have investigated the influence of the tyrosine kinase inhibitor imatinib on a regenerative process. Ductular reaction was induced in mice by the widely used choline‐deficient ethionine‐supplemented diet (CDE). Test animals were treated daily with imatinib. After 6 weeks of treatment, imatinib successfully reduced the extent of ductular reaction and fibrosis in the CDE model. Furthermore, the number of small hepatocytes increased, and these cells had high proliferative activity, were positive for hepatocyte nuclear factor 4 and expressed high levels of albumin and peroxisome proliferator‐activated receptor alpha. The overall functional zonality of the hepatic parenchyma (cytochrome P450 2E1 and glucose 6 phosphatase activity; endogenous biotin content) was maintained. The expression of platelet‐derived growth factor receptor beta, which is the major target of imatinib, was downregulated. The anti‐fibrotic activity of imatinib has already been reported in several experimental models. Additionally, in the CDE model imatinib was able to enhance regeneration and preserve the functional arrangement of hepatic lobules. These results suggest that imatinib might promote the recovery of the liver following parenchymal injury through the inhibition of platelet‐derived growth factor receptor beta.     

PRACTICE GUIDELINES IN PEDIATRIC HEMATOONCOLOGY: Implementation and Survey. A Possible Way for Medical Quality Assurance

The Hungarian Pediatric Oncology Working Group intended to change the practice of prescribing diagnostic tests as well as to examine the possibility of introducing indicators about the time factors of medical care. A nationwide accepted protocol was established for these tests. The examined time factors were the length of elapsed time from admittance to treatment and the length of hospital stay for different reasons (diagnosis, treatment, complications). Included in to this study are the new cases of 5 common groups of malignancies (acute lymphoblastic leukemia and non-Hodgkin lymphoma, osteosarcoma, soft tissue sarcoma, Wilms tumor, neuroblastoma) for a study period of 1 year. The follow-up data of 152 patients were examined; the length of survey was 1-12 months, depending on when the patients entered the study. As a continuous clinical audit, a system of survey was set up for each follow-up test, using a questionnaire about the conformity of physicians to the protocol, evaluating the principal reasons of deviation from the protocol. Using the data provided by this questionnaire, a renewal of the protocols for each disease was made three times during the whole study period. The principal reasons of nonconformity to the protocol were (1) complications, (2) the nonuse of the protocol, (3) nonacceptance of the protocol, and (4) technical problems. The authors intended to use their time indicators for benchmarking, to make a comparison possible between centers concerning the length of treatment, occurrence of complications, and delays in chemotherapy. However, the examination of the time indicators in the most frequent disease (acute lymphoblastic leukemia, n = 73) showed inverse correlation between the numberof admissions per year per center and the length of time elapsed up to the beginning of treatment. This points to a need for better cooperation in small centers at the initial phase of the diagnosis. The main result of this study is the successful elaboration and implementation of practice guidelines by information linked to performance (the feedback) in daily practice: Compliance during the first 3 months of the study was 28%, and compliance during the last 3 months was 61%.     

Development of the " core="" yellow="" flags="" index"="" (cyfi)="" as="" a="" brief="" instrument="" for="" the="" assessment="" of="" key="" psychological="" factors="" in="" patients="" undergoing="" spine="" surgery"="

European Spine Journal - Depression, anxiety, catastrophising, and fear-avoidance beliefs are key "yellow flags" (YFs) that predict a poor outcome in back patients. Most surgeons...     

Estimate of the dose-increment due to outdoor exposure to gamma rays from uranium progeny deposited on the soil around a coal-fired power plant in Ajka Town,Hungary

Brown coal unusually rich in uranium is burnt in a coal-fired power plant that lies inside the confines of a small industrial town named Ajka, Hungary, and has been operational since 1943. The 238U (226Ra) activity discharged to the atmosphere per unit electrical energy produced was about 330-400 GBq (GW y)(-1), which is 66-80 times more than that was estimated by UNSCEAR (1988) as a characteristic value for old type coal-fired power plants [5 GBq (GW y)(-1)]. The objective of this study was the experimentally established assessment of the artificial increment in the dose from external exposure to gamma rays of terrestrial radionuclides outdoors. Soil samples were collected in and near Ajka from 81 locations. The samples were investigated by Ge(Li) gamma spectrometry. Considerably elevated concentrations of uranium and its progeny have been measured in most of the samples that were collected near to the plant. Concentrations of 238U and 226Ra in the top (0-5 cm depth) layer of undisturbed soil at public areas inside town were 4.7 times higher, on average, than those in the uncontaminated deeper layers. Dose rate in air (air kerma) from external exposure to terrestrial gamma rays outdoors at a height of 1 m and effective doses were estimated from the measured activity concentrations using some relevant literature data. The estimated artificial increment in the dose rate in air was, on average, 32.8, 10.3, and 102.1 nGy h(-1) at public areas, vegetable gardens, and backyards, respectively. The mean artificial increment in the annual per caput effective dose from external exposure to terrestrial radionuclides outdoors is 21.8 microSv y(-1). The collective dose commitment per unit energy generated from outdoor exposure to the deposited uranium progeny is about 8.0-9.1 person Sv (GW y)(-1), which is 67-76 times more than that evaluated by UNSCEAR (1988) for a typical "old" coal-fired power plant [0.12 person Sv (GW y)(-1)]. Ajka is a suitable place for studying the dosimetric consequences of the utilization of coal for energy production experimentally.     

The effect of chronic otitis media on the immunoreactivity of human inner ear

Twenty temporal bones (TBs) were removed from autopsy cases and prepared for immunohistochemical examination. Ten TBs were free of ear disease whereas the other ten TBs showed the signs of chronic otitis media. Expression of markers for monocyte-macrophages¶(25F9, 27E10) and natural killer cells (anti-Leu-11) was examined immunohistochemically. There were no specific positive stainings with 25F9 or anti-Leu-11 antibodies in any of the specimens. Staining for 27E10 was found to be negative in each section obtained from normal cochlea. However, 27E10 positivity was detected in three of ten TBs with signs of chronic ear inflammation. This positivity can be explained by two theories: (1) activated monocytes can enter the inner ear from the systemic circulation as a consequence of chronic antigen challenge; (2) mesothelial cells could become activated as a result of a cross-reaction, with resultant positivity. Development of sensorineural hearing loss in some cases of chronic otitis media may be due to these immunological reactions.