Operative treatment of chance injuries in the paediatric population

Purpose

Chance fractures are an uncommon spine injury in the paediatric population. As such there is a relative paucity of evidence in the literature to guide management decisions. We present our single centre experience in the operative management of these injuries.

Methods

All patients presenting to a tertiary paediatric trauma centre between 2000 and 2008 were included. Retrospective analysis of clinical (SRS-22 and Oswestry) and radiological outcomes was undertaken.

Results

Twelve patients underwent operative stabilization of a Chance type injury. Radiological and clinical outcome measures demonstrated excellent outcomes in the majority of patients with no significant complications.

Conclusions

Operative management of paediatric chance injuries with instrumentation results in excellent clinical and radiological outcomes.     

多聚(ADP-核糖)聚合酶抑制剂对大鼠缺血再灌注肾脏损伤的保护作用

目的探讨多聚（ADP-核糖）聚合酶（PARP）抑制剂3-氨基苯甲酰胺（3-AB）在大鼠-肾脏缺血再灌注损伤中的保护作用及对肾组织血管内皮生长因子A（VEGF-A）和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）mRNA表达的影响。方法将54只大鼠随机分为假手术组（S组）、再灌注后模型组（M组）和PARP抑制剂组（P组）,每组8只。比较各组大鼠右侧肾动脉缺血再灌注后2、6、12h后的血肌酐和尿素氮水平、肾脏组织病理学变化、肾组织PARP蛋白表达及肾组织VEGF-A和NGAI．mRNA表达。结果（1）M组各时间点的血肌酐、尿素氮水平均高于S组,P组各时间点血肌酐、尿素氮明显低于M组,差异均有统计学意义（P〈0．01）;（2）P组肾组织病理学表现较M组改善;（3）P组各时间点肾组织PARP表达明显低于M组,差异有统计学意义（P〈0．05）;（4）与M组相比,P组肾组织的VEGF-AmRNA的表达升高,NGALmRNA表达降低,有统计学差异（P〈0．05）。结论PARP抑制剂3AB对大鼠肾脏缺血再灌注损伤具有保护作用,可下调NGAL及上调VEGF-AmRNA表达。     

Neonatal airway obstruction caused by rapidly growing nasopharyngeal teratoma

A case report is presented of a rapidly growing congenital nasopharyngeal teratoma (epignathus) in a preterm infant, leading to severe upper airway obstruction. Prenatal diagnosis by ultrasonography did not reveal the condition because the tumour masses were initially small and there was no polyhydramnios. Epignathus is a rare cause of upper airway obstruction of the newborn that can grow rapidly in the neonatal period and should be treated surgically.
Conclusion:  Epignathus is a rare cause of upper airway obstruction of the newborn that can grow rapidly in the neonatal period.     

Atlanto-axial rotatory fixation: Improved demonstration using spiral CT

Atlanto-axial rotatory fixation (AARF) is an uncommon condition which is often missed at presentation because of its rarity and the relative subtlety of plain film X-ray findings, but early detection and appropriate management are vital for a cure. We describe three cases in which the use of spiral computed tomography scanning with 3D and sagittal reconstructions greatly aided diagnosis and management. The 3D images gave a more graphic picture of the overall alignment of the upper cervical spine and the skull base, while the sagittal reconstructions demonstrated the presence or absence of compensatory atlanto-occipital subluxation. The literature is briefly reviewed.     

Chemosensitization of solid tumor cells by alteration of their susceptibility to apoptosis

Chemosensitization strategies use the administration of one drug or agent to render cancer cells more susceptible to a second agent. Usually this involves enhanced drug metabolism, improvement of drug uptake or blockage of resistance mechanisms. Alteration of the susceptibility of cancer cells to apoptosis, the process of individual cell death by which many chemotherapeutic drugs act, shows particular promise for therapy in the future, and is the focus of this review. The dependence of cancer cells on non-neoplastic cells to form solid tumors allows anti-angiogenic therapy to be used in conjunction with chemotherapy to increase the therapeutic index. Chemosensitization strategies are set to become increasingly important in cancer therapy, allowing rational design of synergistic drug combinations at an earlier stage in drug development.     

A fatal case of coxsackievirus B4 meningoencephalitis

BACKGROUND: Coxsackieviruses and echoviruses are common causes of aseptic meningitis, but they rarely cause life-threatening illness. We report a fatal case of coxsackievirus B4 meningoencephalitis in a woman who developed extrapyramidal symptoms suggestive of encephalitis lethargica. The exact causative agent of encephalitis lethargica has rarely been found, but most cases of the syndrome are assumed to be of viral origin. CASE DESCRIPTION: A 33-year-old woman previously treated with methylprednisolone and cyclophosphamide for Henoch-Sch?nlein purpura was transferred from a referring hospital because of sore throat, fever, and chills. Her neurologic findings progressed from headache with mild photophobia to lethargy, cogwheeling, increased tone in all 4 limbs, and brisk reflexes. The patient was diagnosed as having coxsackievirus B4 meningoencephalitis and, despite treatment with the experimental antiviral agent pleconaril, died of an overwhelming central nervous system infection and myocarditis. Magnetic resonance imaging showed focal hyperintense lesions in the substantia nigra that corresponded to the location of pathological changes seen at autopsy. CONCLUSIONS: This patient had a fulminant coxsackievirus B4 viral meningoencephalitis with a clinical pattern reminiscent of encephalitis lethargica and striking focal abnormalities in the substantia nigra identified on magnetic resonance imaging. The magnetic resonance imaging findings correlated with pathological changes identified at autopsy that were similar to the pathological findings observed in patients with encephalitis lethargica and postencephalitic parkinsonism. It is likely that the patient's immunocompromised state led to an overwhelming infection from an otherwise relatively innocuous viral infection.