Safe zone for the superior gluteal nerve in the transgluteal approach to the dysplastic hip: intraoperative evaluation using a nerve stimulator

Background The superior gluteal nerve can be damaged during the transgluteal approach to the hip in total hip arthroplasty.

Methods We studied 30 patients with hip dysplasia who underwent total hip arthroplasty through the transgluteal approach. The course of the inferior branch of the superior gluteal nerve was identified using a nerve stimulator. The distance between the nerve and the tip of the greater trochanter was measured.

Results The mean distance was 37 (25-45) mm at the anterior third, 40 (30-50) mm at the middle third, and 44 (35-55) mm at the posterior third of the gluteus medius. The distance was influenced by the severity of hip dysplasia and decreased as the degree of hip dysplasia became more severe.

Interpretation A 3-cm safe zone is appropriate in most dysplastic hips. In severely dysplastic hips, however, the superior gluteal nerve occasionally coursed within 3 cm of the tip of the greater trochanter. In such hips, a nerve stimulator can be used to identify the nerve.     

N-acetyl-L-cysteine suppresses constitutive expression of CD11a/LFA-1alpha protein in myeloid lineage

We investigated the possible involvement of redox regulation in constitutive expression of CD11a/LFA-1alpha, a leukocyte integrin alpha subunit, in myeloid cells using antioxidants. In unstimulated HL-60 cells, CD11a/LFA-1alpha was highly expressed, however, no expression of CD11b and CD11c proteins was detected. N-acetyl-L-cysteine (NAC) markedly down-regulated CD11a/LFA-1alpha expression in a dose-dependent manner. The down-regulated CD11a/LFA-1alpha expression was gradually recovered when NAC was deprived 24h after treatment. Pyrrolidine dithiocarbamate (PDTC) also suppressed the level of expression CD11a/LFA-1alpha protein, although the effect of PDTC was less potent than NAC. Both NAC and PDTC suppressed NF-kappaB binding activity to consensus DNA probe, and this result was correlated with a suppressive effect to CD11a/LFA-1alpha expression. Furthermore, NAC also down-regulated CD11a/LFA-1alpha expression in both U937 cells and peripheral blood monocytes. These results indicated that the constitutive CD11a/LFA-1alpha expression in the myeloid lineage is implicated in oxidative stress occurring spontaneously, suggesting that alteration of the intracellular redox state using antioxidants may be effective in the modulation of cell adhesion associated with extravasation in leukocytes, at least, in myeloid cells.     

Value of oxaliplatin treatment in heavily pretreated patients with non-Hodgkin's lymphoma

In order to assess the efficacy and toxicity profile of oxaliplatin, a third generation platinum derivate active against several solid tumors, we carried out a study in a group of heavily pretreated patients with non-Hodgkin's lymphoma (NHL). Between August 2003 and May 2004, 19 pretreated patients were enrolled in a phase II trial and were treated with oxaliplatin. The drug was administered intravenously on day 1 of a 21-day schedule, at a dose of 130 mg/m² for a total of 6 cycles. One (5%) patient achieved complete remission (CR) and 5 patients (27%) had partial response (PR), thus giving an overall response rate of 32%. The patient in CR suffered from an aggressive B NHL. One of the 5 patients in PR had an aggressive B NHL, whereas the remaining 4 had an indolent B NHL. The treatment was well tolerated with minimal hematologic and extrahematologic toxicity. These data suggest and confirm the efficacy and low toxicity of oxaliplatin in the treatment of patients with heavily pretreated NHL. Further trials using oxaliplatin alone or in combination with other conventional drugs are needed.     

Local chemotherapy with interferon-alpha for conjunctival mucosa-associated lymphoid tissue lymphoma: a preliminary report

OBJECTIVE: To evaluate the efficacy of subconjunctival interferon-alpha for the treatment of conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma. DESIGN: Small, noncomparative, interventional case series. PARTICIPANTS: Five patients with histologically proven conjunctival MALT lymphoma were studied prospectively. METHODS: Patients were given 1,500,000 international units (IU) of interferon-alpha (IFN-alpha) (Roferon-A) subconjunctivally inside the lesion, three times a week for four weeks. If there was even a minimal response, a further cycle of 1,000,000 IU three times a week for four weeks was administered. Patients received a maintenance dose of 1 million IU, every 15 days for 4 times, after clinical resolution of the lesion. MAIN OUTCOME MEASURES: Patients were followed clinically, with slit lamp examination, for evidence of tumor disappearance or recurrence. RESULTS: Complete response was obtained in all patients. The lesion resolved completely by the eighth week. Four patients did not show any local recurrence with a median follow-up of 21 months (12-36 months). One patient presented with a recurrence after 11 months, in association with systemic lymphoma progression. CONCLUSIONS: Local chemotherapy with IFN-alpha seems to be an effective treatment modality, alternative to radiotherapy, for conjunctival MALT lymphomas.     

FK506 facilitates chemical kindling induced by pentylenetetrazole in rats

To clarify the possible role played by calcineurin in kindling development, we examined the effects of pretreatment with FK506, a selective calcineurin inhibitor, on pentylenetetrazole (PTZ) kindling in rats. FK506 facilitated the speed of kindling induced by repeated administration of 30-mg/kg PTZ, while FK506 did not ameliorate acute seizure manifestations after a single injection of PTZ. Our results suggested that calcineurin might exert an inhibitory effect on PTZ kindling.     

Lesser sac hematoma as a sign of rupture of hepatocellular carcinoma in the caudate lobe

The purpose of this study was to evaluate the CT findings of rupture of hepatocellular carcinoma (HCC) in the caudate lobe of the liver. The CT scans of five cases of rupture of HCC in the caudate lobe of the liver were retrospectively reviewed and correlated with clinical records. All cases showed exophytic tumors in the caudate lobe of the liver and high-attenuation hematomas in the lesser sac on CT. A lesser sac hematoma may be a sentinel clot sign of rupture of HCC in the caudate lobe. Received: 27 March 2000 Accepted: 18 July 2000