Spinal intradural tumours: Part I--Extramedullary

Sixty-six patients had surgery for an intramedullary nerve sheath tumour under the care of one surgical team in a 16-year period. Surgery concentrated on radical intra- and extradural excision combined if necessary with vertebral column reconstruction. Ninety procedures were used in 35 males and 30 females with an age range 12-81 years. Forty-five per cent were located in the cervical, 26% in the thoracic and 29% in the lumbosacral region. Eighteen patients had NF1 and two patients NF2. Sixty-five per cent were schwannomas, 27% were mixed histology and 6% malignant. In terms of functional outcome, 37 patients improved by one or more Frankel grades, three deteriorated by one Frankel grade and no one who presented with symptoms alone deteriorated. There were no operative deaths; no instrumentation failures and five patients developed a CSF leak.     

Results of a clinical care pathway for radical prostatectomy patients in an open hospital - multiphysician system

OBJECTIVES: The object of this study was to evaluate the results of a comprehensive clinical care pathway (CCP) aimed at reducing the length of hospitalization and overall cost for patients undergoing radical prostatectomy in a setting including both academic and private physicians. METHODS: The clinical records of 1,129 consecutive patients who underwent radical prostatectomy by 24 urologists between July 1, 1990, and December 31, 1996, were reviewed. The factors considered were length of stay, morbidity and mortality, readmission rates, and average cost. The CCP was implemented on January 1, 1994. Its scope was to minimize preoperative evaluation, eliminate the preoperative hospital stay, standardize postoperative care and provide intensive patient education. RESULTS: The average length of stay decreased significantly after implementation of the CCP (8.1 vs. 4.9 days, p = 0.0001). In 1990, there was a large difference in length of stay between academic and private physicians (8.3 vs. 12.6 days) (p = 0. 02) but by 1 year after implementation of the CCP there was virtually no difference (4.69 vs. 4.71 days) (p > 0.05). Complication rates were similar before and after implementation of the CCP. Using the average 1993 cost/case as the baseline preCCP figure, the average cost of radical prostatectomy decreased by 16% in 1994 and by 22% in 1995. CONCLUSIONS: It is possible to successfully implement a CCP in a multi-physician system to reduce length of stay and cost of radical prostatectomy without subjecting the patient to a greater risk of complication.     

The comparative validity of eleven alcoholism typologies

OBJECTIVE: This study directly compared the clinical validity of 11 empirically defined alcoholism typologies to determine whether some typologies are clinically more valid than others. METHOD: A sample of 360 hospitalized alcoholic men were extensively evaluated at entry into the study and again 1 year later. Twenty-three measures of clinical validity were employed; 15 were postdictive and 8 were predictive. Postdictive retrospective measures obtained at entry into the study included family history, age of onset and lifetime course characteristics associated with alcoholism severity, general psychopathology and psychosocial functioning. Predictive outcome measures drawn from information obtained during the 1-year follow-up included: abstinence, alcoholism severity and clinician ratings of outcome. The measures were subjected to various statistical analyses, including factor analysis. RESULTS: We found that all of the alcoholism typologies met at least 7 of the 23 a priori measures of clinical validity. The correlations between these conceptually and methodologically disparate typologies were often striking. Exploratory factor analysis, which explained 35% of the variance, suggested three possible underlying dimensions to account for the overlap among typologies: (1) age and its correlates, including age-of-alcoholism onset; (2) "pure" alcoholism versus psychiatrically heterogeneous alcoholism that encompassed antisocial personality disorder; and (3) current severity of psychiatric distress, impairment and dysfunction. CONCLUSIONS: No single method of subtyping alcoholics clearly emerged as superior. All demonstrated some degree of predictive and postdictive clinical validity. Most methods of subtyping correlated positively with each other at moderate, but typically significant, levels.     

Prostate cancer old problems and new approaches

Rates of prostate cancer (PCa) have increased so dramatically over the last decade that the age adjusted incidence rate for PCa is now greater than that any other cancer among men in the United States. This review, published as a three part series, provides a state-of-art assessment of the PCa problem in its divergent aspects.Part 1 covers epidemiology, incidence and progression. Several epidemiological studies have demostrated that first degree male relatives of men with PCa are at increased risk of developing the disease. Familial and genetic factors as well as medical, anthropometric, dietary, hormonal and occupational factors involved in PCa are discussed. Postmortem examination of the prostate in men without evidence of PCa documented a high frequency of adenocarcinoma. Latent disease occurred as early as the second decade of life. Although there is no significant difference in incidence between Caucasian and African-American males, high grade prostatic intraepithelial neoplasia (HGPIN) is higher in the latter group. While dietary fat, androgens and certain environmental factors may be determinants for PCa, the exact mechanism of tumorigenesis is still relatively unknown. The current thinking of the role of genomic instability, chromosomal alterations, tumor suppressor genes and the androgen receptor are explored.     

An electron microscopic study of the termination of intracortical axons upon Betz cells in area 4 of the monkey.

After small lesions within the cortex of area 4 of the monkey degenerating axon terminals have been seen with the electron microscopy to contact the cell bodies, proximal parts of the apical dendrites and initial segments of Betz cells 0.5 to 2.5 mm from the damage. The degenerating axon terminals make symmetrical synapses which are presumed to be inhibitory in function. The degenerating terminals are probably from the axons of the basket cells described in Golgi-impregnated material, and which correspond to the large stellate cell recognized in electron microscopic studies.     

Human and rodent fibroblasts - model systems for studying senescence and immortalization (review)

Normal mammalian fibroblasts cultured in vitro will not divide indefinitely but undergo senescence and give rise to cells that can no longer be induced to divide. It is possible to overcome this finite life span by either cellular mutation or by the exogenous introduction of some viral or cellular oncogenes. This review describes the characteristics of senescence and the different ways in which it can be overcome.     

Aspirin usage and its influence on femoro-popliteal vein graft patency. The Femoro-popliteal Bypass Trial Participants.

As part of the Femoro-popliteal Bypass Trial patients undergoing femoro-popliteal vein bypass were randomised to aspirin 300 mg and dipyridamole 150 mg twice daily or identical placebo tablets. Blood was taken from a subgroup of 145 patients (mean age 66.3 years) with patent grafts at 6 months. Serum salicylate analysis revealed that of the 65 randomised to receive placebo 18 (28%) had evidence of salicylate in their sample (greater than 50 ng ml-1). Similarly, in those randomised to active treatment and considered to be good compliers 16/61 (26%) had no evidence of salicylate in their serum sample (less than 50 ng ml-1). Analysis of primary graft patency by "intention to treat" failed to detect a difference by life table, the risk being slightly higher in the group assigned to placebo (RR = 1.33, 95% confidence internal C.I. 0.64-2.78, p = 0.438). When comparing patients with no detectable serum concentration (less than 50 ng ml-1) with patients with serum salicylate over 50 ng ml-1 there was a significant difference in graft patency at 66 versus 83% respectively at 3 years (RR = 2.38, 95%C.I. 1.08-5.26, p = 0.024). When corrected for a number of possible risk factors this significant difference was maintained (RR = 2.78, 95%C.I. 1.15-6.67, p = 0.017). Although these findings are based on observational data they provide indirect evidence of an improvement in graft patency with aspirin. This result combined with the finding of a significant reduction in cardiovascular events in the main trial results support the use of aspirin and dipyridamole in patients undergoing femoro-popliteal vein bypass.     

The national athletic injury/illness reporting system 3-year findings of high school and college football injuries*

The National Athletic Injury/Illness Reporting System is a national surveillance system created from several workshops at which physicians, athletic trainers, and sports administrators shared their ideas for obtaining meaningful data. The primary objective was to provide a feasible and inexpensive mechanism for the continuous collection and analysis of information on sports-related injuries. Additionally, the project offers institutions and agencies a useful system of recordkeeping. NAIRS collects data on a wide range of sports, however, this report clarifies the risk of injury for high school and college football. Presented are data on neurotrauma, meniscus/knee sprains, and ankle sprains. Playing surface, surface hardness, surface friction, and shoe-turf interface were also examined. It was concluded that no helmet type or brand was associated with unusually high levels of risk. Artificial surfaces did not constitute an additional risk of significant concussion. An association between playing surface and the risk of knee and ankle injuries was observed. J Orthop Sports Phys Ther 1979;1(2):103-108.     

Inhibition of hyperacute transplant rejection by soluble proteins with the functional domains of CD46 and FcgammaRII

BACKGROUND: Recombinant soluble forms of complement regulatory molecules, including the human complement regulatory protein CD46 (rsCD46), have been shown to inhibit hyperacute transplant rejection (HAR) and protect against complement-mediated inflammatory tissue damage. Similarly, recombinant soluble forms of the immunoglobulin receptor FcgammaRII (rsFcgammaRII) can attenuate antibody-mediated inflammatory responses. We have produced and tested the function of novel recombinant chimeric proteins that incorporate the functional domains of both CD46 (membrane cofactor protein, MCP) and the low affinity human IgG receptor FcgammaRII (CD32). METHODS: Two recombinant soluble chimeric proteins (CD46:FcR and FcR:CD46) were designed and produced using a human cell expression system. Their ability to protect cells against complement-mediated lysis (through the CD46 domain) and bind human IgG (through the Fc receptor domain) was assessed in vitro. They were also tested in vivo in the rat reverse passive Arthus reaction and a murine model of hyperacute cardiac transplant rejection. RESULTS: In vitro, the functional domains of the chimeric proteins each retained their activity. In vivo, the serum half-life of the recombinant chimeric proteins in mice was more than either rsCD46 or rsFcgammaRII. In the rat reverse passive Arthus reaction, intradermal injection of each recombinant protein substantially reduced inflammatory skin edema (>50%) and polymorphonuclear neutrophil infiltration (>90%). In the hyperacute rejection model, i.v. treatment with FcR:CD46 prevented complement-mediated rejection, macroscopic bruising, edema, and thrombosis more effectively than rsCD46. CONCLUSIONS: CD46/FcgammaRII bifunctional proteins have an improved ability to control complement-mediated hyperacute graft rejection and have therapeutic potential in other conditions involving antibody-mediated inflammation.