The spine in sickle cell disease

Summary Bone changes in sickle cell disease occur due to marrow hyperplasia, tissue ischaemia and infarction due to vaso-occlusion. Between 1982 and 1991 thirty four patients were treated in the Orthopaedic and Neurosurgery Departments of the Kind Fahd University Hospital, Al-Khobar, with spinal complications due to sickle cell disease. There were 21 males and 13 females aged between 4 and 28 years (mean 17.4 years). Structural changes in the vertebral bodies due to marrow hyperplasia occurred in 44% of the patients. Avascular necrosis leading to collapse of the vertebral bodies was seen in 9 (27%) patients. Infective spondylitis was the most serious complication seen in 8 (24%) patients; the majority needed anterolateral decompression and bone grafting. The spine is often affected in sickle cell disease and aggressive treatment with close follow-up is required to avoid disabling complications.

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Résumé Les modifications osseuses survenant au cours de la drépanocytose sont la conséquence d'une hyperplasie médullaire, d'une ischémie tissulaire et d'un infarcissement liés à l'occlusion vasculaire. Cette étude rétrospective analyse les complications rachidiennes de la drépanocytose observées de 1982 à 1991. Trente-quatre patients ont été traités dans les services d'orthopédie et de neuro-chirurgie de l'Hôpital universitaire King Fahd à Al Khobar. Il s'agissait de 21 hommes et de 13 femmes, âes en moyenne de 17.4 ans, avec des extrêmes de 4 à 28 ans. Des modifications structurales du corps vertébral liées à l'hyperplasie médullaire sont survenues chez 44% des patients. Des nécroses avasculaires responsables d'un effondrement du corps vertébral ont été observéees chez 9 patients (26.5%). La spondylite infectieuse, qui constitue la complication la plus grave, a concerné 8 patients (23.5%), dont la plupart ont bénéficié d'une décompression antérolatérale et de greffes osseuses. Nous pensons que le rachis est souvent atteint au cours de la drépanocytose et qu'un traitement agressif et une étroite surveillance sont nécessaires pour éviter des séquelles majeures.

     

Inclusion complexation of furosemide in cyclodextrins. Part 2: Implication on bioavailability

The effect of inclusion complexation of furosemide in cyclodextrins (CyD) on the bioavailability of the drug was studied on normal human volunteers. The excretion rate of the drug was determined by HPLC for a period of 24 h. post dosing. Several pharmacokinetic parameters were calculated and statistically analyzed. viz., peak excretion rate, peak excretion time, half peak time, elimination rate constant, area under the excretion rate time-curve as well as the total amount of drug excreted. The obtained results show that on administration of furosemide in the form of an inclusion complex in CyDs particularly beta-CyD or its dimethyl derivative may improve its biological performance, taking into consideration that furosemide is characterized by a rapid onset and a short duration of action. Inclusion complexation of furosemide in CyDs leads to a more or less delay in its onset of action, a significant increase in its duration of action as well as significant augmentation in its overall biological availability.     

Renal cell carcinoma with inferior vena cava tumor thrombi

Renal cell carcinoma is a unique neoplasm because of its common propensity to propagate into the renal vein and inferior vena cava (IVC) as tumor thrombus. Historically, the surgical difficulties encountered in removal of these cancers limited the ability of a single institution to obtain experience with large numbers of instances. Between January 1956 and July 1987, 68 patients with renal cell carcinoma extending into the IVC or right atrium underwent radical nephrectomy with vena cava thrombus extraction at the Cleveland Clinic. Twenty-five patients had partial resection of the IVC with reconstruction. Fifteen patients had partial resection and reconstruction of the IVC; however, because of narrowing of the infrarenal IVC, persisting bland thrombus in the proximal IVC or iliac veins or concern regarding postoperative pulmonary emboli, the infrarenal IVC was either ligated or clipped. Seven patients underwent cavectomy with division of the IVC. A right atriotomy was performed upon 14 patients and cardiopulmonary bypass was used in 20 patients, with 17 also having deep hypothermic circulatory arrest. The tumor thrombus was removed intact in 64 per cent of the patients and in multiple small fragments ("piecemeal") in 36 per cent of the patients. The mortality rate was 7 per cent. Survival was examined relative to extent of vena caval thrombus. Patients with extension into the atrium had a significantly worse prognosis than those with other levels of vena caval involvement. Other factors, such as lymph node status, perinephric fat involvement, resection of IVC and intact or "piecemeal" extraction, did not influence the survival rate. Patients with pre-existing metastases preoperatively had an extremely poor survival rate. The techniques now available for surgical resection of all levels of tumor thrombus of the IVC make resection feasible in most patients. In our opinion, the addition of deep hypothermic circulatory arrest has been a significant advance.     

Primitive intracranial ependymomas. Salah-Aza?z institute experience]

PURPOSE: - To assess the outcome and prognostic factors of patients with primitive intracranial ependymomas treated at the department of radiotherapy of Salah-Aza?z Institute. METHODS AND MATERIAL: - Between 1972 and 1997, 31 patients aged one to 53 years received postoperative radiotherapy. There were 16 males and 15 females. Location of tumor was infratentorial in 24 cases and supratentoriel in seven cases. Surgical treatment consisted of complete resection in 14, incomplete resection in 13 and unknown type in four patients. All patients were treated with radiotherapy to the craniospinal axis in 26 cases, whole brain in five cases. RESULTS: - Five years survival rate was 63%. For infratentorial tumors, two patients failed locally, two patients failed locally and at distance and four patients failed only at distance, while one patient with supratentorial tumor relapsed locally. Age, performances status, tumor site, gender and extent of surgery had no impact on survival. The treatment field extent was the only variable predictive of outcome. Patients treated with craniospinal irradiation had a survival rate of 86% compared with 37,5% for patients treated with whole brain irradiation. CONCLUSION:- Infratentorial ependymomas seem to have a worse prognosis than supratentorial ones. Irradiation field extent should be correlated to prognostic factors.     

Trans-scleral cyclophotocoagulation: a tale of two probes

To compare the histological effects of trans-scleral cyclophotocoagulation (TCP) performed with two different probes, the G-probe (IRIDEX Medical Instruments, Mountain View, CA, USA) and the Ciliprobe (Katalyst Surgical, Chesterfield, MO, USA). TCP was performed on two human cadaver eyes from the same corpse. The vertical meridian was marked and opposite sides were treated using either the G-probe or Ciliprobe. The first eye was treated with each probe at 2000ms/2000 mW and the second eye at 3000ms/1500 mW. Histological examination revealed separation and loss of the non-pigmented ciliary epithelium as well as vacuolization in all sections for both probes and settings. Changes to the non-pigmented ciliary epithelium treated at 3000ms/1500 mW were similar between the two probes. A slightly more complete separation of the non-pigmented epithelium was noted on the Ciliprobe treated sections as compared to the G-probe treated sections in the eye treated at 2000ms/2000 mW. Therefore, in human cadaver eyes, both the G-probe and Ciliprobe produced separation, vacuolization, and loss of the non-pigmented ciliary epithelium at two different, clinically utilized settings.     

Dextromethorphan Abuse in Texas, 2000–2009

ABSTRACT

This article aims at identifying a threshold number of drinks per day beyond which there is a high risk of developing alcoholic behavior that would enable physicians to more confidently support the use of alcohol for cardiovascular risk prevention. In a randomly selected, population-based sample of 2,042 adults 45 years or older, we graded alcohol drinking behavior using the Self-Administered Alcoholism Screening Test, quantified alcohol amount by questionnaire, and assessed the prevalence of cardiovascular disease (coronary, peripheral, or cerebrovascular disease) by medical record review. Although optimal alcohol use (≤2 drinks/day) was associated with reduced odds of cardiovascular disease, 43% of alcoholics and 82% of problem drinkers reported alcohol use in the optimal range as well. The association of alcohol use in the optimal range with alcohol-related behavioral problems supports the reluctance in physicians from recommending alcohol use for cardiovascular benefit, not withstanding the underreporting of alcohol use by alcoholics.