Acute graft extrusion following central corpectomy in patients with cervical spondylotic myelopathy and ossified posterior longitudinal ligament

We studied the influence of surgeon experience, number of levels operated and level of the lower mortise on acute graft extrusion in patients undergoing uninstrumented one-level to three-level central corpectomy (CC) for cervical spondylotic myelopathy (CSM) or ossified posterior longitudinal ligament (OPLL). Between 1992 and 2005, 410 consecutive patients underwent one-level to three-level CC with autologous iliac (in one-level and two-level corpectomy) or fibular (in three-level corpectomy) graft. The surgeon’s experience was divided into four eras (I-IV; three eras of 100 consecutive patients each and the fourth with the last 110 patients). Eight patients (1.95%) experienced acute graft migration and seven required re-exploration. The graft extrusion rate in the first era was significantly higher than in the other three eras (6%, 1%, 1%, 0%; p = 0.01) implying a significant learning curve. The extrusion rates for one-level, two-level and three-level CC were not significantly different (3%, 1.6%, 0% respectively; p = 0.3). The extrusion rate for grafts ending in the C7 body (3/230, 1.6%) was not significantly different from the data for grafts ending in other bodies (5/180, 2.8%) (p = 0.23). There is a low incidence of acute graft migration in patients undergoing uninstrumented CC with autologous bone grafts with a significant learning curve in avoiding graft extrusion.     

Effect of pretreatment with a tyrosine kinase inhibitor (PP1) on brain oedema and neurological function in an automated cortical cryoinjury model in mice

Cerebral oedema is a significant cause of morbidity in neurosurgical practice. To our knowledge, there is no ideal drug for prevention or treatment of brain oedema. Based on the current understanding of the pathogenesis of brain oedema, tyrosine kinase inhibitors could have a role in reducing brain oedema but preclinical studies are needed to assess their effectiveness. We evaluated the role of pretreatment with 4-amino-5-(4-methylphenyl)-7-(t-butyl)pyrazolo(3,4-d)pyrimidine (PP1), an Src tyrosine kinase inhibitor, in reducing cerebral oedema and preserving neurological function measured 24 hours after an automated cortical cryoinjury in mice. Sixteen adult male Swiss albino mice were subjected to an automated cortical cryoinjury using a dry ice–acetone mixture. The experimental group (n = 8) received an intraperitoneal injection of PP1 dissolved in dimethyl sulfoxide (DMSO) at a dose of 1.5 mg/kg body weight 45 minutes prior to the injury. The control group (n = 8) received an intraperitoneal injection of DMSO alone. A further eight mice underwent sham injury. The animals were evaluated using the neurological severity score (NSS) at 24 hours post-injury, after which the animals were sacrificed and their brains removed, weighed, dehydrated for 48 hours and weighed again. The percentage of brain water content was calculated as: {[(wet weight – dry weight)/wet weight] × 100}. The mean (standard deviation, SD) NSS was 11.7 (1.8) in the experimental group and 10.5 (1.3) in the control group (p = 0.15). The mean (SD) percentage water content of the brain was 78.6% (1.3%) in the experimental group and 77.2% (1.1%) in the control group (p = 0.03). The percentage water content in the experimental and control groups were both significantly higher than in the sham injury group. The immediate pre-injury administration of PP1 neither reduced cerebral oedema (water content %) nor preserved neurological function (NSS) when compared to a control group in this model of cortical cryoinjury.     

Synthesis of Novel Hybrids Inspired from Bromopyrrole Alkaloids Inhibiting MMP‐2 and ‐12 as Antineoplastic Agents

Synthesis of novel set of forty semicarbazide/thiosemicarbazide hybrids inspired from marine bromopyrrole alkaloids is reported. Biological screening of these hybrids against a panel of five human cancer cell lines identified a number of hits endowed with interesting cytotoxicity profile. Compounds 5c and 5e (IC₅₀ = 0.03 μm ), 5t (IC₅₀ = 0.03 μm ), 4s (IC₅₀ = 0.07 μm ), and 5n (IC₅₀ = 0.01 μm ) displayed maximum cytotoxicity toward hormone‐dependent breast cancer cells MCF 7 , hepatic cancer cells WRL 68 , colon cancer cells Ca CO 2 and mouth and oral cancer cells KB 403 , respectively. The most active hits were further investigated for their potential to inhibit MMP‐2 and MMP‐12. Compound 5e showed maximum activity (IC₅₀ = 1.8 μm ) toward MMP‐2. Further, we preformed anti‐invasive assay on the most active compounds, where Ca CO 2 tumor cell migration was significantly decreased (77.9%) by hybrid 5e . The non‐toxicity toward human VERO cells (IC₅₀ = 83.1 to 231.8 μm ) indicated the selectivity of most active hits ( 5c , 5e , 5t and 5n ) toward cancer cells.     

Efficacy of Single Dose Azithromycin as Prophylactic Antibiotic in Surgical Removal of Mandibular Third Molars: A Clinical Study

Objective

To evaluate the efficacy of single dose Azithromycin as prophylactic antibiotic in surgical removal of mandibular third molar.

Materials and Methods

The study was carried out as an open clinical trial on fifty (23 males & 27 females) patients chosen from the ones referred to our Oral & Maxillofacial Surgery Department for surgical removal of mandibular third molar (SRMTM). Pre-surgical evaluation of pain, swelling, lymphadenopathy, fever and purulent discharge from the surgical site were made. All patients were administered oral Azithromycin 500mg, 1 hour prior to the procedure. The patients were followed up clinically for a minimum period of 10 days post operatively. Evaluation for pyrexia, purulent discharge from surgical site, persistent pain &/or swelling & lymphadenopathy was done on 1st, 3rd, 7th and 10th postoperative day to determine SSI (surgical site infection). All patients received same set of post-operative medications (Tab. Diclofenac sodium (50mg) TID, Tab. Ranitidine 150 mg BID for 5 days) and set of instructions.

Results

Surgical site infection was seen in only one patient (2%) out of the total fifty patients included in the study when oral Azithromycin was administered one hour prior to surgical removal of mandibular third molar.

Conclusion

Our study suggests that, giving antibiotics pre-operatively 1 hour before the SRMTM is beneficial to reduce/avoid SSI. The surgeon must consider all potential factors that may contribute to the post-operative complication and decide whether the benefits of antibiotic therapy outweigh its risks.