Current status of anterior spine surgery for scoliosis

The greatest need for anterior spine surgery is for those cases that have neurological involvement with pressure or stress forces exerted on the spinal cord. With anterior decompression excising anomalous bone, shortening the spine with posterior osteomies, and correction with Harrington instrumentation, many of these cases were protected against neurological sequelae as well as correction of the deformity. Anterior spine reconstruction is a 2-stage procedure. The procedure protects against damage to the blood supply, untethers the spinal cord, corrects deformity, and stabilizes the spinal column. As more cases that can benefit from anterior spine correction of scoliosis are recognized, the expertise to deal with these lesions continues to grow.     

Characterization of NADPH-cytochrome P-450 reductase in a mouse hepatoma cell line

NADPH-cytochrome c reductase in Hepa-1 cells was induced 2-fold by phenobarbital, but was not induced by benz[a]anthracene or 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). The apparent K_m of the enzyme for NADPH was 0.57 μM; the activity was inhibitable by NADP; and segregated primarily to the microsomal fraction. Cytoplasm of Hepa-1 cells bound antibody to rabbit cytochrome P-450 reductase. 3T3 cells, which possessed one sixth of the cytochrome c reductase activity of Hepa-1 cells, bound correspondingly less cytochrome P-450 reductase antibody. This supports the notion that cytochrome P-450 reductase was responsible for the cytochrome c reductase activity that was measured.     

Effect of ultrafiltrate volume on determination of free phenytoin concentration

Monitoring free phenytoin concentration is clinically useful for patients with uremia, hepatic disease, hypoalbuminemia, and related conditions. Free phenytoin is commonly measured by immunoassay in the protein-free ultrafiltrate prepared by centrifuging serum for 20-30 minutes, using an appropriate ultrafiltration device. We studied the effect of centrifugation time (15-40 minutes) and protein concentrations on ultrafiltration volume, and the related effects on measured free phenytoin concentrations. Temperature was ambient for all studies. The ultrafiltration volumes were directly proportional to centrifugation time and were inversely proportional to the protein concentrations. Although ultrafiltration volume significantly increased with longer centrifugation time, the measured free phenytoin concentrations did not increase proportionately. The concentration of phenytoin in the residual serum retained in the ultrafiltration device did not change proportionally either. Therefore, equilibrium of phenytoin concentrations between the ultrafiltrate and retentate was maintained, regardless of centrifugation time or protein concentration.     

Progress in Treatment of Thoracoabdominal and Abdominal Aortic Aneurysms Involving Celiac, Superior Mesenteric, and Renal Arteries

This is a report of surgical treatment of thoracoabdominal aortic aneurysms and aneurysms of the abdominal aorta from which the visceral vessels arise during the 18 year period from April 5, 1960, to April 20, 1978. The extent of aneurysm is divided into five groups. Group I (10 patients) involved most of the thoracic and abdominal aorta down to celiac axis. Group II (22 patients) involved most of the thoracic and abdominal aorta distal to left subclavian artery. Group III (20 patients) were those with lesser involvement of the thoracic aorta and most of the abdominal aorta. Group IV (18 patients) with involvement of the entire abdominal aorta and Group V (12 patients) with involvement of lower abdominal aorta and renal arteries. Treatment in the majority of these cases was by graft inclusion technique with visceral vessel reattachment by direct suture of orifice to openings made in the graft. Intercostal and/or lumbar arteries were also reattached in some with the more extensive lesions. Aortic and renal artery occlusion times varied from 15 to 155 minutes. Paraplegia developed in five patients with the more extensive lesions but was reduced to one-third and made less severe by reattaching intercostal and lumbar arteries. Renal dysfunction was mild in four patients and severe in three patients after operation. All these were transient except one who died while recovering from renal failure. The latter cases were those difficult to reattach or were not initially successful and required reoperation. Of the 82 patients, 77 (94%) survived operation and long-term followup was obtained in 95% of cases, 23 performed over five years ago. Actuarial curves were constructed and compared to survival curves following simple infrarenal abdominal aortic resection. The survival rate both immediately and at six years, were the same.