Ethanol binging exacerbates sinusoidal endothelial and parenchymal injury elicited by acetaminophen

BACKGROUND/AIMS: The pathophysiology of binge drinking of ethanol and its potentiation of acetaminophen (APAP) toxicity has received very little attention. To evaluate if ethanol binging sensitizes hepatic sinusoidal endothelial cells (SEC) and liver to APAP toxicity. METHODS: The histopathological responses to APAP were evaluated in the livers of mice gavaged with APAP alone, following a single, week-end type ethanol binge (4 g/kg every 12 h x 5 doses) or three weekly binges. RESULTS: Six hours after APAP, 600 mg/kg elicited severe centrilobular necrosis together with hemorrhagic congestion and infiltration of erythrocytes into the Space of Disse through large gaps that had formed in SEC. There was no evidence of parenchymal injury at 2 h, but gaps already were formed through the cytoplasm of the SEC by coalescence of fenestrae. A single binge followed by 300 mg/kg APAP elicited SEC and parenchymal injury equivalent to 600 mg/kg APAP alone at 2 and 6 h. The responses were exacerbated following three binges. Lower glutathione levels in the liver were shown in ethanol-binged animals. CONCLUSIONS: Ethanol binging increases APAP hepatotoxicity. SEC are an early target for APAP-induced injury and ethanol binging enhances the SEC injury prior to evidence of parenchymal cell injury.     

Cytocompatibility and viscoelastic properties of phthalate ester-free tissue conditioners

We prepared prototype phthalate ester-free tissue conditioners (PFT) from a powder of poly(ethyl methacrylate) and a mixture of several liquids, including di-n-butyl sebacate, benzyl benzoate (BB), and ethanol. The estrogenic activities of the liquids in the PFT were measured by an E-screen assay. We also assessed the cytotoxicity of the prototype and commercial tissue conditioners against a living skin equivalent. Finally, the viscoelastic properties were determined by measuring the rubber hardness and initial flow, while the effect of the mixing liquid on the mechanical properties of a denture resin was assessed by three-point bending test. PFT did not show any estrogenic activity and displayed a low or a similar level of cytotoxicity as the conventional materials. The viscoelastic properties and the effect of the mixing liquid on mechanical properties were influenced by the quantity of BB present in the mixing liquid. The prototype is therefore a reasonable PFT candidate.     

Long-term serological outcome of infants who received frozen-thawed milk from human T-lymphotropic virus type-I positive mothers

AIM: Human T-lymphotropic virus type-I (HTLV-I) infection occurs via mothers' milk during feeding. However, freeze-thaw processing can eliminate the infectivity of the mother's milk of HTLV-I carriers. METHODS: A long-term follow-up survey was conducted to investigate the HTLV-I infectivity of frozen-thawed mothers' milk among infants whose mothers were HTLV-I seropositive. RESULTS: Infants fed frozen-thawed mothers' milk did not become HTLV-I antibody-positive up until 1 year old, and all children followed up until an age of 11-12 years were antibody negative. CONCLUSIONS: This study showed that freeze-thaw processing can eliminate the HTLV-I infectivity of mothers' milk, and that HTLV-I carriers can indirectly feed their infants using frozen-thawed mothers' milk as a way to prevent HTLV-I infection.     

Intensity-modulated stereotactic radiotherapy of paraspinal tumors: a preliminary report

OBJECTIVE: Radioresistant paraspinal tumors may benefit from conformal treatment techniques such as intensity-modulated radiotherapy (IMRT). Local tumor control and long-term palliation for both primary and metastatic tumors may be achieved with IMRT while reducing the risk of spinal cord toxicity associated with conventional radiotherapy techniques. In this article, we report our initial clinical experience in treating 16 paraspinal tumors with IMRT in which the planning target volume was 2 mm or greater from the spinal cord. METHODS: IMRT was administered by using a linear accelerator mounted with a multileaf collimator. Two immobilization body frames developed at Memorial Sloan-Kettering Cancer Center were used for patients with and without spinal implants. During a 30-month period, 16 patients underwent IMRT for metastatic and primary tumors. Eleven patients were treated for symptomatic recurrences after undergoing surgery and prior external beam radiotherapy, and one patient was treated after undergoing radiotherapy for a metastatic pancreatic gastrinoma with overlapping ports to the spine. Four patients with primary tumors were treated after primary resection that resulted in positive histological margins. Twelve patients were symptomatic with pain, functional radiculopathy, or both. Tumoral doses were determined on the basis of the relative radiosensitivity of tumors. Patients with metastatic tumors were administered a median tumoral dose of 20 Gy in four to five fractions and a spinal cord maximum dose of 6.0 Gy in addition to the full tolerance dose administered in previous radiation treatments. The primary tumors were delivered a median dose of 70 Gy in 33 to 37 fractions and a spinal cord maximum dose of 16 Gy. The median tumoral volume was 7.8 cm(3). RESULTS: Of the 15 patients who underwent radiographic follow-up, 13 demonstrated either no interval growth or a reduction in tumor size in a median follow-up period of 12 months (range, 2-23 mo). Two patients, one with a thoracic chondrosarcoma and one with a chordoma, showed tumor progression 1 year after undergoing IMRT. Pain symptoms improved in 11 of 11 patients, and 4 of 4 patients had significant improvement in their functionally significant radiculopathy and/or plexopathy. Pain relief was durable in all patients except the two with tumor progression. No patient showed signs or symptoms of radiation-induced myelopathy, radiculopathy, or plexopathy, including 12 patients with a median follow-up of 18 months. CONCLUSION: IMRT was effective for treating pain and improving functional radiculopathy in patients with metastatic and primary tumors. Although long-term tumor control is not established in this study, high-dose tumoral irradiation can be performed without causing radiation myelopathy in more than 1 year of follow-up.     

Traumatic spondylolisthesis of the lumbosacral spine with multiple fractures of the posterior elements

We describe a patient with a traumatic spondylolisthesis of L5 and multiple, bilateral pedicle fractures from L2 to L5. Conservative treatment was chosen, with eventual neurological recovery and bony union. We are not aware of previous reports of this pattern of injury.     

Prosthetic alignment and sizing in computer-assisted total knee arthroplasty

We implanted 60 posterior stabilized total knee prostheses (P.F.C. Sigma, DePuy, Warsaw, USA). In 30 cases, we used a CT-free navigation system (Vector Vision, Brain LAB, Heimstetten, Germany), and in 30 matched-paired controls, we used a conventional manual implantation. We compared postoperative long-leg radiographs in the two groups. The results revealed a significant difference in favor of navigation. In addition, we compared the preoperative anteroposterior dimension of the femoral condyle with the postoperative value. While there were no significant differences in the preoperative anteroposterior dimension of the femoral condyle between the two groups, the postoperative value in the navigation group was significantly larger than that of the preoperative value. Therefore, surgeons using navigation systems should guard against the possibility of oversizing when determining the size of the femoral component.

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Résumé Nous avons implanté 60 prothèses totales postéro-stabilisées du genou (P.F.C. Sigma, DePuy). Dans 30 cas nous avons utilisé un système de navigation sans scanner (Vector vision R, Laboratoire du Cerveau, Heimstetten, Allemagne) et dans 30 contrôles appairés nous avons utilisé une implantation manuelle habituelle. Nous avons comparé les grandes radiographies postopératoires des membres inférieurs dans les deux groupes. Les résultats ont révélé une différence notable en faveur de la navigation. De plus nous avons comparé la dimension antéro-postérieure du condyle fémoral avant lintervention avec la valeur postopératoire. Tandis quil ny avait pas de différence notable dans la dimension antéro-postérieure préopératoire du condyle fémoral entre les deux groupes, la valeur postopératoire dans le groupe de la navigation était nettement plus grande que la valeur préopératoire. Par conséquent les chirurgiens qui utilisent des systèmes de navigation doivent prendre garde à ne pas implanter un composant fémoral sur-dimensionné.

     

Spontaneously stabilized severe dysplastic spondylolisthesis without operation: long-term follow-up of a preteenage patient

Surgical management is the accepted treatment choice for grade III or IV spondylolisthesis, and many satisfactory clinical and radiologic follow-up results have been reported. Very little, however, has been written about long-term results in preteenage patients in whom dysplastic spondylolisthesis has been treated nonoperatively, especially in those who have > or =50% displacement of the fifth lumbar vertebra on the sacrum. We report an unusual case of spontaneous stabilization of severe dysplastic spondylolisthesis in an 8-year-old girl who presented with grade III spondylolisthesis of L5-S1 and was followed up for >14 years in the absence of surgical intervention. On presentation, she complained of a restriction in forward bending and tightness of hamstrings, but she was undisturbed in her daily activities. Initial radiographs showed severe dysplastic spondylolisthesis; however, magnetic resonance imaging (MRI) performed at age 9 years showed that the amount of listhesis was much less than that seen in the initial radiograph. Routine radiographic follow-ups were chosen over early operative measures until she became a teenager. There was no change in the slip, and unusually a gradual ossification of the cartilaginous promontory of the S1 and the posterior lip of the L5 was observed. At 22 years old, the patient is asymptomatic and not conscious of her cosmetic appearance. Surgical treatment has generally been indicated for patients with grade III or IV spondylolisthesis, because slippage progression has been noted in most reported cases. However, MRI may be a tool for predicting which dysplastic spondylolisthesis cases are more likely to progress and therefore circumvent surgical intervention, while maintaining an excellent outcome.