Management options for lower pole renal calculi

PURPOSE OF REVIEW: The optimal treatment of lower pole renal calculi is controversial. Shock wave lithotripsy, ureteroscopy and percutaneous nephrostolithotomy all constitute viable therapeutic options in select patients. RECENT FINDINGS: Lower pole stones smaller than 1 cm in diameter can be managed with observation, shock wave lithotripsy or ureteroscopy. Patients electing expectant management should be counseled regarding the potential for stone-related symptom progression and need for future intervention. Shock wave lithotripsy and ureteroscopy have similar stone-free rates, although shock wave lithotripsy may be preferable due to more favorable secondary outcomes. Lower pole stones 1-2 cm in diameter are best managed with percutaneous nephrostolithotomy, although ureteroscopy is an option in select patients, particularly those not considered candidates for percutaneous nephrostolithotomy. Finally, patients with lower pole stones larger than 2 cm are best served with percutaneous nephrostolithotomy, as the morbidity in experienced hands is low and stone-free rates are unequivocally higher than those of other treatment modalities. SUMMARY: A variety of factors, including patient body habitus, local renal anatomy, cost and patient preference, must be taken into consideration when determining the optimal treatment modality for lower pole renal calculi.     

Teratogenicity of antiepileptic drugs: role of drug metabolism and pharmacogenomics

The approach to clinical decision-making pertaining to the use of antiepileptic drugs (AEDs) during pregnancy has relied on previous accumulated experience and, since the 1990s, on data from pregnancy registries. The limitations of this process are that no information regarding the chemical attributes of the AED under consideration, nor the role of a number of enzyme systems that are known to interact with foreign compounds to modify their potential for harm, are included. The role of the hepatic mixed function oxidase system may be especially important in conferring teratogenic risk. However, systems such as epoxide hydrolase, glutathione reductase, superoxide dismutase and other toxin-scavenging systems may be important modifiers that lower the risk. Knowledge is also accumulating on the interactions of AEDs with molecular targets such as histone deacetylase and peroxisome proliferator-activated receptors that may play important roles in teratogenesis. While our knowledge of these factors are incomplete, progress can be achieved by beginning to include these concepts in our discussion on the topic and by promoting research that may improve our ability to individualize the analysis of risk for a specific patient with regards to specific AEDs.     

A presenilin 1 mutation (Arg278Ser) associated with early onset Alzheimer's disease and spastic paraparesis

Early onset familial Alzheimer’s disease (EOFAD) has been associated with mutations in three genes, of which presenilin 1 (PSEN1) mutations are the most frequent. Several families with an association of progressive dementia and spastic paraplegia caused by PSEN1 mutations have been described. Here we described a novel PSEN1 mutation that was associated with dementia and spastic paraplegia in a family with 5 affected individuals in three generations. The proband was a 44-year-old woman who presented with 5 years history of progressive difficulties in walking, cognition and visuospatial impairment. Her maternal grandmother, mother and two maternal aunts also had similar neurological presentation. Molecular genetic analysis showed a missense mutation predicted to substitute an arginine residue for a serine residue at position 278 in the PSEN1 polypeptide (Arg278Ser). The novel PSEN1 mutation identified in this patient adds to the diverse list of existing mutations causing EOFAD associated with spastic paraparesis.     

A new technique of internal suture mastopexy for mild to moderate breast ptosis

BACKGROUND:

Current mastopexy techniques rely on incisions on the breast to correct ptosis. Trading a ptotic breast for a visibly scarred breast can be a difficult choice.

OBJECTIVE AND METHODS:

A technique of internal suture mastopexy that consists of plicating sutures placed in the superficial fascia of the breast from the deep surface is presented. The procedure leaves no scar on the breast and may be safer than other techniques when combining mastopexy with augmentation.

RESULTS:

The senior author has performed this procedure on over 120 patients, with a mean follow-up of two years. Patients and the surgeon have expressed satisfaction with the procedure.

CONCLUSION:

Based on this experience with over 120 patients, the authors believe that internal suture mastopexy is an effective alternative in selected patients.     

The development of acetabular retroversion in children with Legg-Calvé-Perthes disease

BACKGROUND: Ezoe et al showed that the prevalence of acetabular retroversion in adults with Legg-Calvé-Perthes disease (LCPD) was 42% versus 6% in normal controls. Our purpose was to study the development of acetabular retroversion in children with LCPD and perhaps draw conclusions regarding cause and effect. METHODS: We reviewed all 271 patients with LCPD seen at our institution to identify those patients with axial imaging before closure of the triradiate cartilage. Fifty-three hips (44 patients) formed our study population; the 35 normal hips in those patients with unilateral disease served as an internal control. Acetabular version was measured on the axial cut with the largest femoral head cross-section. Diseased versus control hips were compared using a paired t test. Two disease-severity subgroups, Herring A or B (42 hips) and B/C or C (11 hips), were compared using an independent-samples t test. In those patients followed past skeletal maturity (16 of 53 hips), we evaluated final AP pelvic radiographs for acetabular retroversion (presence of a crossover sign). RESULTS: Before skeletal maturity, all but 1 patient in our series demonstrated positive acetabular version (anteversion). We found no significant difference between the diseased and control hips: mean acetabular version in LCPD hips was 13.6 +/- 4.3 versus 15.4 +/- 5.4 degrees in unaffected hips. More severe cases (B/C or C) exhibited significantly more relative retroversion (10.8 degrees) than less severe cases (14.6 degrees, P = 0.047). Of the 16 hips followed past skeletal maturity, 5 demonstrated crossover signs on anteroposterior pelvic radiographs, indicating a 31% prevalence of acetabular retroversion. CONCLUSION: Early after diagnosis, the prevalence of acetabular retroversion in our skeletally immature children with LCPD was extremely rare (1.8%), and there was no significant difference in version between the normal hips and hips with LCPD. However, over time, a child with a more deformed femoral head is more likely to develop acetabular retroversion, suggesting a cause-and-effect relationship. LEVEL OF EVIDENCE: Level III (case-control).     

How safe is the operative treatment of Gartland type 2 supracondylar humerus fractures in children?

Whereas operative treatment of supracondylar fractures is now standard of care for Gartland type 3 supracondylar humerus fractures in children, the treatment of type 2 fractures remains somewhat controversial. The purpose of this article was to examine the safety and efficacy of closed reduction and pinning of type 2 supracondylar humerus fractures in children. METHODS: We performed a retrospective review of 189 type 2 supracondylar humerus fractures operatively treated at one tertiary care children's hospital from 2000 to 2006. Data were acquired from a review of radiographs and clinical notes. RESULTS: We found no intraoperative surgical or anesthetic complications in our series. None of our cases lost reduction after closed reduction and percutaneous pinning. There were 4 pin tract infections (2.1%) in our series: 3 were treated with antibiotics, and 1 needed irrigation and debridement in the operating room. This was the only patient who required reoperation for any reason. CONCLUSIONS: In this study, the largest reported series of type 2 supracondylar humerus fractures in children, we found an extremely low rate of complications after closed reduction and percutaneous pinning; secondary operations were also uncommon (0.5%). Our series demonstrates a high probability of satisfactory outcome after operative treatment of type 2 supracondylar fractures compared with previous studies of children treated by closed reduction without pinning. LEVEL OF EVIDENCE: Therapeutic study, level 4 (case series [no or historical control group]).     

Effect of tetracycline on pancreas and liver function of adult male albino rats

The effect of tetracycline, at two doses of 50 and 200 mg kg(-1) daily, was studied on pancreatic and liver tissue function for 14 and 21 days in adult male albino rats. For pancreatic function the parameters studied were content of amylase and lipase in pancreas, serum amylase and lipase, serum glucose and faecal fat excretion. For liver function, liver specific enzymes in serum, namely alanine amino transaminase, aspartate amino transaminase and lactate dehydrogenase were estimated. In addition, total lipid, antiperoxidative enzymes and lipid peroxidation were measured in pancreas and liver. The content of amylase and lipase in pancreas showed a small but significant decrease in the rats given 50 mg kg(-1) for 21 days and the decrease was much more significant in those receiving the 200 mg kg(-1) dose. In pancreas free radical levels show a significant increase and reduced glutathione shows a substantial decrease at the 50 mg kg(-1) level and a significant change in these parameters was observed at the 200 mg kg(-1) dose. Antioxidant enzymes, superoxide dismutase, glutathione peroxidase, glutathione reductase and catalase, showed a small but significant decrease in the pancreas of the rats treated with 50 mg kg(-1) tetracycline. A significant decrease in the antioxidant enzymes level was observed at the 200 mg kg(-1) dose. In the liver, free radical levels and reduced glutathione were within the normal range at the 50 mg kg(-1) level and significant changes were observed at 200 mg kg(-1). The antioxidant status was unaffected in liver after treatment with tetracycline at the 50 mg kg(-1) level and a significant decrease was observed at the higher dose. Our results reveal the safe nature of tetracycline with respect to the liver at the lower dose tested, whereas, both the higher and lower doses seem to have detrimental effect on the pancreas as revealed by the rise in free radical levels and decrease in the antioxidant enzyme levels.     

Single-level cervical radiculopathy: clinical outcome and cost-effectiveness of four techniques of anterior cervical discectomy and fusion and disc arthroplasty

Although there are several accepted methods of surgical treatment for single-level cervical radiculopathy, the choice depend on the surgeon’s preference. The techniques may vary in peri-operative morbidity, short- and long-term outcome, but no study so far has analyzed their cost-effectiveness. This study might give some insight in balancing cost and effectiveness and deciding the right technique. Sixty consecutive patients (15 each group), mean age 36 (range 24–76 years) with single-level cervical disc disease underwent surgical treatment with four different techniques in two centers over the period of 1999–2005. The four groups were—(1) plate and tricortical autograft, (2) plate, cage, and bone substitute, (3) cage only, and (4) disc arthroplasty. The data was collected prospectively according to our protocol and subsequently analyzed. The clinical outcome was assessed comparing visual analog scale (VAS) of neck pain and, short form 12 (SF12) questionnaire both pre- and postoperatively. The radiological assessment was done for fusion rate and postoperative related possible complications at 3 months, 6 months, 1 year, and final follow-up. The cost analysis was done calculating the operative time, hospital stay, implant cost together. The mean follow-up period was 31 months (range 28–43 months). The clinical outcome in terms of VAS of neck and arm pain and SF12 physical and mental score improvement (P = 0.001) were comparable with all four techniques. The radiological fusion rate was comparable to current available data. As the hospital stay was longer (average 5 days) with plate and autograft group, the total cost was maximum (average ￡2,920) with this group. There was satisfactory clinical and radiological outcome with all four techniques. Using the cage alone was the most cost-effective technique, but the disc arthroplasty was comparable to the use of cage and plate. Anterior cervical discectomy and fusion is an established surgical treatment for cervical radiculopathy. Single-level cervical radiculopathy was treated with four different techniques. The clinical outcome and cost-effectiveness were compared in this study.     

Synthesis and anti-microbial screening of some Schiff bases of 3-amino-6,8-dibromo-2-phenylquinazolin-4(3H)-ones

In the present study, a series of novel Schiff bases were synthesized by condensation of 3-amino-6,8-dibromo-2-phenylquinazolin-4(3H)-ones with different aromatic aldehydes via cyclized intermediate 6,8-dibromo-2-phenyl benzoxazin-4-one. The chemical structures were confirmed by means of IR, (1)H NMR, (13)C NMR, Mass spectral and Elemental analysis. These compounds were screened for anti-bacterial (Staphylococcus aureus ATCC-9144, Staphylococcus epidermidis ATCC-155, Micrococcus luteus ATCC-4698, Bacillus cereus ATCC-11778, Escherichia coli ATCC-25922, Pseudomonas aeruginosa ATCC-2853, and Klebsiella pneumoniae ATCC-11298) and anti-fungal (Aspergillus niger ATCC-9029 and Aspergillus fumigatus ATCC-46645) activities by paper disc diffusion technique. The minimum inhibitory concentrations (MICs) of the compounds were also determined by agar streak dilution method. Among the synthesized compounds 3-(3,4,5-trimethoxybenzylideneamino)-6,8-dibromo-2-phenylquinazolin-4(3H)-one 10 was found to be the most potent anti-microbial activity with MICs of 18.9, 19.1, 18.8, 21.7, 18.2, 19.3, 16.7, 8.6 and 10.1 microg/ml against above mentioned respective strains. Compounds were found to exhibit more anti-fungal than anti-bacterial activity.