Intra-articular infiltration analgesia for arthroscopic shoulder surgery: a systematic review and meta-analysis

Phrenic-sparing analgesic techniques for shoulder surgery are desirable. Intra-articular infiltration analgesia is one promising phrenic-sparing modality, but its role remains unclear because of conflicting evidence of analgesic efficacy and theoretical concerns regarding chondrotoxicity. This systematic review and meta-analysis evaluated the benefits and risks of intra-articular infiltration in arthroscopic shoulder surgery compared with systemic analgesia or interscalene brachial plexus block. We sought randomised controlled trials comparing intra-articular infiltration with interscalene brachial plexus block or systemic analgesia (control). Cumulative 24-h postoperative oral morphine equivalent consumption was designated as the primary outcome. Secondary outcomes included visual analogue scale pain scores during the first 24 h postoperatively; time-to-first analgesic request; patient satisfaction; opioid-related side-effects; block-related adverse events; and any indicators of chondrotoxicity. Fifteen trials (863 patients) were included. Compared with control, intra-articular infiltration reduced 24-h postoperative analgesic consumption by a weighted mean difference (95%CI) of −30.9 ([−38.9 to −22.9]; p < 0.001). Intra-articular infiltration also reduced the weighted mean difference (95%CI) pain scores up to 12 h postoperatively, with the greatest reduction at 4 h (−2.2 cm [(−4.4 to −0.04]); p < 0.05). Compared with interscalene brachial plexus block, there was no difference in opioid consumption, but patients receiving interscalene brachial plexus block had better pain scores at 2, 4 and 24 h postoperatively. There was no difference in opioid- or block-related adverse events, and none of the trials reported chondrotoxic effects. Compared with systemic analgesia, intra-articular infiltration provides superior pain control, reduces opioid consumption and enhances patient satisfaction, but it may be inferior to interscalene brachial plexus block patients having arthroscopic shoulder surgery.     

Gene delivery to glioma cells in rat brain by grafting of a retrovirus packaging cell line

Retrovirus vectors only integrate into the genome of dividing cells and can thus be used to selectively infect tumor cells in the adult rat brain. Gene delivery was assessed by using the retrovirus BAG vector, which bears the Escherichia coli lacZ gene under the MoMLV LTR promoter-enhancer element, and by histochemical staining for bacterial beta-galactosidase activity. Direct injection of this vector (90-900 cfu) into the adult rat brain, with or without prior inoculation of C6 glioma cells (2 x 10(5) cells) resulted in labeling of only a few cells as assessed 1 week later. When the psi 2-BAG packaging line was grafted into the brain, labeled psi 2-BAG cells could be found after 1 day, but not after 5 days, following grafting, suggesting that the grafted cells had been rejected and that no endogenous cells had integrated released vector, or that expression of lacZ had been turned off. In contrast, when the psi 2-BAG packaging line was grafted into a brain region, which had been inoculated previously with rat C6 glioma cells (2 x 10(5) cells), beta-galactosidase labeling of these tumor cells, identified by immunocytochemistry for glial fibrillary acidic protein and S100, could be demonstrated 10 days later. Thus, grafting of retrovirus packaging lines into adult brain provides a mean to infect tumor cells in situ. The grafted packaging cells may continue to release retrovirus particles for an extended period, thus infecting more cells at the stage of division appropriate for viral integration, as compared to inoculation of the virus alone. Grafting of retrovirus packaging cell lines could be used to selectively deliver "killer" or "suppressor" genes to tumor cells in the brain to curtail their growth.     

Detection and survival of Listeria monocytogenes in milk and dairy products

Detection of L. monocytogenes in raw and pasteurized milk, Zabady, Karish, Domiati and Romi cheeses were done in this study using direct and cold enrichment methods. Out of 140 samples 3 samples were positive by cold enrichment and they were 2 of raw milk and one of Domiati cheese. Survival of L. monocytogenes was studied during heat treatment of milk by the sealed tube method of inactivation and it was found that L. monocytogenes inactivated completely at 60 degrees C for 15 minutes. There was a statistically inverse correlation between time of storage of dairy products and viable cell count of L. monocytogenes. PH played an important role in survival of that pathogen.     

Influence of surgery on renal amyloidosis

It is well known that renal amyloidosis (RA) leads to ESRD in a few years. This evolution may be accelerated by several factors such as steroids, renal vein thrombosis, infections or surgery. We report 22 patients (14M,8F) mean age = 41.6 years (13-72) with RA in whom surgery revealed or aggravated renal disease. The group I includes 15 patients with no previous history of renal disease and who developed oedema few days after surgery with acute renal failure in 5 of them. Proteinuria was present in all the cases with a nephrotic syndrome in 10. Percutaneous kidney biopsy (KB) showed renal amyloidosis in all patients (AA+ = 8 cases, AA- = 3 cases). Only 9 patients were followed-up (mean period = 40 months): 2 patients are stationary; 1 is on complete remission 2 are on HD and 4 died. The group II includes 7 patients with a previous history of nephropathy (Histologically proven amyloidosis: 3 CRF = 1, Oedema: 3). All these patients developed oedema few days after surgery with acute RF in 4 patients. KB performed in all of them showed RA (AA+ = 33, AA- = 1). 6 patients were followed up for a mean period of 11 months: 5 died, 1 patient is on HD. The influence of surgery on renal amyloidosis is often unforeseeable. It may have no effect on renal disease, but very often it reveals RA and sometimes dramatically aggravates the course of the disease with occurrence of irreversible CRF. The pathogenic role of surgery on RA is discussed.     

Progressive ECG changes in arrhythmogenic right ventricular disease Evidence foran evolving disease

Electrocardiography results were used to assess diagnosis andevolution of arrhythmogenic right ventricular disease. The initialECG presentation and long-term changes were analysed in 74consecutivepatients with symptomatic ventricular tachycardia and arrhythmogenicright ventricular disease. On first available tracings, a left axis deviation of the QRSwas found in 18 patients. The QRS length in V¹ was 110 ms in39 patients, an epsilon wave was present in 17, and a completenght bundle branch block in four patients. The T wave was negativein V₁–V₃ in 37 patients (50%). In 36 patients, long-term electrocardiographic follow-up of9.5 ± 3.2 years was available. During this period, ECGchanges were observed in 20 patients (56%):negative T wavesin 11 patients, a new left axis deviation in three, QRS enlargementin 13 (including eight right bundle branch block), right atrialhypertrophy in three, and paroxysmal or established atrial fibrillationin three. On studying all 110 ECG tracings (74 initial recordings +36follow-up ECGs), we found a strong correlation between QRS orT wave changes and the length of follow-up after the first symptom;mean time interval between first ventricular tachycardia andECG recording was significantly longer in patients with negativeT waves in the right precordial leads, QRS enlargement, or leftaxis deviation, than in patients without such abnormalities.ECG abnormalities were more frequent at 10 year and 5 year follow-upthan on initial tracings. A normal ECG was found in 40% of patientsduring the first year of follow-up, 8% at 5 years, and neverlater than the 6th year. In conclusion, electrocardiographic diagnosis of arrhythmogenicright ventricular disease may be difficult in the initial stageof the disease, since a normal ECG is found in up to 40% ofpatients. During the follow-up, progressive and characteristicECG changes will occur. Arrhythmogenic right ventricular diseasecan be excluded if the ECG is found to be normal 6 years orlater after a first ventricular tachycardia attack.     

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.     

Primary intramedullary ependymomas: retrospective study of 16 cases]

PURPOSE: To review the radiotherapy department experience in treating primary spinal cord ependymomas (PSCE), analyse prognostic factors and provide treatment recommendations regarding literature review. MATERIALS AND METHODS: Sixteen patients with PSCE received postoperative radiotherapy between 1972 and 1997. There were 10 male and 6 female patients with a mean age of 34 years (range 2-63). Surgery was gross total resection in 2 cases, subtotal resection in 9, biopsy in 4 and of unknown type in one patient. All patients were treated with radiotherapy to the craniospinal axis (4 cases), spinal cord (1 case) and to the site of primary tumour in 11 cases. RESULTS: Five year-survival rate was 73%. Two patients had recurrent tumours within the primary site. Gender, extent of surgery and treatment field extent were not prognostic factors. Histologic type was the only variable predictive of outcome. Patients with myxopapillary type had a 5-year survival rate of 100% compared with 47% for those with other histology types. CONCLUSION: We conclude that aggressive surgery is not necessary in the management of PSCE, localised field radiotherapy is associated with favourable outcome, and tumour grade is an important prognostic factor.