Effect of the F508del genotype on outcomes of endoscopic sinus surgery in children with cystic fibrosis

Objective

Numerous authors have sought to describe genotype–phenotype correlations in cystic fibrosis (CF), notably to pancreatic insufficiency and lung disease. However, few studies have focused on the association between the F508del genotype and response to sinus surgery. The objective of this study is to assess the effect of the F508del genotype on sinonasal disease severity and outcomes following functional endoscopic sinus surgery (FESS) in a pediatric population.

Methods

A retrospective chart review of 153 children with CF seen at a tertiary care pediatric hospital from 1995 to 2008 was performed. Patients were classified into one of three groups according to F508del genotype, either as homozygous, heterozygous or not carrying a F508del mutation. The sinonasal disease phenotype of the three groups was compared based on clinical and radiological findings, extent of endoscopic sinus surgery and rate of revision surgery.

Results

The relationship between the F508del genotype and pancreatic insufficiency was confirmed (p < 0.05). There was no association between the F508del genotype and increased need for FESS (p = 0.75). Moreover, no association was established between F508del homozygosity and presence of nasal polyps, Lund–Mackay score, extent of surgery or length of postoperative hospitalization. The rates of revision surgery did not differ significantly among the three genotypes analyzed (p = 0.59).

Conclusion

There is no clear association between the F508del genotype and an increased need for FESS, extent of surgery, or revision surgery. Given the phenotypic variability of sinonasal disease in patients with CF, a prospective study is needed to better understand outcomes following FESS and the contribution of gene modifiers to this effect.     

ORIGINAL ARTICLE: Long-term outcomes of vertebroplasty for osteoporotic compression fractures

Introduction: This study aimed to determine outcomes of percutaneous vertebroplasty for osteoporotic vertebral compression fractures (VCFs). Methods: Prospective assessment of short-term (≤6 weeks), medium-term (6 months) and long-term (29 months) outcomes of vertebroplasty, followed by a retrospective long-term follow-up of patients treated with vertebroplasty compared with conservative therapy. Outcomes measured were visual analogue scale pain scores, analgesic use, disability scores using the Roland Morris Disability questionnaire and a number of new VCFs. Results: In 27 patients with acute VCFs followed prospectively, vertebroplasty resulted in significant reductions in pain levels (56-mm reduction on a 100-mm scale) and disability scores (11.8-point reduction on a 24-point scale) at all follow-up points up to a mean of 29 months compared with pre-vertebroplasty levels (P < 0.001). Analgesic use was significantly less intense in the short and medium term after vertebroplasty (P < 0.005). In 25 patients who had vertebroplasty for VCF, a sustained reduction in all outcomes was demonstrated at a mean follow-up of 30 months, with less pain, significantly lower disability scores (P < 0.05) and less analgesic use (P < 0.05) compared with nine conservatively treated subjects. During the follow-up period, six new VCFs occurred in 4/25 vertebroplasty patients compared with four new VCFs in 2/9 control subjects. Conclusions: Vertebroplasty provides significant and clinically meaningful reductions in pain, analgesic use, and disability in the short, medium and long term. Compared with conservative therapy, vertebroplasty provides significantly greater functional improvement and reduction in analgesic use. The procedure is relatively safe with no clearly increased risk of new vertebral fractures.     

高位腰椎间盘突出症9例

1 临床资料高位腰椎间盘突出9(男7,女2)例,年龄18～72(平均49)岁,病程8～36(平均15) mo. 均有腰背痛,但无明确压痛点. 伴有大腿前方痛、股四头肌肌力减退、膝反射减弱5例,坐骨神经痛、足拇背伸肌力减退、跟腱反射减弱3例,直腿抬高试验阳性4例,2例跟臀试验阳性. 均经腰椎正侧位X线平片及CT,MRI检查、腰椎管造影而确诊.     

Human myelogenous leukemia: enhanced clonal proliferation in the presence of phorbol diesters

Phorbol diesters, including 12-0-tetradecanoyl-phorbol-13-acetate (TPA) at low concentrations, enhanced the clonal proliferation of a human myelogenous leukemia cell line (KG-1). TPA (1.0 X 10(-9) -5.0 X 10(-11) M) increased KG-1 clonal growth by four to tenfold in the presence of suboptimal concentrations of colony stimulating factor (CSF) and by two to fourfold in the presence of maximally stimulating concentrations of CSF. The ability of TPA analogs to enhance KG-1 clonal growth paralleled their reported ability to promote tumors in mice. Only slight CSF activity was detected in the conditioned medium from KG-1 cells cultured in liquid medium with TPA. TPA was unable to increase myeloid clonal growth of CSF-stimulated normal human model to study TPA enhancement of CSF-stimulated growth.     

Notfallmedizinisches Zentrum Hamburg

Die Geschichte des Hamburger Rettungsdienstes kann über 200 Jahre zurückverfolgt werden. Schon 1794 beschaffte die “Hamburgische Rettungsgesellschaft” unter Hinweis auf die gro?e Bedeutung der schonenden Bef?rderung 20 leichte “Tragbahren von Korbarbeit geflochten mit erh?hter Kopflage und beiderseitigen Tragestangen” zum Preis von je 10 Hamburger Curant. Diese Tragen wurden in den “n?chst am Wasser gelegenen Wachth?usern” aufgestellt. Sp?testens mit der 1850 ergangenen beh?rdlichen Anordnung, einen eigenen Krankenwagen in Betrieb zu nehmen, darf Hamburg für sich in Anspruch nehmen, die erste deutsche Stadt mit einem organisierten Rettungswesen gewesen zu sein. Dieser Beitrag beschreibt, wie sich aus der geschichtlichen Entwicklung heraus die heutige Situation des Hamburger Rettungsdienstes mit seinen Strukturen, Rettungsmitteln und Aufgabengebieten darstellt.     

Antitrust aspects of exclusive contracts in medical imaging

Exclusive contracts between radiologists and hospitals may be more frequently scrutinized for antitrust violations because of the Hyde v Jefferson Parish Hospital District No. 2 case. In the Hyde case, the lower court decided antitrust law had been violated, and it was the first antitrust case about exclusive medical contracts to be reviewed by the U.S. Supreme Court. The case is a precedent for considering similar circumstances according to traditional business antitrust analyses such as per se violations, tying arrangements, group boycott, and market foreclosure. Areas that may be scrutinized for anticompetitiveness include hospital privileges when radiologists have exclusive contracts with the community's only hospital or provide services unique within an area, and physicians' access to scarce resources (e.g., computed tomography [CT], magnetic resonance [MR] imaging). Radiologists must understand antitrust implications of their hospital contracts; examine the terms of staff appointment, bylaws, and rights; and be able to guide their attorneys through contract negotiations.