Behavior of C-reactive protein in association with surgery of facial fracture and the influence of dexamethasone

Purpose

To clarify pre- and postoperative C-reactive protein (CRP) levels in patients with facial fractures and to investigate the influence of perioperatively administered dexamethasone on postoperative CRP levels.

Patients and methods

Facial fracture patients were randomized to receive perioperatively a total dose of 30 mg of dexamethasone (Oradexon®), whereas patients in the control group received no glucocorticoid. The analysis included patients who had CRP measured pre- and postoperatively.

Results

A total of 73 adult patients with facial fractures were included in the final analysis. Mean CRP level was elevated preoperatively and the level increased further after surgery. However, postoperative CRP rise was significantly impeded by dexamethasone (p?<?0.001), regardless of gender, age, treatment delay, site of fracture, surgical approach, and duration of surgery. CRP rise halved on the 1st postoperative day when dexamethasone was used. In addition, dexamethasone resulted in a CRP decrease on the 2nd postoperative day, whereas the CRP rise continued in the control group.

Conclusions

CRP rise is a normal body response after facial fracture and surgery that can be markedly reduced with dexamethasone. CRP changes should be considered with caution if perioperative dexamethasone is used.

     

Erratum to: Long-term results of surgery for lumbar spinal stenosis: a randomised controlled trial

European Spine Journal -     

Bisphosphonate treatment in craniofacial fibrous dysplasia—a case report and review of the literature

Fibrous dysplasia (FD) is a benign skeletal disorder which may affect one or multiple bones. Lesions often involve long bones, ribs, and craniofacial bones and cause pain, fractures, and disfigurement. We describe an adolescent girl with mandibular FD who was successfully treated with bisphosphonates. She presented with a tumor-like lesion of the mandible. During the 2-year follow-up, the lesion expanded and caused significant disfigurement and pain necessitating psychiatric support. Treatment with bisphosphonate administered intravenously resulted in rapid pain relief, normalization of bone turnover, and cosmetic improvement. Management of FD has previously consisted of either conservative follow-up or surgery depending on disease activity and localization. Based on published reports and our experience, bisphosphonates should be considered in the treatment of symptomatic cases. This line of treatment may be suitable especially for craniofacial FD in which surgical treatment is particularly challenging.     

Lipophilic metabolite of [123I]β-CIT in human plasma may obstruct quantitation of the dopamine transporter

I-123 or C-11 labelled 2β-carbomethoxy-3β-(4-iodophenyl)tropane (β-CIT) is a recently developed radioligand for the study of dopamine and serotonin reuptake sites in humans with single photon emission tomography (SPET) or positron emission tomography (PET). Determination of the radioligand metabolite pattern is fundamental for a quantitative analysis of radioligand binding. The metabolism of [¹²³I]β-CIT was determined by a gradient HPLC method in plasma samples of six human subjects. Two metabolites of [¹²³I]β-CIT were found, a polar and a lipophilic. At 4 h after [¹²³I]β-CIT injection the percentages of parent compound and polar and lipophilic metabolites were 23 ± 3% (mean ± SD), 33 ± 11%, and 44 ± 8%, respectively. The lipophilic metabolite might pass the blood-brain barrier and account for a fraction of free and nonspecifically bound radioactivity in brain. The existence of a lipophilic metabolite of [¹²³I]β-CIT may obstruct the use of simple ratio methods for quantitation of the dopamine transporter in brain. © 1995 Wiley-Liss, Inc.     

Quality of brain perfusion single-photon emission tomography images: multicentre evaluation using an anatomically accurate three-dimensional phantom

The aim of the study was to evaluate the quality of routine brain perfusion single-photon emission tomography (SPET) images in Finnish nuclear medicine laboratories. Twelve laboratories participated in the study. A three-dimensional high resolution brain phantom (Data Spectrum’s 3D Hoffman Brain Phantom) was filled with a well-mixed solution of technetium-99m (110 MBq), water and detergent. Acquisition, reconstruction and printing were performed according to the clinical routine in each centre. Three nuclear medicine specialists blindly evaluated all image sets. The results were ranked from 1 to 5 (poor quality–high quality). Also a SPET performance phantom (Nuclear Associates’ PET/SPECT Performance Phantom PS 101) was filled with the same radioactivity concentration as the brain phantom. The parameters for the acquisition, the reconstruction and the printing were exactly the same as with the brain phantom. The number of detected ”hot” (from 0 to 8) and ”cold” lesions (from 0 to 7) was visually evaluated from hard copies. Resolution and contrast were quantified from digital images. Average score for brain phantom images was 2.7±0.8 (range 1.5–4.5). The average diameter of the ”hot” cylinders detected was 16 mm (range 9.2–20.0 mm) and that of the ”cold” cylinders detected, 11 mm (5.9–14.3 mm) according to visual evaluation. Quantification of digital images showed that the hard copy was one reason for low-quality images. The quality of the hard copies was good only in four laboratories and was amazingly low in the others when comparing it with the actual structure of the brain phantom. The described quantification method is suitable for optimizing resolution and contrast detectability of hard copies. This study revealed the urgent need for external quality assurance of clinical brain perfusion SPET images. Received 2 February and in revised form 31 May 1998     

Evaluation of myocardial viability with technetium-99m hexakis-2-methoxyisobutyl isonitrile and iodine-123 phenylpentadecanoic acid and single photon emission tomography

The detection of viable myocardium in infarcted regions, i.e. hibernating myocardium, is a major goal in clinical cardiology today. We applied combined planar and single photon emission tomography (SPET) to the non-invasive estimation of the left ventricular ejection fraction (LVEF), myocardial blood flow and free fatty acid uptake in the heart. Of the 31 patients with coronary artery disease, 25 (81%) had had a previous myocardial infarction. All patients had at least one persistent perfusion defect on the stress-rest technetium-99m hexakis-2-methoxyisobutyl isonitrile (Sestamibi) study, and the results revealed 57/124 (46%) persistent perfusion defects. As a part of the perfusion study, the LVEF was measured at rest using the first-pass ^99mTc-Sestamibi injection, and the mean LVEF was 47% ±9% (mean ± 1 standard deviation). Iodine-123 phenylpentadecanoic acid (¹²³I-pPPA) imaging at rest was performed within 2 weeks from the perfusion study. Then 6-mm transaxial, sagittal and coronal slices of the perfusion and ¹²³I-pPPA studies were reconstructed. The bull's eye displays of the coronal slices were visually surveyed and divided into 4 quadrants: anterior, lateral, posterior and septal. The following image score was used: 0 = fixed defect, 1 = partial uptake and 2 =normal uptake. Moreover an index of metabolic reserve (MR) was calculated by dividing the bull's eye of the ¹²³I-pPPA study by the bull's eye of resting ^99mTc-Sestamibi, and its maximum value was normalized to 100%. Fourteen segments (25%) had a normal ¹²³I-pPPA uptake with a MR value of 96% ±8%. Twenty-two segments (39%) had a partial ¹²³I-pPPA uptake with a MR of 74% ±20%, whereas 21 segments (36%) had no ¹²³I-pPPA uptake and a very low MR of 36%±34%. There was a highly significant correlation (r =0.70) between LVEF and MR. These findings suggest that it is possible to identify viable myocardium by measuring contractile function (first-pass, multiple-gated ^99mTc-Sestamibi) and myocardial perfusion (stress-rest ^99mTc-Sestamibi) and by combining these parameters with myocardial fatty acid uptake (1231-pPPA) studies. Correspondence to: IT Kuikka     

Cell aggregation centers—initial strength elements in human wound healing

The cell aggregate phenomenon in human wound healing was studied by the Cellstic method in 496 surgical patients, aging from 5 to 70 years. Single cells and cell aggregates, called cell aggregation centers (CAC), were washed out of the Cellstic sponge by the retrograde injection technique 3–144 hr after surgery, centrifuged, and stained with May-Grünwald-Giemsa. A transient aggregation of the inflammatory cells on the first postoperative day was followed, from the second day on, by the persistent aggregation of polymorphonuclear leukocytes, mononuclear cells, and fibroblasts with cell-connecting intercellular substance. These turbulence resistant, gradually growing CACs are considered as early strength elements which, by fusing to each other and to the edges of the wound, essentially contribute to the increase of tensile strength in wound healing.