Retrospective case series on patients with chronic spinal pain treated with dextrose prolotherapy

OBJECTIVES: To determine the clinical benefits of dextrose prolotherapy in patients with chronic spinal pain. DESIGN: Retrospective case series. SETTING/LOCATION: During the first 2 years at an outpatient prolotherapy clinic. SUBJECTS: One hundred and seventy-seven (177) consecutive patients with a history of chronic spinal pain completed prolotherapy treatment and were followed for a period ranging from 2 months to 2.5 years. INTERVENTIONS: Patients were treated with a proliferant solution containing 20% dextrose and 0.75% xylocaine. One half milliliter (0.5 mL) of proliferant was injected into the facet capsules of the cervical, thoracic, and lumbar spine, or combinations of the three areas. The iliolumbar and dorsal sacroiliac ligaments were also injected in patient with low back pain. Injections were typically done on a weekly basis for up to 3 weeks. A set of three injections was repeated in 1 month's time if needed. OUTCOME MEASURES: Level of pain, and improvement in activities of daily living were measured on a five-point scale. Improvement in ability to work was also assessed. RESULTS: Ninety-one percent (91.0%) of patients reported reduction in level of pain; 84.8% of patients reported improvement in activities of daily living, and 84.3% reported an improvement in ability to work. Women required on average, three more injections than men. Cervical spine response rates were lower than thoracic or lumbar spine. No complications from treatment were noted. CONCLUSIONS: Dextrose prolotherapy appears to be a safe and effective method for treating chronic spinal pain that merits further investigation. Future studies need to consider differences in gender response rates.     

Cancer immunotherapy and heat-shock proteins: promises and challenges

Recent mechanistic studies on the role of heat-shock proteins (HSPs) to induce innate and adaptive immune responses have resulted in conflicting reports. Whereas some groups reported that HSPs have direct immunological function, others emphasised the endotoxin contamination of HSP preparations and questioned the antigen-specificity of HSP vaccines. The present review will discuss these issues and suggest that HSPs have diverse and distinct immunological functions that could be superimposed on effects resulting from endotoxin contamination or misunderstood by using experimental procedures with inadequate controls. To understand the actual function of HSPs in their interaction with the immune system, methods and procedures need to be optimised and appropriate controls need to be used. These points should also clarify the conflicting findings about HSPs and promote our knowledge about other immuologically important components that may be present in HSP preparations.     

Three-dimensional virtual cholangioscopy: a reliable tool for the diagnosis of common bile duct stones

OBJECTIVE: Our goal was to evaluate the clinical reliability of a new software system employing 3-dimensional (3D) virtual anatomic reconstruction and intraluminal virtual exploration for detection of choledocholithiasis and preoperative visualization of the biliary anatomy. SUMMARY BACKGROUND DATA: Virtual reality systems have been proposed for gastroscopy, bronchoscopy, and colonoscopy, as well as for the 3D reconstruction of liver anatomy and hepatic lesions. The impact of these systems in preoperative diagnostics has not been established due to the lack of large clinical series evaluating their reliability. METHODS: From November 2000 to July 2002, all patients presenting to our Institute with suspected choledocholithiasis were prospectively included in the study. All patients underwent conventional magnetic resonance cholangiopancreatography (MRCP) and either intraoperative cholangiogram (IOC) or endoscopic retrograde cholangiopancreatography (ERCP). The digital data from MRCP were incorporated into an original virtual reality software system to generate a 3D reconstruction. All 3D reconstructions were evaluated by a surgeon and a computer software engineer who were blind to the results of the IOC or ERCP. Sensitivity and specificity were then calculated based on the results of either the IOC or ERCP. RESULTS: Sixty-five patients were enrolled in the study. The average time required to reconstruct the images into navigable virtual reality was 7.5 minutes (range, 4-13.5). The 3D virtual cholangioscopy had sensitivity and specificity rates of 71% and 91%, respectively, compared with 61% and 86% of the standard MRCP. CONCLUSION:: The 3D virtual cholangioscopy provides detailed preoperative reconstruction of biliary anatomy and reliable identification of choledocholithiasis with acceptable sensitivity and specificity in a clinical setting. Newer software developments may further enhance its accuracy, so that virtual cholangioscopy might challenge or replace more invasive diagnostic measures in the near future.     

Suprarenal fixation of endograft in abdominal aortic aneurysm treatment: focus on renal function

OBJECTIVE: The objective of this work was to evaluate any variation of renal function detected by renal scintigraphy after the suprarenal fixation of endografts for abdominal aortic aneurysm (AAA) repair. SUMMARY BACKGROUND DATA: In the few articles that have considered this problem, renal function was evaluated only by biochemical tests, which are inadequate in demonstrating small changes in renal function and in appreciating the worsening of a single kidney's function. METHODS: Between April 1999 and May 2002, 47 patients with an inappropriate infrarenal proximal neck had a suprarenal fixation for AAA. To assess renal function, a technetium-99m diethylene triamine penta-acetic acid (TC-DTPA) perfusion scintigraphy was performed preoperatively on the third postoperative day and at 6, 12 months, and then yearly thereafter. Worsening of renal function was defined as a decrease of glomerular filtration rate (GFR) > or =20% (detected with Gates method). Serum creatinine level was tested preoperatively and at the first and third postoperative day. RESULTS: Endograft deployment was technically successful in 44 patients (93.6%); clinical perioperative success was obtained in 46 patients (97.8%). In 12 patients (25.5%), a permanent reduction of the GFR was observed using postoperative TC-DTPA perfusion scintigraphy. By 99m TC-DTPA perfusion scintigraphy, a permanent reduction of GFR was observed postoperatively in 12 patients. A slight GFR reduction (<20%) was present in 7 (14.9%) patients, due to the planned occlusion of accessory renal arteries. A more significant GFR reduction (>20%) was present unexpectedly in 5 (10.6%) patients, in 3 of these a single kidney was involved, in 5 both with an increase of the serum creatinine level >20%. CONCLUSIONS: Suprarenal fixation of endografts in AAA treatment is a safe procedure with good early and midterm procedural results and a risk of GFR impairment (>20%) of 10.6%.     

Septal reshaping for exclusion of anteroseptal dyskinetic or akinetic areas

BACKGROUND: Our purpose is to describe a technique for exclusion of anteroseptal dyskinetic or akinetic areas. METHODS: From January to December 2002, 22 consecutive patients with myocardial infarction following left anterior descending artery occlusion underwent septal reshaping. All of them were admitted for dyspnea. Eight patients were referred for angina. After a 5 to 8 cm apical incision, 2 U stitches were passed from inside to join the anterior wall to the septum, as high as possible, following the border of the scars. An oval Dacron patch was then sutured from the septum (end of the direct suture through the border with the inferior septum) to the anterior wall (between the healthy and the scarred wall) up to the new apex. Purpose of the procedure is to maintain a longitudinal size as similar as possible to the normal. The incision was closed in a double layer. RESULTS: No patient died and only one had acute renal failure. No patients had restrictive syndrome. After a mean follow-up of 6.7 +/- 3.6 months (3 to 15), mean New York Heart Association Class improved from 2.7 +/- 1.1 to 1.2 +/- 0.3 (p < 0.001). Echocardiographic results showed reduction of left ventricle volumes and normalization of the stroke volume. In patients with low ejection fraction (相似文献   

Cervical and mediastinal hematoma: presentation of an asymptomatic cervical parathyroid adenoma: case report and literature review

The spontaneous rupture with extracapsular hemorrhage of a cervical parathyroid adenoma is a rare cause of cervical and mediastinal hematoma. We describe this case to emphasize that a failure to consider this diagnosis may result in delayed operative intervention with potentially fatal complications.     

Intraparenchymal renal artery aneurysms. Case report with review and update of the literature

Increased interest in aneurysms involving therenal artery and its branches has occurredduring the past 3 decades. The prevalence ofrenal artery aneurysms is approximately 0.01%–1% in the general population as well as2.5% in hypertensive patients undergoingangiography. Intraparenchymal renal arteryaneurysms (IPRAAs) are rare since beingdetected in less than 10% of patients withrenal artery aneurysms. The Authorsreport an unusual case of multiple smallintrarenal artery aneurysms associatedwith a large IPRAA located in the mid portionof the right kidney. Usually, IPRAAs aresecondary to diseases or injuries of the kidneyvascular network. They are classified as true,false, saccular, fusiform, dissecting, andmicroaneurysms. Potential complications ofIPRAAs include peripheral dissection,thrombosis, hypertension, renal infarction andrupture. IRAAs may be detected incidentally aswell as present with urologic symptoms andsigns related to complications. Actually, IRAAsare investigated by non invasive modalitiesincluding duplex ultrasound, magnetic resonanceangiography, spiral three-dimensional computedtomography angiography, and three-dimensionalreconstructed rotational digital substractionangiography of the segmental and distantbranches of the renal artery. Angiography withintrarterial injection of contrast material isthe gold standard in diagnosing IPRAAs.Treatment options for IPRAAs includeobservation, aneurysmectomy with surgicalrepair, endovascular procedures, nephrectomy orpartial nephrectomy. Observation is indicatedfor asymptomatic intraparenchymal renal arteryaneurysms measuring less than 2 cm in diameter.Surgical repair of IPRAAs includesaneurysmectomy and reconstruction of the renalartery by in vivo or ex vivo technique. Theprocedure is indicated for IPRAAs causingrenovascular hypertension, dissection, urologicsymptoms, embolization, local expansion andwomen of childbearing age with a potential forpregnancy. In recent years, transcatheterarterial embolization has emerged as a simple,useful and effective technique in managingIRAAs. The procedure is performed bytransfemoral catheterization as well as bysuperselective catheterization and embolizationof interlobar arteries with 3F microcatheters.Endovascular occlusion is obtained by usinggelatin sponge, steel coils, detachablebaloons, and conventional non-detachablemicrocoils delivered through a microcatheter.Nephrectomy or partial nephrectomy are reservedfor conditions precluding renalrevascularization which include overt RAArupture, covert RAA rupture, artery-to-veinfistula, renal cell carcinoma, end stagenephropaty, renal infarction, severe ischemicrenal atrophy or complex intrarenal aneurysms.Recently, partial nephrectomy by thelaparoscopic approach has been proposed formanaging IPRAAs and the procedure is consideredfeasible and safe.     

Immunohistochemical evidence of vanilloid receptor 1 in normal human urinary bladder

PURPOSE: Experimental and clinical evidences have shown the importance of the vanilloid receptor 1 (TRPV1) in the lower urinary tract. In humans, this receptor has been detected in nerve endings of primary sensory neurons, smooth muscle and connective tissue cells and in the rat also in the urothelium. The aim of this study is to identify, by immunohistochemistry, the cell types expressing TRPV1 in the human urinary bladder. MATERIAL AND METHODS: Specimens, obtained from normal urinary bladder by multiple biopsy and from ureter at the time of radical nefrectomy for renal cell carcinoma, were fixed and frozen. Full-thickness sections were processed for light and fluorescence microscopes. To label the TRPV1, three polyclonal antibodies were used: the anti-capsaicin receptor, the anti-VR1 (N-15) and the anti-VR1 (C-15). RESULTS: Urothelium, smooth muscle cells, mast cells and endothelium were labelled and the labelling was intracytoplasmatic. In the urothelial cells, the labelling was slightly granular. In the bladder urothelium, the superficial cells were more intensely stained than the basal and club-shaped cells. VR1-positive nerve fibers were seen running single and/or in groups in the sub-urothelium and as single varicose fibers in the muscle coat, and VR1-positive nerve endings in the urothelium. CONCLUSION: The present findings provide the evidence of the presence of TRPV1 on normal human urothelium where it could have important implications in the mechanism of action of intravesical vanilloids (capsaicin and resiniferatoxin).     

Handling and pathology reporting of specimens with carcinoma of the urinary bladder, ureter, and renal pelvis

OBJECTIVE: Pathologists play a pivotal role in the diagnosis and in the report of the pathological features related to prognosis. METHODS: To meet these endpoints, the following issues must be accomplished: adequate information about the patient history, proper handling of the specimens, identification of the reliable histopathological techniques necessary to reach the more detailed diagnostic information and evaluate the prognostic variables, and a standardized pathological report. RESULTS: Recent efforts to standardize the histopathological evaluation have generated significant confusion among the urological and pathological communities as well. No consensus has been achieved about the optimal pathological grading of urothelial tumors, to date. CONCLUSION: A proposal for standardization of sampling and reporting of the urothelial tissues achieved within Uropathology follows. The urologists have a great role in assisting pathologists in the proper examination by providing them with clinical information.