Spinal cord stimulation in the treatment of failed back surgery syndrome

A significant number of patients undergoing lumbar spine surgery do not obtain pain relief. Such patients with chronic low back or lower extremity pain may be difficult to treat. A frequent component of therapy is the use of spinal cord stimulation to help control pain. With careful patient selection, many patients can achieve reasonable levels of pain relief. We review recent clinical reports, including prospective and randomized studies, that demonstrate up to three quarters of patients implanted with a spinal cord stimulator for the treatment of failed back surgery syndrome may benefit from its use. This technology must not be indiscriminately applied. Careful patient selection and a period of trial stimulation are vital to the successful use of spinal cord stimulation as treatment for chronic pain.     

Blood pressure reactivity in young children: comparing three stressors.

Blood pressure (BP) reactivity in children, the transient elevation of BP after an acute stressor, is a stable characteristic that may predict cardiovascular disease (CVD) and hypertension. The purpose of the present study was to assess the generalizability of BP reactivity across various stressors in young children. BP reactivity was measured in 85 children (ages 3 to 6 years) after each of three different stressors. Systolic BP reactivity level was highest after physical exertion (104 mm Hg), followed by competitive task (95 mm Hg) and cognitive task (93 mm Hg). Resting systolic BP was 90. The 2-week test-retest reliability was higher for physical stress systolic BP reactivity level (r = .66) than for baseline systolic BP (r = .58) and the other two stressors. The reliability of the systolic BP change score was significant only for physical stressor (r = .33). Correlations among the three stressors ranged from .75 to .79 for systolic BP reactivity level and from .37 to .50 for change in systolic BP. Change in systolic BP after physical stress correlated with skin-fold thickness (r = .32). There was evidence of generalizability across stressors. The physical task is the most promising for future study of BP reactivity in young children.     

Social networks of residents in supportive housing

One goal of supportive housing is to enlarge and improve the functioning of the social support networks of residents. The networks of a convenience sample of 42 residents were assessed using scales developed by Barrera. The size of the networks (11.5) was no larger than that reported for similar clients living in other types of community settings but the composition differed. Staff and co-residents appear to partially replace rather than add to family and friends. This is of concern because friends are uniquely important determinants of satisfaction. An association between perceived need for support and network size was also found. These findings suggest some positive influences but also raise questions about unintended negative consequences of living in artificially constructed social environments.When this project was undertaken, Dr. Goering, Janet Durbin, Bill Lancee and Taras Babiak were all members of the Social and Community Psychiatry Section, Clarke Institute. Robert Foster was Executive Director of Regeneration House, Inc., where Susan Boyles is Assistant Executive Director.     

Postnephrectomy pseudoaneurysm with arteriovenous fistula

Sonography detected a paraaortic pulsatile tubular mass in a patient 10 years after “stump” nephrectomy, which was subsequently confirmed as a renal artery-renal vein fistula by computed tomography, angiography, and laparotomy.     

Postnephrectomy pseudoaneurysm with arteriovenous fistula

Sonography detected a paraaortic pulsatile tubular mass in a patient 10 years after "stump" nephrectomy, which was subsequently confirmed as a renal artery-renal vein fistula by computed tomography, angiography, and laparotomy.     

In vitro pharmacodynamic evaluation of VP-16-213 and implications for chemotherapy

Summary VP-16-213 (Etoposide) is an active antineoplastic agent which has undergone extensive evaluation of clinical dose escalation. To corroborate a putative dose-response relationship, we studied, in a modified clonogenic assay, various doses and durations of exposure. VP-16-213 at doses of 0.01, 0.05, 0.10, 0.50, 1.0, 5.0 and 10.0 g/ml, each with exposure durations of 1, 3, 18, and 30 h, was studied in vitro against two human tumor cell lines, MOLT and 9812. The doses and durations of exposure were chosen to approximate some of the pharmacokinetic values achievable in either standard-dose or high-dose clinical studies. The results, summarized as linear regression lines, demonstrate with statistical significance (p<0.03) that there is correlation between dose and cytotoxicity and between dose x duration of exposure (representing the area under the concentration-time curve) and cytotoxicity. Our in vitro data thus support the concept of intensive use of VP-16-213 to maximize antitumor activity. However, how best to accomplish the manipulation of dose and duration of exposure is not yet clear and will be the subject of future clinical investigations.Supported in part by Grant ROI CA39686 from the NIH (KR Hande)     

Trapeziometacarpal arthroplasty using the entire flexor carpi radialis tendon

Fifty-eight patients (62 joints) with arthritis of the thumb carpometacarpal joint were treated with resection arthroplasty, ligament reconstruction, and tendon interposition with the entire flexor carpi radialis tendon. The mean age of the patients at the time of surgery was 58.4 years (range, 28-80 years), and the average followup was 42.5 months (range, 21-86 months). The entire flexor carpi radialis tendon was used for reconstruction and interposition. In 32 of the 62 joints, a partial trapezoidectomy was performed for scaphotrapezoidal arthritis. Finger-tip pinch improved by 88%, key pinch improved by 86%, and grip strength improved by 69%. Palmar and radial abduction also improved by 8% and 10%, respectively. Fifty-five (95%) patients reported excellent pain relief, whereas three patients reported only mild pain. No patients experienced an increase in pain. All thumbs were stable radiographically. This study indicated ligament reconstruction with tendon interposition, accompanied by partial trapezoidectomy when indicated, provides excellent pain relief and restoration of function. No morbidity was observed with use of the entire flexor carpi radialis tendon.