Management of postprocedural discitis Silber, Jeff S.; Anderson, D.Greg; Vaccaro, Alexander R. ...
The spine journal,
2002 Jul-Aug, Letnik:
2, Številka:
4
Journal Article
Recenzirano
Background context: Fortunately, the incidence of postprocedural discitis is relatively uncommon. The paucity of physical examination findings behooves the spine care practitioner to have a high ...index of suspicion in any patient presenting with increasing back pain after an invasive spinal procedure. The diagnosis can often be established in a timely fashion based on the history, physical examination, laboratory studies (erythrocyte sedimentation rate, C-reactive protein and blood cultures) and imaging studies (plain radiographs, magnetic resonance imaging, computed tomography and radionuclide scanning).
Purpose: To review the English literature on the subject of postprocedural discitis. The incidence, pathophysiology, laboratory markers and imaging findings are discussed. Recommendations on treatment strategies are presented along with long-term clinical outcomes of this postprocedure complication.
Methods: A contemporary English literature search of MEDLINE and PubMed on the topic of postoperative discitis was performed.
Results: The incidence of postprocedural discitis is approximately 0.2%. The most common etiologic agent is Staphylococcus aureus. The C-reactive protein is the most sensitive clinical laboratory marker to assess the presence of infection and effectiveness of treatment response. Magnetic resonance imaging is the imaging modality of choice in the diagnosis of spinal infection. The majority of patients are managed adequately with organism-specific antibiotics and spinal immobilization with good long-term outcomes. Operative intervention (open biopsy followed by antibiotic treatment and spinal immobilization or debridement and reconstruction) in patients who fail to respond to nonoperative treatment or in the presence of neurologic worsening has been demonstrated.
Conclusion: Postprocedural discitis is a rare complication after any invasive spinal procedure. It is imperative for the treating surgeon to maintain a high index of suspicion. Appropriate laboratory and imaging studies are invaluable in establishing a timely diagnosis. In the majority of patients, antibiotic treatment along with spinal immobilization has been shown to produce good long-term outcomes. Operative intervention is rarely necessary in patients failing conservative treatment.
Increasing numbers of dietary supplements with ecdysteroids are marketed as "natural anabolic agents". Results of recent studies suggested that their anabolic effect is mediated by estrogen receptor ...(ER) binding. Within this study the anabolic potency of ecdysterone was compared to well characterized anabolic substances. Effects on the fiber sizes of the soleus muscle in rats as well the diameter of C2C12 derived myotubes were used as biological readouts. Ecdysterone exhibited a strong hypertrophic effect on the fiber size of rat soleus muscle that was found even stronger compared to the test compounds metandienone (dianabol), estradienedione (trenbolox), and SARM S 1, all administered in the same dose (5 mg/kg body weight, for 21 days). In C2C12 myotubes ecdysterone (1 µM) induced a significant increase of the diameter comparable to dihydrotestosterone (1 µM) and IGF 1 (1.3 nM). Molecular docking experiments supported the ERβ mediated action of ecdysterone. To clarify its status in sports, ecdysterone should be considered to be included in the class "S1.2 Other Anabolic Agents" of the list of prohibited substances of the World Anti-Doping Agency.
Lumbar discography Guyer, Richard D; Ohnmeiss, Donna D; Vaccaro, Alexander
The Spine Journal,
2003 May-Jun, Letnik:
3, Številka:
3
Book Review, Journal Article
Recenzirano
Study design: A comprehensive review of the literature dealing with lumbar discography was conducted.
Objective: The purpose of the review is to update the North American Spine Society position ...statement published in 1994 that addressed criticisms of lumbar discography, to identify indications for
Summary of background data: Lumbar discography remains a controversial diagnostic procedure. There are concerns about its safety and clinical value, although many support its use in specific applications.
Methods: Articles dealing with lumbar discography were reviewed and are summarized in this report.
Results: Most of the recent literature supports the use of discography in selected patients. Although not to be taken lightly, many of the serious complications and high complication rates reported before 1970 have decreased since then because of improvement in injection technique, imaging and contrast materials.
Conclusions: Most of the current literature supports the use of discography in select situations. Indications for discography include, but are not limited to:
1. Further evaluation of demonstrably abnormal discs to help assess the extent of abnormality or correlation of the abnormality with the clinical symptoms. Such symptoms may include recurrent pain from a previously operated disc and lateral disc herniation.
2. Patients with persistent, severe symptoms in whom other diagnostic tests have failed to reveal clear confirmation of a suspected disc as the source of pain.
3. Assessment of patients who have failed to respond to surgical intervention to determine if there is painful pseudarthrosis or a symptomatic disc in a posteriorly fused segment and to help evaluate possible recurrent disc herniation.
4. Assessment of discs before fusion to determine if the discs within the proposed fusion segment are symptomatic and to determine if discs adjacent to this segment are normal.
5. Assessment of candidates for minimally invasive surgical intervention to confirm a contained disc herniation or to investigate dye distribution pattern before chemonucleolysis or percutaneous procedures.
Lumbar discography should be performed by those well experienced with the procedure and in sterile conditions with a double-needle technique and fluoroscopic imaging for proper needle placement. Information assessed and recorded should include the volume of contrast injected, pain response, with particular emphasis on its locations and similarity to clinical symptoms, and the pattern of dye distribution. Frequently, discography is followed by axial computed tomography scanning to obtain more information about the condition of the disc.
Anemia is one of the most impactful nutrient deficiencies in the world and disproportionately affects children in low-resource settings. Point-of-care devices (PoCDs) measuring blood hemoglobin (Hb) ...are widely used in such settings to screen for anemia due to their low cost, speed, and convenience. Here we present the first iteration of Aptus, a new PoCD which measures Hb and hematocrit (HCT). To evaluate the accuracy of Aptus and HemoCue® Hb 301 against an automated hematology analyzer (Medonic®) in Gambian children aged 6-35 months and the Aptus' usage in the field. Aptus, HemoCue® and Medonic® were compared using venous blood (n = 180), and Aptus and HemoCue® additionally using capillary blood (n = 506). Agreement was estimated using Bland-Altman analysis and Lin's concordance. Usage was assessed by error occurrence and user experience. Mean Hb values in venous blood did not significantly differ between Aptus and HemoCue® (10.44±1.05 vs 10.56±0.93g/dl, p>0.05), but both measured higher Hb concentrations than Medonic® (9.75±0.99g/dl, p<0.0001). Lin's coefficient between Aptus and Medonic® was r.sub.c = 0.548, between HemoCue® and Medonic® r.sub.c = 0.636. Mean bias between the PoCDs venous measurements was -0.11g/dl with limits of agreement (LoA) -1.63 and 1.40g/dl. The bias was larger for the comparisons between the Medonic® and both Aptus (0.69g/dl, LoA 0.92 and 2.31g/dl) and HemoCue® (0.81g/dl, LoA 0.17 and 1.78g/dl). ROC curves showed an AUC of 0.933 in HemoCue® and 0.799 in Aptus. Capillary Hb was higher with Aptus than HemoCue® (10.33±1.11g/dl vs 10.01±1.07g/dl, p<0.0001). Mean bias was 0.32g/dl with LoA of -1.91 and 2.54g/dl. Aptus' usage proved intuitive, yet time-to-results and cuvettes could be improved. Both PoCDs showed a relatively limited bias but large LoA. Aptus and HemoCue® showed similar accuracy, while both overestimated Hb levels. Aptus showed promise, with its operation unimpaired by field conditions as well as being able to show HCT values.
Spinal metastases are an increasing societal health burden secondary to improvements in systemic therapy. Estimates indicate that 100,000 or more people have symptomatic spine metastases requiring ...management. While open surgery and external beam radiotherapy have been the pillars of treatment, there is growing interest in more minimally invasive technologies (eg separation surgery) and non-operative interventions (eg percutaneous cementoplasty, stereotactic radiosurgery). The great expansion of these alternatives to open surgery and the prevalence of adjuvant therapeutic options means that treatment decision making is now complex and reliant upon multidisciplinary collaboration. To help facilitate construction of care plans that meet patient goals and expectations, clinical decision aids and prognostic scores have been developed. These have been shown to have superior predictive value relative to more classic prediction models and may become an increasingly important aspect of the clinical practice of spinal oncology. Here we overview current therapeutic advances in the management of spine metastases and highlight emerging areas for research. Given the rapid advancements in surgical technologies and adjuvants, the field is likely to undergo further transformative changes in the coming decade.
Interbody fusion techniques have been used for many years for the treatment of a variety of lumbar spine diagnoses. Part of the interest in increasing methods of interbody fusion has stemmed from ...concern that posterior fusion alone may allow micro-motion, which may generate pain in a ruptured or degenerated disc. Stabilization of the anterior segment led to the development of interbody fusion cages. These devices were designed to stabilize the spine while bony ingrowth from the vertebrae to the bone graft occurred. There are a variety of techniques for cage insertion, including open and laparoscopic techniques anteriorly, and open posterior approach. A lateral approach for cage placement has also been reported. The purpose of this paper is to present a review of the literature on lumbar intervertebral fusion performed using interbody cages. The reported results for these procedures vary, but in general the majority of patients have had favorable results. The complications are similar to those encountered with traditional interbody fusion procedures using bone grafts. There is a learning curve associated with the procedures, particularly with the laparoscopic techniques. Appropriate training for the spine surgeon as well as the access surgeon is important. There is a great deal of disparity in reports on using the cages as stand-alone devices as well as on laparoscopic approaches. Overall, the use of interbody cages for fusion appears to be a viable treatment, yielding good results. Fusion cages appear to have a role in spine care; however, as with any procedure, patient selection and proper training of the surgeon are critical.
The generation of clinical good manufacturing practices (GMP)-grade adeno-associated virus (AAV) vectors requires purification strategies that support the generation of vectors of high purity, and ...that exhibit a good safety and efficacy profile. To date, most reported purification schemas are serotype dependent, requiring method development for each AAV gene therapy product. Here, we describe a platform purification process that is compatible with the purification of multiple AAV serotypes. The method generates vector preparations of high purity that are enriched for capsids with full vector genomes, and that minimizes the fractional content of empty capsids. The two-column purification method, a combination of affinity and ion exchange chromatographies, is compatible with a range of AAV serotypes generated by either the transient triple transfection method or the more scalable producer cell line platform. In summary, the adaptable purification method described can be used for the production of a variety of high-quality AAV vectors suitable for preclinical testing in animal models of diseases.
To assess national trends in ectopic pregnancy incidence among assisted reproductive technology users and identify risk factors associated with ectopic pregnancy.
We identified 553,577 pregnancies ...reported to the National ART Surveillance System between 2001 and 2011. Of those, 9,480 were ectopic, of which 485 were heterotopic. As a result of small numbers, ectopic and heterotopic pregnancies were combined for analysis. We assessed temporal trends in annual ectopic pregnancy rates using Poisson regression. We used log-binomial regression models with generalized estimating equations for correlated outcomes within clinics to calculate unadjusted and adjusted risk ratios for the association between ectopic pregnancy and selected patient characteristics and treatment factors.
The rate of ectopic pregnancy declined from 2.0% (n=735, 95% confidence interval CI 1.9-2.2) in 2001 to 1.6% (n=968, 95% CI 1.5-1.7) in 2011 (P for trend <.001). The ectopic pregnancy rate ranged from 2.0% (n=7,469, 95% CI 1.9-2.0) for fresh, nondonor cycles to 1.0% (n=641, 95% CI 0.9-1.1) for fresh, donor cycles. Among fresh, nondonor cycles, the rate of ectopic pregnancy was 1.6% (95% CI 1.4-1.7) when one embryo was transferred compared with 1.7% (95% CI 1.7-1.8), 2.2% (95% CI 2.1-2.3), and 2.5% (95% CI 2.4-2.6) when two, three, or four or more embryos were transferred, respectively (adjusted risk ratios 1.11, 95% CI 0.94-0.30; 1.33, 95% CI 1.12-1.56; and 1.49, 95% CI 1.25-1.78).
Ectopic pregnancy incidence after assisted reproductive technology has decreased over time, but factors such as multiple embryo transfer increase the risk of ectopic pregnancy.
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