Degenerative change in the adjacent segments to the fusion site after posterolateral lumbar fusion with pedicle screw instrumentation--a minimum 4-year follow-up.

BACKGROUND: Controversy remains regarding the subsequent degeneration of adjacent segments, and little reliable information could be found in the literature regarding long-term clinical results and adjacent segment degeneration. The objective of this study is to investigate the degenerative change of adjacent segments to the fusion site and clinical outcome after posterolateral lumbar fusion with pedicle screw instrumentation and identify the risk factors in degenerative change at adjacent segments. METHODS: Thirty-two patients who underwent posterolateral lumbar fusion and were able to be followed over four years were evaluated in this study. The intervertebral disc height, percent of slip, lumbosacral joint angle, lumbar lordosis and disc angle were all examined. The postoperative progression of degeneration at adjacent segments were defined as more than a 50 % narrowing in the adjacent disc height or more than a 5 % slip in adjacent segments in comparison to the preoperative neutral lateral radiographs. The clinical results were assessed using an evaluation scores for lumbar lesions proposed by the Japanese Orthopedic Association. RESULTS: Fifteen (46.8%) of the 32 patients had adjacent segment degeneration including slip or narrowing. No significant correlation was found between the adjacent segment degeneration and the recovery rate at the final follow-up. In addition, no significant correlation was observed between the adjacent segment degeneration at the lastest follow-up and postoperative radiographic measurements. CONCLUSIONS: The rate of radiographic degeneration at the adjacent segments was 46.8%. No significant correlation was found between degenerative change in the adjacent segments and the clinical results. We could not identify any preoperative radiographic factors which might have influenced the segments adjacent to the fusion.

Irinotecan enhances IL-12 production by OK-432-activated murine macrophages.

BACKGROUND: Our previous study showed that the combination of irinotecan (CPT-11) and OK-432 had an additive antitumor effect. The purpose of this study was to analyze the mechanism by which this combined treatment had an effect on immunity. MATERIALS AND METHODS: To investigate the immune effects of murine splenocytes stimulated by SN-38 (the active form of CPT-11) and OK-432, endogenous interleukin (IL)-12 p70 production was assayed by ELISA and flow cytometry. RESULTS: Endogenous IL-12 production was increased by SN-38 stimulation of cultures of OK-432-activated splenocytes from C57BL/6, C3H and Balb/c mice, which was not observed with LPS-activated splenocytes. IL-12 production by splenocytes was higher at an early stage after tumor inoculation. SN-38 and OK-432 stimulated IL-12 production in cultures of peritoneal exudate macrophages (PEM), and T cell cooperation was essential in cultured splenocytes. CONCLUSION: These results suggest that the interaction of SN-38 and OK-432 may support a type 1 T helper (Th1)-dominant state through increasing endogenous IL-12 production, mainly by macrophages.

Evaluation of intraoperative intraperitoneal cytology for advanced gastric carcinoma.

OBJECTIVE: We evaluated intraperitoneal cytology during surgery as a significant predictor of survival and tried to establish strategies for preventing peritoneal carcinomatosis. METHODS: The study included 236 patients with gastric carcinoma macroscopically invading the serosa who underwent intraperitoneal cytological examination during surgery. In the 215 resected patients, the relationship between cytological positivity for cancer cells and various clinicopathologic features was analyzed. Additionally, postoperative survival was assessed in relation to the positivity of intraoperative cytology. RESULTS: Cancer cells were positive [Cy+] in 78 (33.1%) of 236 patients who underwent cytological examinations. Among 73 patients with peritoneal metastases, 53 patients (72.6%) were Cy+, as were 25 (15.3%) of the 163 patients without peritoneal metastases. Multivariate analysis indicated that peritoneal metastasis (p = 0.0001) and the depth of tumor invasion (p = 0.0069) were significant factors correlated with Cy+. Among patients with curative surgery, the 5-year survival rate of the Cy+ group was 22.2%, which was worse (p = 0.0004) compared with that of the Cy(-) group (60.9%). Among Cy+ patients, the survival rate of the group treated with intraperitoneal administration of mitomycin C (MMC) and OK-432 was better (p = 0.0108) than that of the historical control group. CONCLUSION: These results suggest that intraperitoneal cytological examination can be a significant prognostic factor for gastric carcinoma with serosal invasion. In addition, dissemination of cancer cells in the peritoneum may be controlled by intraperitoneal immunochemotherapy with MMC and OK-432.