[THE SEARCH AFTER PROGNOSTIC TESTS OF DEVELOPMENT OF UROLITHIASIS OF PATIENTS WITH VERTEBRO-CEREBROSPINAL TRAUMA].

The article presents analysis of alterations of biochemical indicators in blood serum and day urine of 22 patients in acute and early periods after vertebro-cerebrospinal trauma. Out of total number of patients in 10 (main group) in post-traumatic period urolithiasis developed In 12 patients no signs of urolithiasis were detected These examinedpatients were included into comparative group. The reference group was composed with 20 healthy individuals. The concentration of urea, creatinine, uric acid, calcium and inorganic phosphate in blood serum and day urine were detected In patients of main group statistically significant increasing of levels of urea and creatinine was detected in blood serum relative to patients of comparative group. In examined patients of main group clearance of urea was reliably lower than both values of comparative group (up to 2.55 times; p < 0.05) and indicators of reference group (up to 3.75 times; p < 0.05). In patients of this group, clearance of uric acid also had reliable differences from indicators both in comparative group and reference group. Therefore, in patients in acute and early periods of vertebro- cerebrospinal trauma expressed disorders of biochemical indicators of blood serum and urine that can be referred to predictors of risk of development of urolithiasis in the following. The most informative tests were increasing of concentration of urea in blood serum more than 5.30 mmol/l (ratio of likelihood ofpositive test--4.26) and decreasing of clearance of uric acid and urea.

[Pathogenesis and early diagnosis of deep vein thrombosis in case of polytrauma].

Pathogenesis and early diagnosis characteristics of acute deep vein thrombosis (advt) have been studied in 323 polytrauma patients (iss: 29.4 +/- 2.0 score). Acute vein thrombosis, confirmed by us examination, was determined in 22.3% of patients (in the case of severe craniocerebral trauma--scct--12.6%, extremity trauma--60.5%, spinal trauma 75%, severe sepsis--25%). Despite the complex diagnosis and prophylaxis (thrombus removal, thrombosed veins ligation, external iliac vein and inferior vena cava clipping, permanent and removable cava-filters positioning) pulmonary artery thromboembolism (pate) developed in 3.1%. ADVT in patients with polytrauma developed as a pathogenic basis of systemic inflammatory response syndrome (sirs), which was observed to be associated with endothelium damage and thrombophilia. Hence, thrombophilia values (high levels of crp, f.viiia, D-dimer, low levels of antithrombin iii--at-iii), which are characteristic of sirs, lose their informativeness in the early diagnosis of advt and pate risks identification. In this regard, early advt diagnosis in polytrauma should be based on doppler study results, and the adequacy of anticoagulant and antiplatelet therapy should be determined by the levels of crp, f.viiia, D-dimer, activated partial thromboplastin time--aptt, anti- xa heparin activity, international normalized ratio--inr, platelet aggregation, thrombodynamic potential, at-iii.

Lead toxicity and management of gunshot wounds in the lumbar spine.

INTRODUCTION: Gunshot wounds are one of the commonest causes of spinal injury. Management of these patients differs from other blunt trauma injuries to the spine. We present a case of a gunshot wound to the lumbar spine that occurred in 1985 which was treated non-operatively. METHODS: In the last 10 years, the patient was admitted multiple times for confusion and lead toxicity with blood levels over 100 µg/dl. Inpatient chelation therapy was implemented. After multiple recommendations for surgery, the patient agreed to have as much of the bullet removed as possible. The patient successfully underwent decompression and fusion from both anterior and posterior approaches. Lead levels subsequently declined. CONCLUSION: The purpose of this paper is to show a case of a gunshot wound to the spine that ultimately caused plumbism and required surgery. Technical aspects of the surgery are described as well as pre- and post-procedural imaging. Recommendations for the general management of spine gunshot wounds are also described.

[Immunological monitoring in the surgical treatment of damages to the thoracic and lumbar parts of the vertebral column].

Adequacy of diagnostic actions, choice, on their basis, of a treatment for patients with vertebral fractures and spinal cord injury, improvement of the results of surgical treatment are anactual problem of modern traumatology and neurosurgery. The purpose of the study was to define the role of immunological monitoring in the evaluation of patients' condition in the presence of spinal damage. Blood was tested in 111 patients during two-stage surgical treatment for spinal damages: 1) osteosynthesis by an external fixation device and 2) anterior spinal fusion. The results of general clinical blood checks, lymphocytic phenotyping, determination of neutrophilic functional and metabolic activity, the levels of circulating immune complexes and immunoglobulins, the concentrations of cytokines (IL-1alpha, IL-1beta, IL-1ra, IL-8, tumor necrosis factor-alpha) and acute-phase proteins were estimated before surgery and in different periods up to 6 months inclusive. Statistical studies were conducted using the STATISTICA program. Examination of three groups of patients (two of which had postoperative complications, the other was a control group) has ascertained that immunological monitoring in the treatment of spinal injure may be used to predict postoperative complications, such as delayed consolidation and impaired formation of a bone block in the vertebral segment, be made in different management periods (before surgery and on follow-up days 2 or 10), and include prognostic tests, by taking into account the capacities of a laboratory service.

Increased prevalence of radiological spinal deformities in active acromegaly: a cross-sectional study in postmenopausal women.

UNLABELLED: This cross-sectional study shows that high numbers of postmenopausal women with acromegaly develop vertebral fractures in relation to the activity of disease. In patients with active acromegaly, vertebral fractures occur even in presence of normal BMD, whereas in patients with controlled acromegaly, vertebral fractures are always accompanied by a pathological BMD. INTRODUCTION: We studied the frequency of radiological vertebral fractures in a cohort of postmenopausal women with active or controlled acromegaly. MATERIALS AND METHODS: Thirty-six postmenopausal acromegalic patients (15 with active and 21 with controlled disease) were evaluated for BMD, bone metabolism (serum 25-hydroxyvitamin D, PTH, bone-specific alkaline phosphatase [BSALP], and urinary deoxypyridinoline [Dpd]), and vertebral quantitative morphometry. Thirty-six nonacromegalic postmenopausal women, matched for age, were selected among the patients consulting the Bone Center as a control group for BMD evaluation and vertebral quantitative morphometry. RESULTS: Vertebral fractures were shown in 19 patients (52.8%) and 11 controls (30.6%; chi2: 3.7; p=0.06). Fractured acromegalic women were older and had higher serum IGF-1, Dpd, and BSALP and lower T score and serum vitamin D values compared with nonfractured patients. Moreover, the fractured women had a longer diagnosis and were in the postmenopausal period for a longer period than the nonfractured women. The fracture rate was significantly higher in active than in controlled acromegaly (80% versus 33.3%; chi2: 7.6; p=0.008). The patients with active acromegaly who fractured (12 cases) had significantly higher serum IGF-1 values (356 ng/ml; range: 212-950 versus 120 ng/ml; range: 84-217; p<0.001) and T scores (-1.3 SD, range: -2.9 to +1.3 versus -2.7 SD, range: -3.4 to -1.5, p=0.04) compared with the fractured women whose disease was controlled (7 cases). All fractured women with controlled acromegaly had T scores<-1.0 SD (57.1% of them had osteoporosis, and 42.9% were osteopenic). In contrast, 41.7% of women whose fractures were associated with active disease had a normal T score (>-1.0 SD), whereas osteopenia and osteoporosis were found only in 33.3% and 25.0% of them, respectively. CONCLUSIONS: This cross-sectional study shows that high numbers of postmenopausal women with acromegaly develop vertebral fractures in relation to the activity of disease. Furthermore, our study shows that, in patients with active acromegaly, vertebral fractures occur even in the presence of normal BMD, whereas in patients with controlled acromegaly, vertebral fractures are always accompanied by a pathological BMD.

Serum amylase and lipase elevation is associated with intracranial events.

Serum amylase and lipase elevation has been observed in trauma patients and patients with traumatic intracranial bleeding. However, the causes of this elevation have not been clearly elucidated. A further question remains as to whether other intracranial events are associated with such enzyme elevation as well. We retrospectively reviewed 75 patients consecutively admitted to Cook County Hospital Neurosurgical Intensive Care Unit over a 3-month period for trauma, infection, tumor, or other space-occupying lesions with an unstable condition or neurological deficit. Eleven patients (15%) had elevated amylase and lipase levels. The patients were divided into two groups: Group I (n = 64) had normal and Group II (n = 11) had raised amylase and lipase levels [amylase 402 +/- 444 U/L with normal < or = 125 U/L and lipase 474 +/- 313 U/L with normal < or = 55 U/L]. All Group II patients suffered an intracranial event. Twenty-four Group I (38%) and 10 Group II (91%) patients required craniotomy (P < 0.01). No patients had clinical or radiographic evidence of pancreatitis. In summary, intracranial events are associated with serum amylase and lipase elevation probably through centrally activated pathways. Because of the lack of diagnostic value, routine pancreatic enzyme monitoring should not be performed in this patient population.

Risk factors for vertebral fractures in renal osteodystrophy.

We determined the prevalence of vertebral fractures in hemodialysis (HD) patients, investigated whether low bone mineral density (BMD) is predictive of vertebral fracture, and evaluated the effect of serum intact parathyroid hormone (iPTH) and alkaline phosphatase (ALP) levels on vertebral fracture. One hundred eighty-seven male HD patients were assessed for vertebral fractures, and lumbar-spine and total-body BMD were measured by dual-energy x-ray absorptiometory. Thirty-nine patients (20.9%) had vertebral fractures. Each standard deviation (SD) decrease in lumbar-spine BMD increased the age-adjusted odds ratio of vertebral fracture 2.0 times (95% confidence interval [CI], 1.4 to 2.0) and 1.6 times (95% CI, 1.1 to 1.6) for total-body BMD. The area under the receiver operating characteristic curve for lumbar-spine BMD was significantly greater than that for total-body BMD (P < 0.05). Patients with serum iPTH levels in the lowest tertile had a 2.4-fold greater risk for vertebral fracture than those in the middle tertile and a 1.6-fold greater risk than those in the highest tertile (P < 0.05). When the two criteria of lowest tertile of serum iPTH level and highest tertile of serum ALP level were combined, the prevalence of vertebral fractures was the greatest. Similarly, when the lowest tertile of serum iPTH level and lowest tertile of serum ALP level were combined, the prevalence was the second greatest among the combined groups according to tertiles of serum iPTH and ALP levels. We conclude that low lumbar-spine BMD might be a sensitive predictor of vertebral fracture in HD patients, and patients with relatively low iPTH levels would have a greater risk for vertebral fracture than those with hyperparathyroidism.

Evaluation of prognostic significance of circulating interleukin-6 in patients with accident spine injuries.

Our study aimed to verify whether patients with spine accident injury present altered plasma levels of IL-6 and whether the levels of this cytokine are related with the production of acute phase proteins which are elevated after trauma and infection. 34 subjects admitted to an Intensive Care Unit for spine injuries were examined: 26 presented fever over 38.5 degrees C and in 13 of them blood or local cultures were positive for pathogenic bacteria. IL-6, C-reactive protein (CRP), haptoglobin (HPT), alpha 2-macroglobulin (alpha 2Mg), C3c and C4 Complement factors were determined on admission and in the course of their hospital stay. No changes in IL-6 systemic levels were present in the subjects examined and only CRP was constantly high. Although within the normal range IL-6 levels inversely correlated with fever. Our results show the difficulty to utilize the IL-6 circulating levels as prognosis parameter in patients subjected to spine accident injuries.

[Alteration of thromboxane A2/prostacyclin and their effect on spinal cord blood flow in experimental spinal cord injury in rats].

In order to document the contribution of Thromboxane (TXA2) and Prostacyclin (PGI2) to the secondary damage following spinal cord injury (SCI) and their effects on spinal cord blood flow (SCBF), the alteration of SCBF, TXB2 and 6-keto-PGF1 alpha concentration in injury site (T13-L1) and adjacent cords (upper: T12, under: L2) were studied using a rat SCI model induced by Allen's weight drop method (50g-cm). The result showed that after SCI the SCBF in injury site significantly reduced during 1-2 hrs and reduced further during 4-8 hrs. The SCBF in adjacent cords also decreased during 4-8 hrs. TXB2 levels significantly increased at 1 hr and reached peak value at 4 hrs. The 6-keto-PGF1 alpha concentration also significantly increased at 1 hr and maintained that level for 24 hrs. The TXB2/6-keto-PGF1 alpha ratio was significantly elevated at 1 hr and reached its peak at 4 hrs after SCI, then gradually decreased to the preinjury level during 8-24 hrs. The negative correlation of SCBF with TXB2 concentration and TXB2/6-keto-PGF1 alpha ratio were appeared. The experimental results indicated that the imbalance of TXB2/6-keto-PGF1 alpha could be the main cause of microcirculatory disturbance and secondary damage in SCI.

D-dimer in the early diagnosis of thromboembolic disease in acute spinal injuries.

The role of monitoring plasma levels of D-dimer (XDP) as a diagnostic aid for thromboembolic disease was investigated in 267 patients admitted for acute care to the Prince Henry Hospital Spinal Unit. Elevated plasma XDP levels were found in 103 patients (39%) and a diagnosis of thromboembolic disease was made in 33. Thromboembolic disease was not found in patients whose XDP levels remained normal.

[Operative injury in spinal surgery in the management of polytrauma patients]. / Operationstrauma Wirbelsäule in der Versorgung polytraumatisierter Patienten.

The release of indicators and mediators of the posttraumatic inflammatory response following spine surgery was measured in patients with multiple injuries. Eight of a group of 113 patients (mean injury severity score 36) who underwent delayed operative stabilization of vertebral fractures (> 24 h after trauma) were studied. The following significant postoperative changes of blood levels (median values, Wilcoxon signed-rank test) compared with the preoperative starting point were found: polymorphonuclear granulocyte elastase rose from 220 to 337 ng/ml, cathepsin B from 84.5 to 135.5 mU/l, C-reactive protein from 9.1 to 11.6 mg/dl, lactate from 9.6 to 15.2 mg/dl and neopterin from 6.9 to 15.2 nmol/l, while antithrombin III fell from 107.5% to 84%, platelet count from 102 to 88 x 10(9)/l and pO2/FiO2-ratio from 361 to 260. The alterations in the blood levels of these parameters following spine surgery showed a pattern similar, albeit of lesser magnitude, to that which can be observed after severe accidental trauma. We conclude that the additional activation of the inflammatory response following surgery for vertebral lesions should be taken into account when planning these operations in patients with multiple injuries.

[Plasma cortisol levels in the newborn infants with hypoxic and traumatic injuries of the spinal cord]. / Soderzhanie kortizola v plazme u novorozhdennykh s gipoksicheskim i travmaticheskim povrezhdeniem spinnogo mozga.

Adrenal glucocorticoid function was studied in 56 newborns with natal injuries of the cervical section of the spine and the contribution of the hypoxic factor to such injuries defined. The babies were examined by the cliniconeurologic and electron-neuromyographic methods in order to specify the level of the injury. Blood serum and umbilical blood hydrocortisone levels were radioimmunoassayed immediately at birth and on days 5-7 of life. Spinal injury at the C1-C4 level was associated with low hydrocortisone levels, that may be regarded as an additional criterion for the differentiation of the level of injury in traumas of the cervical portion of the spine in the newborns.

Relationship of bone density to estradiol and cortisol in anorexia nervosa and bulimia.

Dual photon absorptiometry was used to assess the risk of developing osteoporosis in patients with anorexia nervosa and patients of normal weight with bulimia nervosa. Anorectic patients had significantly lower vertebral bone mineral densities compared with healthy controls. Bulimic patients had values similar to those of controls, and the differences between bulimics and anorectics narrowly missed significance. No significant difference was found between patient groups in measurements of serum estradiol, but anorectics, compared with bulimics, had significantly higher values of 24-hour urinary free cortisol. Hypercortisolemia, by diminishing bone formation and increasing bone resorption, is likely to contribute to the development of osteoporosis in patients with eating disorders.

Fibrinolysis and spinal injury. Relationship to post-traumatic deep vein thrombosis.

Tissue plasminogen activator (t-PA) activity and antigen (t-PA:Ag) at rest and after venous occlusion (VO), were measured on admission to hospital in 9 patients with acute spinal cord injury (SCI) (group P) and in 12 patients who were immobilized due to a fracture of the cervical spine without paralysis (group C). In addition, the levels of t-PA:Ag, t-PA activity, t-PA inhibitor activity (PAI), the von Willebrand factor (vWF:Ag), F VIII:C and fibrinogen were monitored until the 10th post-traumatic day. Venous thrombosis (VT) was detected by the 125I-labelled fibrinogen test in 78% in group P and in 8% in group C. The median t-PA activity after VO was 8.6 IU/ml and 41.6 IU/ml in groups P and C, respectively (p less than 0.01). The t-PA:Ag increased similarly during VO in both groups and reached a level of 55.0 ng/ml in group P and 64.9 ng/ml in group C. The median level of PAI activity before VO was 19.2 U/ml in group P and 15.8 U/ml in group C. The trend of higher PAI values in group P than in C was more pronounced after VO (13.4 U/ml vs. 2.0 U/ml). High individual levels of PAI were found during the first 72 h of immobilization in both group P and group C. The levels of vWF:Ag and fibrinogen were significantly higher in group P than in group C on the 6th and 10th post-traumatic days and the level of FVIII:C on the 10th day.(ABSTRACT TRUNCATED AT 250 WORDS)

Raised serum albumin in hip osteoarthrosis: a comparative study in women of some blood chemical parameters in aging and in cases of femoral neck fractures, osteoporotic vertebral crush fractures, and hip osteoarthrosis.

Twelve blood parameters were studied in five groups of women totalling 120 subjects--group I: 26 blood donors (average age 45.2 years, range 23-66); group II: 18 patients with various cerebral, cardiovascular, or infectious illnesses (average age 79.9 years, range 66-92); group III: 28 patients with femoral neck fractures (average age 79.4 years, range 56-95); group IV: 12 patients with hip osteoarthrosis (average age 71.7 years, range 60-87); group V: 36 patients with vertebral crush fractures associated with postmenopausal and involutional osteoporosis (average age 63.0 years, range 51-75). The parameters measured were total proteins, albumin, total, alpha 1, alpha 2, beta, and gamma globulins, total calcium, phosphates, alkaline phosphatase, bilirubin, and haemoglobin. Statistical analysis showed that each group differed from the others even with adjustment for age. Among the discriminant parameters, serum albumin had a distinctive position. Significantly high concentrations of serum albumin in the group with osteoarthrosis raise the question of the possible existence of a population prone to osteoarthrosis in whom the serum albumin level may reflect a special nutritional state associated with the well known bone density in subjects with hip osteoarthrosis. Albumin values in patients with femoral neck fractures are lower than normal but non-significantly. The difference between the group with vertebral crush fractures and that with femoral neck fractures seems to be due to age.

The blood F VIII:Ag/F VIII:C ratio as an early indicator of deep venous thrombosis during post-traumatic immobilization.

Twenty-two consecutive patients with spinal fractures (eight with spinal cord injuries) were studied. All patients were immobilized in bed for 6 weeks after trauma. The occurrence of deep venous thrombosis (DVT) was detected by the 125I-labeled fibrinogen test and confirmed by venography. F VIII:C, F VIII:Ag, and AT III activities were determined 2, 6, and 10 to 12 days after trauma. All paralyzed patients (n = 8) developed DVT and two of them had pulmonary embolism within 5 days after trauma. F VIII:Ag and F VIII:C disproportionally increased and the values of F VIII:Ag/F VIII:C ratio above 2 predicted DVT. AT III remained normal during the whole immobilization time and the values of DVT(+) and DVT(-) groups were comparable.

Serial concentrations of C-reactive protein as an indicator of urinary tract infection in patients with spinal injury.

C-reactive protein (CRP) was measured serially in 16 patients with an acute spinal injury. Twelve episodes of acute urinary tract infection (UTI) occurred during the study period. These were all associated with an increased concentration of CRP greater than 50 mg/l, which returned to normal after successful treatment. Thirteen episodes of asymptomatic bacteriuria associated with increased concentrations of CRP greater than 20 mg/l occurred, indicating tissue damage. More commonly, significant bacteriuria was associated with normal concentrations of CRP, and presumably, simple colonisation of the urinary tract, which, we suggest, does not require treatment with antibiotics. Serial measurement of CRP in patients with spinal injury may help distinguish between urinary tract colonisation and infection and be useful in monitoring the response to the treatment of clinical UTI.