The promise of autologous and allogeneic cellular therapies in the clinical trials of autism spectrum disorder.

Autism spectrum disorder (ASD) is a consortium of developmental conditions. As scientists have not yet identified the exact underlying cause for these disorders, it is not easy to narrow down a singular therapy to propose a reliable cure. The preponderance of research suggests that stem-cell therapy improves aspects of outcome measure scales in patients with ASD; therefore, future studies should give us more confidence in the results. This overview considers the data that have emerged from the small set of published trials conducted using different approaches in stem-cell therapy for ASD, evaluates their results and proposes additional steps that could be taken if this field of endeavor is to be pursued further.

The eggshell technique for prevention of cement leakage during kyphoplasty.

Cement extravasation during kyphoplasty occurs between 4% and 9%, a much lower incidence than with vertebroplasty. However, because of the potential complications of cement in and around the spinal canal, any egress of cement outside the vertebral body is extremely concerning. Aborting the procedure will cease the extraosseous leakage and minimize potential immediate complications. However, the cavity will remain unfilled and the fracture unstable. Rather than aborting, we have devised a technique, called the eggshell technique, to manage the patient's fracture once extravasation is noted so that the procedure can be safely completed.

Lumbar disc herniation: evaluation of information on the internet.

STUDY DESIGN: An original study was performed evaluating the information presented on existing web sites for the topic of lumbar disc herniation. OBJECTIVES: The purpose of this study was to evaluate the type and quality of internet information available to patients on the topic of lumbar disc herniation. Our secondary objectives were to rank the identified World Wide Web sites with respect to the caliber of relevant information and to determine the propensity for secondary commercial gain by the web site sponsors. SUMMARY OF BACKGROUND DATA: Two-thirds of the United States population "surfs" the internet. A substantial percentage of internet users search for medical information on the World Wide Web. Because no standards exist regarding the publication of medical literature on the internet, the relevant web sites vary dramatically in terms of content and quality. Misleading or inaccurate information poses a theoretical risk to patients seeking treatment for medical conditions. METHODS.: Five search terms (lumbar disc herniation, herniated nucleus pulposus, herniated disc, slipped disc, and sciatica) were entered into 5 commonly used search engines. The first 25 links displayed by each engine were evaluated for a theoretical total of 625 web sites. Each site was evaluated in terms of content, authorship, and secondary commercial gain. An information quality score of 0 to 25 points was generated for each site; a score of 20 or greater was indicative of "high-quality" content. RESULTS: Our search identified 169 unique web sites of which only 16 (9.5%) scored >or=20 on the information quality score; 103 (60.9%) scored

A technique for reducing splash exposure during pulsatile lavage.

Pulsatile lavage is a frequently used method among orthopaedic traumatologists at our institution in the management of open fractures and contaminated wounds. Due to the pressure generated by the pulsatile lavage systems, splash exposure in the operating room environment becomes an unavoidable occurrence. The potential exists for a mucocutaneous exposure for either the surgeon or the operating room personnel. We have devised a method of decreasing the exposure risk to surgeons and operating room personnel during the pulsatile lavage irrigation portion of the procedure. An x-ray cassette drape is placed over the affected limb with enough clamps to create a closed system. Then small holes are created for the pulsatile lavage and the suction tubing, and the irrigation procedure is begun. This inexpensive cassette cover has proved to be a substantial advantage in our institution for decreasing mucocutaneous exposure.

Biomechanical comparison of cervical interbody cage versus structural bone graft.

BACKGROUND CONTEXT: Clinically, cervical interbody cages provide fusion rates equivalent to structural bone grafting. No published studies have biomechanically compared cages with grafts. PURPOSE: We sought to compare the stability offered by threaded interbody cages versus structural bone graft and to evaluate the additional stability provided by adding a one- or two-level anterior plate to both interbody techniques. STUDY DESIGN/SETTING: Nondestructive nonconstraining repeated-measures in vitro flexibility tests were performed on surgically instrumented specimens. SUBJECT SAMPLE: Sixteen human cadaveric specimens were separated into two groups (specimens receiving graft and specimens receiving cage) with matched bone mineral density. OUTCOME MEASURES: Angular range of motion (ROM), neutral zone (NZ) and elastic zone (EZ) were quantified to assess stability. Student's t tests compared outcomes between and within groups. METHODS: Quasistatic nonconstraining torques (maximum 1.5 Nm) induced flexion, extension, lateral bending and axial rotation while angular motion was recorded stereophotogrammetrically. Specimens were tested normal, after discectomy, with graft or cage, with two-level plate and with one-level plate. RESULTS: Graft alone and cage alone reduced ROM and EZ but not NZ to within normal. In both groups, adding a one- or two-level plate significantly reduced motion in all modes of loading. There were no significant differences in motion parameters between groups whether plated or unplated. A two-level plate provided significantly better stability than a one-level plate. CONCLUSIONS: The interbody cage performed equivalently to the structural graft. Substantial increases in stability can be gained for either interbody technique by adding an anterior plate.