[Thromboprophylaxis and platelet aggregation inhibitors in spinal surgery: perioperative management]. / Thromboseprophylaxe und Aggregationshemmer in der Wirbelsäulenchirurgie: perioperative Management.

BACKGROUND: The perioperative use of anticoagulants (AC) and platelet aggregation inhibitors (PAI) in the field of spinal surgery suggests an increased rate of epidural bleeding. However, evidence is lacking and these medications are most often indispensable in the prevention of thromboembolic complications. Comprehensive recommendations for the correct use of AC and PAI are lacking. OBJECTIVE: The aim of this study was an analysis of the current situation with regards to the use of AC and PAI in spinal surgery and development of new recommendations. MATERIAL AND METHODS: Two independent surveys on the perioperative use of AC and PAI were obtained from centers for spinal surgery in Germany. The study obtained information on the perioperative use of AC and PAI, risk assessment of thromboembolic and hemorrhagic events as well as on the type and extent of the substance groups used. RESULTS: Almost the entire patient collective (98%) received perioperative low molecular weight heparin. In 64% the medical prophylaxis was started before surgery and in 36% after surgery. The period of prophylaxis was determined arbitrarily. Approximately 40% of interviewees employed paravertebral infiltration and 19% injected into the epidural space in patients on PAI medication. Open spinal canal surgery was performed in 30% of PAI medicated patients and closed spinal canal surgery was executed in 40%. The risk assessment of PAI differed significantly between aspirin and receptor blocker medication as well as dual administration of PAI. DISCUSSION: The use of AC and PAI in spinal surgery in Germany is very heterogeneous and large deviations from the guidelines frequently occurred. Therefore, there is a strong need for further studies to accurately assess the perioperative use of AC and PAI and to formulate precise recommendations.

Five-year Evaluation of Chronic Diseases in Hamadan, Iran: 2005-2009.

BACKGROUND: Now the increasing growth of chronic diseases is the major health challenge worldwide. This survey was conducted to assess noncommunicable diseases related risk factors. METHODS: A population-based cross sectional study was conducted in 2005 and repeated annually by 2009 in Hamadan province, the west of Iran using two-stage cluster sampling method. A total sample of 6500 subjects 15 to 64 years old were enrolled. RESULTS: The total prevalence of cigarette smoking was 18% [95% CI 17% to 19%], 35.1% in men versus 1.1% in women. The smokers consumed on average 15 cigarettes per day. Almost 26.3% [95% CI 24.8% to 27.7%] of the target population eat five or more servings of fruits and vegetables per day; 52.8% [95% CI 51.2% to 54.3%] had work related physical activity; 28.1% [95% CI 26.7% to 29.4%] had physical activity during leisure time; 80.3% [95% CI 79.0% to 81.5%] had transportation related physical activity; 47.2% [95% CI 46.0% to 48.4%] were either overweight or obese; 8.1% [95% CI 7.1% to 9.2%] had impaired fasting blood sugar or were confirmed diabetes; 33.7% [95% CI 31.9% to 35.5%] had hypercholesterolemia; and 15.6% [95% CI 13.0% to 18.3%] had hypertriglyceridemia. There was a statistically significant association of age and gender with body mass index, systolic and diastolic hypertension, hyperglycemia, hypercholesterolemia and hypertriglyceridemia. CONCLUSIONS: The evidences of the present survey promise a silent progressive epidemic of chronic diseases among Iranian citizens that may lead to an increasing growth of noncommunicable diseases in the next decade.

Breast cancer metastasis to the medulla oblongata: a case report.

Breast cancer metastasis to the brain stem is uncommon. Because of the rarity of the condition, the clinical course of such patients is not known. The case of a 41-year-old woman with advanced-stage carcinoma of the breast involving the medulla oblongata is presented and the literature concerning management, including patient outcome, is reviewed.

Contribution of PET imaging to the initial staging and prognosis of patients with Hodgkin's disease.

BACKGROUND: Positron emission tomographic (PET) scanning utilizing [18F]fluorodeoxyglucose (FDG) is a new method of tumor imaging based on the increased glucose metabolic activity of malignant tumors. In Hodgkin's disease (HD), PET has proven value for the evaluation of residual masses following treatment and for the early diagnosis of relapse. In the initial staging of HD, PET frequently shows a higher stage than conventional methods (upstaging by PET). In the present study, we evaluated the frequency of stage changes by PET in a multicenter setting and determined its prognostic relevance. PATIENTS AND METHODS: A total of 73 patients with newly diagnosed HD were staged with both conventional methods and whole-body PET scanning. All histological types and stages were represented. The median time of follow-up after the initial diagnosis was 25 months (range 1 month to 5 years). The response to treatment was determined by standard clinical and diagnostic criteria. For the purpose of this analysis, data from a PET center associated with a university medical center and a PET center associated with a group oncology practice were combined. RESULTS: A total of 21 patients (28.8%) were upstaged by PET compared with conventional methods. In two cases (2.7%), a lower stage was suggested by PET scanning. With one possible exception, the upstaging had no obvious clinical or biological correlate. Among 12 patients in stage I (A + B) by conventional methods, seven were upstaged by PET (58.3%), four to stage II, one to stage III and two to stage IV. Among 42 patients in stage II, eight were upstaged by PET (19.0%), six to stage III and two to stage IV. Among 12 patients in stage III, six (50%) were upstaged to stage IV by PET. If only early-stage patients and major changes are considered (stages IA-IIB to III or IV), among 49, 10 were upstaged to III or IV, whereas in 39 staging was unchanged following PET. In the former group, three relapsed or were refractory compared with none in the latter group (P<0.006). In advanced stage patients (IIIA or IIIB) a trend toward treatment failure was apparent in patients who were upstaged by PET. CONCLUSIONS: PET scanning is an interesting new modality for the accurate staging of patients with HD and frequently shows a higher stage than conventional methods. PET should be performed at initial diagnosis and should be included in prospective studies of patients with HD. Upstaging by PET may represent a risk factor for a more advanced stage or a biologically more aggressive tumor. Patients with early-stage disease as identified by conventional methods have a significant risk of treatment failure if a more advanced stage is indicated by PET. At present, major stage changes suggested by PET imaging should be confirmed by an independent diagnostic method.