Health service cost associated with percutaneous vertebroplasty in patients with spinal metastases.

AIMS: To ascertain prospectively the health service cost of vertebroplasty in a cohort of consecutive patients with spinal metastases. MATERIALS AND METHODS: Percutaneous vertebroplasty was performed under conscious sedation and local anaesthetic in the Interventional Suite with fluoroscopic guidance. Data were collected prospectively on standard forms. Quality of life questionnaires (EQ-5D) were filled out pre-, 6 weeks, and at 6 months post-vertebroplasty. RESULTS: The majority of the procedures were performed on an outpatient basis (8/11). The median duration of the procedure was 60 min (range 40-80 min) with a further 60 min spent in the recovery room (range 10-230 min). Personnel involved included a consultant radiologist, a radiology registrar, four nurses, and two radiographers. The average cost of vertebroplasty per patient, including consumables, capital equipment, hotel/clinic costs, and staffing, was £2213.25 (95% CI £729.95). The mean EQ-5D utility scores increased from 0.421 pre-treatment to 0.5979 post-treatment (p = 0.047). The visual analogue scale (VAS) of perceived health improved from a mean of 41.88 to 63.75 (p = 0.00537). CONCLUSION: Health service costs for percutaneous vertebroplasty in patients with spinal metastases is significantly lower than previously estimated and is in keeping with that of other palliative radiological procedures.

Rin, a neuron-specific and calmodulin-binding small G-protein, and Rit define a novel subfamily of ras proteins.

cDNAs encoding two novel 25 kDa Ras-like proteins, Rit and Rin, were isolated from mouse retina using a degenerate PCR-based cloning strategy. Using the expressed sequence tag database, human orthologs were also obtained and sequenced. The protein sequences of Rit and Rin, which are 64% identical, are more similar to each other than to any known Ras protein. Their closest homologs in the databases are Mucor racemosus Ras2 and Ras3, to which they show approximately 48% identity. Rit and Rin both bind GTP in vitro. An unusual feature of their structure is that they lack a known recognition signal for C-terminal lipidation, a modification that is generally necessary for plasma membrane association among the Ras subfamily of proteins. Nonetheless, transiently expressed Rit and Rin are plasma membrane-localized. Both proteins contain a C-terminal cluster of basic amino acids, which could provide a mechanism for membrane association. Deletion analysis suggested that this region is important for Rit membrane binding but is not necessary for Rin. Rit, like most Ras-related proteins, is ubiquitously expressed. Rin, however, is unusual in that it is expressed only in neurons. In addition, Rin binds calmodulin through a C-terminal binding motif. These results suggest that Rit and Rin define a novel subfamily of Ras-related proteins, perhaps using a new mechanism of membrane association, and that Rin may be involved in calcium-mediated signaling within neurons.

Blood loss and transfusion in head and neck tumour surgery.

Major head and neck surgical procedures at the Department of Otolaryngology, Singapore General Hospital during a two year period were reviewed. Sixty-three patients were available for study. Data obtained included tumour site and stage, surgical procedure, duration of operation, preoperative haemoglobin and haematocrit, estimated surgical blood loss, amount of blood ordered and used. Data were grouped by procedure. Temporal bone resections showed the highest average estimate of blood loss (1203 mL) and the highest average blood use (3.0 units), followed by composite resections (1067 mL and 2.3 units) and maxillectomy/midface procedures (616 mL and 1.4 units). The degree of blood loss showed a positive correlation with the duration of operative procedure. The majority of patients (62%) met all criteria to qualify as autologous blood donors making autologous transfusion a feasible option for these patients.

Slow exponential decay of rate of superoxide production in phorbol ester-activated human neutrophils.

Proper quantification of the superoxide (O2-) respiratory burst induced in human neutrophils is important for better understanding of the mechanism of action of stimulators and inhibitors. Reexamination of the reaction triggered by phorbol myristate acetate (PMA) indicated that it was a persistent process which lasted over 60 min. Plots of rates versus time show that rates of O2- release decayed logarithmically with a mean half-life (T1/2) of 21 +/- 6 min (SD), N = 12). Calculations of areas under curves indicate an average O2- yield of 217 +/- 99 nmol/10(6) cells. The inclusion of catalase in incubation mixtures did not alter the T1/2 or O2- yield, nor was the latter value affected by the quantitive scavenging of O2- by cytochrome c. Under certain conditions--the presence of excess dimethyl sulfoxide, the substitution of a less potent phorbol ester or activation of cells at high densities--the initial rate was either increased or decreased but a complementary alteration in the T1/2 resulted in little or no change in the total O2- yield. Retinol and retinol acetate decreased the initial rate, but retinoic acid enhanced it. By comparison, total O2- production was markedly reduced by all three agents with the following order of potency: retinoic acid greater than retinol greater than retinol acetate. In contrast, the serine protease inhibitor, TPCK, suppressed both the O2- yield and initial rate to a similar extent. On the basis of present observations, it is proposed that under normal conditions of PMA cellular activation, the logarithmic decay of the rate of O2- release was not due to autoinactivation of the O2--generating system, but rather to another factor, a possibility being the depletion of intracellular NADPH.

Idiopathic retroperitoneal fibrosis with protein-losing enteropathy and duodenal obstruction successfully treated with corticosteroids.

A 40-year-old carpenter presented with vomiting due to duodenal obstruction. On further investigation he had partial obstruction of both ureters and occlusion of the inferior vena cava. At laparotomy a large retroperitoneal mass of fibrous tissue was found, which extended into the root of the mesentery of the small intestine and partially occluded the duodenum. There was enlargement of lymphatics and stasis of lymph throughout the mesentery. Hypoalbuminemia was present. (131)I-labelled human serum albumin disappeared rapidly from the plasma and there was excessive loss of plasma albumin into the gastrointestinal tract, presumably owing to obstruction of the lymphatic drainage of the small intestine. Prompt improvement followed treatment with prednisolone. Steroids are apparently useful in this condition, early in the disease before irreversible fibrosis has developed. The presenting feature, vomiting due to duodenal obstruction, has been reported in retroperitoneal fibrosis only once before. This is the first report of protein-losing enteropathy in this disorder.