[Current status of vertebroplasty and kyphoplasty in Germany: an analysis of surgical disciplines]. / Aktueller Stand der Vertebroplastie und Kyphoplastie in Deutschland: Eine Untersuchung in den operativen Fachdisziplinen.

OBJECTIVE: This study was performed to provide an overview of the current practice of balloon kyphoplasty (BKP) and percutaneous vertebroplasty (PVP) in Germany. All surgical departments were evaluated for indications, experience and expertise, and the complications. METHODS: Questionnaires were mailed to 1330 surgical departments. RESULTS: A total of 582 (43.76%) surveys were returned; 257 departments perform neither BKP nor PVP. Osteoporotic compression fractures and to a lesser extent hemangiomas and metastasis were treated. About 30% of the BKP users consider traumatic vertebral fractures in young patients as an indication, 76% of the respondents perform further spinal surgery, and 71% of the users operate within the first 2 weeks. For both interventions cement leakage is the most common complication. CONCLUSION: Nationwide kyphoplasty and vertebroplasty are widely used by surgeons. The number of users as well as the annual number of cases in each center are increasing continuously. The partially incomplete present state of the studies must be validated by future high-quality, randomized studies.

[Percutaneous vertebroplasty -- the role of osseous phlebography]. / Die perkutane Vertebroplastie -- Rolle der ossären Phlebographie.

PURPOSE: To evaluate the usefulness of osseous phlebography preceding percutaneous vertebroplasty. MATERIALS AND METHODS: Seventy-five patients with painful osteoporotic (57) or malignant (18) vertebral fractures were treated by percutaneous vertebroplasty under fluoroscopic control. Prior to cement injection, osseous phlebography was performed, with 247 phlebographic studies included in the retrospective correlation with radiographic and CT images. Clinical results were assessed by standardized questionnaire. RESULTS: In 69/75 (92 %) patients, pain and mobility improved and medication needed for pain control decreased significantly after vertebroplasty. Two clinically apparent complications occurred. The results of osseous phlebography prompted correction of the needle position in 34/247 (14 %) of the procedures and cancellation of the cement injection in 19/247 (8 %). No complications occurred related to osseous phlebography. CT was superior to conventional radiography in detecting extra-osseous cement leakage (106/247 by CT vs. 63/247 by conventional radiography). The cement leakage was asymptomatic in 104/106 (98 %) cases for the duration of follow-up. DISCUSSION: Osseous phlebography prior to percutaneous vertebroplasty had a significant impact on the procedure in our retrospective study and was able to predict the cement distribution in the majority of cases. However, phlebography was unable to foresee and therefore prevent 2 clinically relevant complications. Complications related to phlebography did not occur.

Diverse BF recombinants have spread widely since the introduction of HIV-1 into South America.

OBJECTIVE: To describe the genetic diversity of HIV-1 in South America by full genome sequencing and analysis. METHODS: Purified peripheral blood mononuclear cell DNA from HIV-infected individuals in Argentina, Uruguay and Bolivia was used to amplify full HIV-1 genomes. These were sequenced using the ABI 3100 automated sequencer and phylogenetically analysed. RESULTS: Twenty-one HIV-1 strains from three South American countries, 17 of which were pre-screened by envelope heteroduplex mobility assay (HMA), were studied. Ten out of 10 HMA subtype F and four out of seven HMA subtype B strains were actually BF recombinants upon full genome analysis. Two BF recombinants from Argentina and two from Uruguay had the same structure, representing a new circulating recombinant form termed CRF12_BF(ARMA159). Twelve other BF recombinants had structures related to CRF12 but with additional segments of subtype B; each was unique. BF recombinants were temporally and geographically widespread, found as early as 1986-1987 in vertically infected Argentinian children and in Argentina, Uruguay, and Bolivia.

Fatal disseminated adenovirus infection in a renal transplant recipient.

A 61 year old woman died of diffuse interstitial adenovirus pneumonia 55 days after receiving a cadaveric renal allograft. The adenovirus was serologically distinct from the 33 known human adenovirus serotypes and appears to represent a new human adenovirus. Pathologic and virological findings indicate that the pneumonia was only one manifestation of a disseminated infection, the source of which may have been a latent adenovirus infection preexisting in the donor kidney. The establishment of the etiologic diagnosis in this case, which was complicated by the presence of oculocutaneous and esophageal herpes simplex virus infection as well as focal pulmonary aspergillosis, required coordinated histopathologic and virological investigation. Our findings demonstrate that severe viral infections in transplant recipients are not caused exclusively by members of the herpesvirus group.

Loss of dopamine-D2 receptor binding sites in Parkinsonian plus syndromes.

UNLABELLED: This study analyzed temporal changes of striatal dopamine-D2 receptor binding during the course of different extrapyramidal movement disorders using 123I-iodobenzamide (IBZM) SPECT. METHODS: Eighteen patients (9 with Parkinson's disease, 9 with parkinsonian plus syndrome) were followed for 11-53 mo. Dopamine-D2 receptor binding was assessed using 123I-IBZM SPECT at the beginning and at the end of the follow-up period. SPECT data were acquired 120 min postinjection of 3-5 mCi 123I-IBZM. A semiautomated algorithm was applied to the raw data for semiquantitative evaluation of regional cerebral receptor binding. RESULTS: Intraobserver (r = 0.992) and interobserver (r = 0.930) variance was low for the semiautomated interpretation of the SPECT examination of the dopaminergic D2 receptor binding, reflecting a highly reproducible SPECT algorithm. Mean specific dopamine-D2 receptor binding was lower in patients with parkinsonian plus syndrome compared to patients with Parkinson's disease on the initial (p < 0.001) as well as the follow-up study (p < 0.001). In patients with Parkinson's disease, we observed an unaffected receptor binding compared to a reduced binding of radiotracer in patients with parkinsonian plus syndrome during the course of the disease (p < 0.001). CONCLUSION: During the follow-up, patients with Parkinson's disease showed a constant dopamine-D2 receptor binding. In contrast, patients with parkinsonian plus syndrome revealed a decline of the binding of dopamine-D2 receptor. These findings are in agreement with histopathological data that demonstrated a preserved dopamine-D2 receptor status in patients with Parkinson's disease and a decline of the dopamine-D2 receptors in patients with parkinsonian plus syndrome. SPECT examinations using 123I-IBZM are useful for assessing dynamic changes of dopamine-D2 receptors in extrapyramidal movement disorders. Semiquantitative SPECT evaluations may provide valuable information for clinical management and prognosis of the patient with extrapyramidal movement disorders.

Dopamine D2 receptor imaging with iodine-123-iodobenzamide SPECT in idiopathic rotational torticollis.

UNLABELLED: The cause of idiopathic rotational torticollis (IRT) is not completely understood to date. However, basal ganglia are believed to be involved in the pathophysiology of IRT. To elucidate this disorder further, the value of iodobenzamide (IBZM) SPECT was studied for the evaluation of striatal dopamine D2 receptors in these patients. METHODS: Striatal dopamine D2 receptor density was assessed in 10 patients with IRT using 123I-IBZM SPECT. The images were interpreted by a nuclear medicine physician initially to determine IBZM binding within the striatum and the cerebellum and, secondly, interstriatal IBZM binding. The results were correlated with the clinical parameters of the patients and compared with the results obtained from normal controls. RESULTS: No difference was found in average, specific striatal IBZM binding (basal ganglia/cerebellum ratio) between patients and controls. However, interstriatal analysis of IBZM binding revealed a significantly higher binding in the striatum contralateral to the direction of the torticollis (p = 0.026, by chi-square test). CONCLUSION: It was concluded that the striatal dopamine D2 receptor status is altered in patients with IRT.

Iodine-123-iodo-lisuride SPECT in Parkinson's disease.

UNLABELLED: Recently, [123I]iodo-lisuride was synthesized for possible applications in SPECT studies. The purpose of this investigation was to compare the striatal binding and kinetics of this radioligand in patients with Parkinson's disease and normal controls. METHODS: Six patients with Parkinson's disease and three normal controls were examined. After intravenous injection of 111 MBq [123I]iodo-lisuride, sequential SPECT examinations at 20, 40, 80 and 120 min were performed. For each SPECT series the basal ganglia-to-cerebellum ratio of tracer accumulation was calculated. In one patient a repeat SPECT examination was undertaken under identical conditions to test the reproducibility of the procedure. In two other patients a second SPECT examination was performed after injection of cold lisuride as a receptor saturation study. In addition, the time course of the radioactivity was measured in the plasma and red blood cells in each individual. RESULTS: In both patients and controls, the highest tracer accumulation was found within the striatum. The basal ganglia-to-cerebellum ratio was 1.182 and 1.303 at 20 min, 1.353 and 1.450 at 40 min, 1.490 and 1.533 at 80 min, 1.550 and 1.583 at 120 min for patients and controls, respectively, which was not statistically different. In the saturation study, 50 micrograms and 100 micrograms cold lisuride led to a 28% and 33% reduction, respectively, of the basal ganglia-to-cerebellum ratio at 120 min. The ligand showed a rapid decline in plasma and red blood cells. The percent injected dose per liter was calculated to be 1.6 and 0.9, respectively, for plasma and red blood cells at 20 min. CONCLUSION: Iodine-123-iodo-lisuride SPECT seems useful for imaging intact striatal dopamine D2 receptors in patients with Parkinson's disease and may provide clinically relevant information for quantitative assessment of the availability and integrity of dopamine D2 receptors.

Mother-to-child HIV type 1 transmission in Argentina: BF recombinants have predominated in infected children since the mid-1980s.

The molecular epidemiology of HIV-1 in Argentina is more complex than was previously appreciated. One circulating recombinant form, CRF12_BF, and many related BF recombinant forms predominate in the capital city, Buenos Aires. This study of HIV-1 subtypes acquired perinatally between 1984 and 2000 has permitted, for the first time, a reconstruction of the history of BF recombination in Argentina. Sequencing of a partial genome region from the beginning of vpu to the beginning of env(gp120), which spans a breakpoint common in most contemporary Argentine BF recombinants, enabled samples to be rapidly screened. Among 23 children born between 1984 and 2000, 15 including 1 child born in 1986, harbored a BF recombinant. Thirteen of the 15 recombinants shared a common breakpoint at the 5' end of env(gp120). Full genome sequencing of two viruses, from 1986 and 1987, respectively, revealed them to be genetically related but not identical to CRF12_BF. Both contained more subtype B sequence than did CRF12_BF. BF recombinants related to CRF12_BF have been in circulation in Buenos Aires since 1986 and continue to predominate in perinatal transmissions.

Circulating recombinant form CRF02_AG in South America.

With the objective of monitoring the distribution of HIV-1 subtypes and circulating recombinant forms (CRFs)in South America, population-based surveillance studies were performed in seven countries. Peripheral blood mononuclear cell, filter paper, fresh blood, and cocultivation samples were collected from HIV-positive patients from Colombia, Ecuador, Peru, Bolivia, Chile, Argentina, and Uruguay, during a 7-year period(1995-2001). DNA was prepared and HIV envelope subtypes were determined by heteroduplex mobility as-say and DNA sequencing from 1289 HIV-positive samples. While subtypes B and F were the most commonly observed subtypes, two CRF02_AG strains were detected, in Ecuador. This is the first report of the existence of this CRF in South America.

MRI and CT in the differential diagnosis of pleural disease.

STUDY OBJECTIVE: To explore the role of MRI in the differential diagnosis of pleural disease. PATIENTS: Forty-two patients with pleural disease were included. METHOD: Retrospective study. All patients were examined with both CT and MRI. The morphologic features of pleural lesions and magnetic resonance signal intensity on T1-weighted, T2-weighted, and contrast-enhanced T1-weighted images were evaluated. RESULTS: Mediastinal pleural involvement, circumferential pleural thickening, nodularity, irregularity of pleural contour, and infiltration of the chest wall and/or diaphragm were most suggestive of a malignant cause both on CT and MRI. Pleural calcification on CT was suggestive of a benign cause. Contrary to what has been previously reported in the literature, neither on CT nor on MRI, pleural thickness >1 cm revealed significant difference between malignant and benign pleural disease (p>0.05, chi(2) test). High signal intensity in relation to intercostal muscles on T2-weighted and/or contrast-enhanced T1-weighted images was significantly suggestive for a malignant disease. Using morphologic features in combination with the signal intensity features, MRI had a sensitivity of 100% and a specificity of 93% in the detection of pleural malignancy. CONCLUSION: When signal intensity and morphologic features are assessed, MRI is more useful and therefore superior to CT in differentiation of malignant from benign pleural disease.

Epidemic keratoconjunctivitis in a chronic care facility: risk factors and measures for control.

OBJECTIVE: To study patterns of transmission of epidemic keratoconjunctivitis (EKC) in a chronic care facility and to assess control measures and prevent future outbreaks in this setting. DESIGN: A retrospective cohort study. SETTING: A 120-bed, four-unit, skilled nursing facility. PATIENTS: Residents and employees of the above facility. INTERVENTIONS: Increased frequency of cleaning; use of bleach disinfectant; universal precautions in handling eye secretions from residents with conjunctivitis; cohorting residents by unit; suspension of new admissions; closure of common gathering areas. MEASUREMENTS: Resident demographics; possible risk factors for infection among residents (including mobility, underlying illness, medications, involvement in social activity, level of confusion) and among employees (including co-morbid illnesses and eye conditions, exposures to persons with conjunctivitis, visits to eye care specialists, use of contact lenses or glasses); testing of conjunctival specimens from symptomatic persons for viral and bacterial agents. RESULTS: Of 95 residents on three chronic care units, 47 (attack rate 49%) had onset of eye symptoms consistent with EKC between September 14 and December 7, 1990. Thirty-eight (81%) of these had onset following the onset of symptoms in a resident with dementia who, despite habitual eye-rubbing and wandering into other residents' rooms, was not isolated or restricted in any way. Attack rates were higher (though not statistically significant) among more mobile residents (60% for ambulatory residents) and among those considered by staff to be confused (56%). Rapid antigen detection and culture confirmed adenovirus type 37 as the etiologic agent. CONCLUSIONS: Transmission of infection with adenovirus type 37 was successfully interrupted following strict infection control, suspension of new admissions, cohorting of residents by unit, and change to a disinfectant that inactivates adenovirus. Recognition of conjunctivitis as an appropriate reason for restricting movement of an infected resident may have prevented extensive viral transmission in this outbreak.

The effect of centrifugation on the rapid detection of adenovirus in shell vials.

Monoclonal antibody, specific for the adenovirus group-reactive hexon antigen, was used for the detection of this agent by immunofluorescence 24 and 48 hours after inoculation of HEp-2 cell monolayers in 1-dram shell vials after low-speed centrifugation (700 X g, 30 minutes). Of 31 adenovirus isolates, 16 (sensitivity, 52%) and 30 (sensitivity, 97%) were detected after incubation for 24 hours and 48 hours, respectively. All adenovirus strains were detected in conventional tube cell cultures but required an average of four days incubation. The shell vial assay is rapid, sensitive, and specific and can be easily implemented in laboratories with cell culture experience.

Isolation of parainfluenza virus type 3 from cerebrospinal fluid associated with aseptic meningitis.

Parainfluenza virus type 3 has been isolated from the cerebral spinal fluid (CSF) from six individuals--four children and two adults--over a 10-year period. All had fever, and four had signs of meningitis. All recovered uneventfully, including one child undergoing chemotherapy for medulloblastoma. The clinical presentation of this child who developed parainfluenza virus type 3 meningitis is described, and the cases of five other individuals with parainfluenza virus type 3 isolated from the CSF are briefly reviewed. The paramyxovirus parainfluenza type 3, in addition to mumps virus, may be considered capable of infecting the central nervous system.

Morphological changes in chest radiographs of patients with acute respiratory distress syndrome (ARDS).

OBJECTIVE: To determine whether the quality of infiltrations in chest radiographs can accurately predict the histological extent of fibrotic change in patients with acute respiratory distress syndrome (ARDS). DESIGN: Retrospective clinical investigation. SETTING: Intensive care unit (ICU) of a university teaching hospital. PATIENTS AND METHODS: Of 47 patients treated with extracorporeal membrane oxygenation (ECMO) for severe ARDS over a 5-year period, 23 patients underwent open lung biopsy at thoracotomy for treatment, mostly of pneumothorax. Chest films obtained by portable chest roentgenography preceding the operation were reviewed retrospectively and compared to the histomorphological results of the lung specimen. RESULTS: Chest radiographs displayed mixed alveolar-reticular opacification in 60.2%, alveolar patterns in 22.9% and reticular opacities in 10.5%. In 0.4% there were no infiltrates, 6% could not be evaluated because of insufficient quality. There was no relevant difference between the right and left lungs. Subdividing patients into two groups according to the histological results of either absent or mild (1) or severe (2) lung fibrosis, we found an alveolar haziness in 12.3% in group 1 compared with 28.2% in group 2, while reticular characteristics were identified in 13% and 11%, respectively. CONCLUSIONS: The most common opacity in chest radiographs of patients with severe ARDS treated with ECMO is mixed alveolar-reticular opacification. Severe lung fibrosis is not positively correlated with a reticular radiographic pattern. ECMO does not lead to specific radiological changes in conventional radiograms, contrary to clinical findings that treatment with ECMO might induce pleural or pulmonic haemorrhage, especially in the earlier days when systemic heparinization had to be used instead of the heparin-coated tube-surfacing.

Acute hemorrhagic conjunctivitis in Southeast Asian refugees arriving in the United States--isolation of enterovirus 70.

During July-September 1980, an epidemic of acute hemorrhagic conjunctivitis (AHC) occurred in several refugee camps and transit centers in Southeast Asia. Of 2,356 refugees examined in Bangkok, 200 (8.5%) had conjunctivitis, including 116 (58%) with hemorrhagic signs. Because increasing numbers of refugees were arriving in the United States with conjunctivitis, a program of surveillance and control was implemented. Enterovirus 70, not previously reported from patients in the Western Hemisphere, was cultured from four arriving refugees. A fourfold rise in titer to enterovirus 70 was found in 10 others, either in the United States or Thailand. After control measures were instituted, the prevalence of the United States or Thailand. After control measures were instituted, the prevalence of conjunctivitis in arriving refugees declined from 49.8 per 1,000 to 3.8 per 1,000. Follow-up of cases after arrival in the United States revealed only one possible secondary case. Extensive epidemics of AHC in the Western Hemisphere are most likely to occur following importation into the humid, coastal areas of Central and South America.

Restriction endonuclease patterns of adenovirus type 12 and 18.

Restriction endonuclease analysis using 10 restriction enzymes was performed on six and three wild isolates of adenovirus (Ad) type 12 and 18, respectively. Among the Ad12 strains, five DNA variants could be identified. The degree of pairwise comigration of restriction fragments suggests a high degree of genomic diversity within Ad12. The wild isolates of Ad18, on the other hand, displayed a low degree of genetic variability and comprised one DNA variant closely related to the prototype strain. The BglII, BstEII, and HindIII restriction endonuclease patterns of Ad18 were inconsistent with those originally presented. Identical RE-patterns among Ad18 prototype strains (DC) obtained from four different sources, including directly from the American Type Culture Collection, verify that the genuine Ad18 prototype was used in the present study. Using the revised restriction patterns of BglII, BstEII, and HindIII, a proper identification of Ad18 will be facilitated.

Spectrophotometric quantitation of peroxidase-stained protein bands following gel electrophoresis and the western blot transfer technique with respiratory syncytial virus.

A procedure is described for spectrophotometrically measuring the position and intensity of ELISA-stained protein bands after western blot analyses. Partially purified virus proteins separated by acrylamide gel electrophoresis and electrophoretically transblotted onto nitrocellulose paper were identified by ELISA reactions according to established procedures. The nitrocellulose paper strips were then rendered transparent on glass slides by treatment with a plastics solvent (Gelman Sepra-Clear). The slides were then scanned at 480 nm to obtain the precise migration distance and area under the curve (i.e., quantity) of each band, thus allowing accurate comparison of the proteins from different virus strains.

Viral susceptibility of an immortalized human microvascular endothelial cell line.

CDC/EU.HMEC-1 is the first immortalized human microvascular endothelial cell line that retains morphologic, phenotypic, and functional characteristics of a normal human microvascular endothelial cell. This study evaluates a variety of viruses and their effects on this human endothelial cell line. The data indicate that adenoviruses, some herpesviruses, reoviruses and most picornaviruses grow well in HMEC-1, with distinctive cytopathic effects. The paramyxoviruses, however, do not appear to propagate, nor does HIV. The findings indicate that microvascular endothelial cells may act as a reservoir of these viruses; it also suggests the possibility that microvascular endothelium could be involved in the processing and presentation of antigen to immune cells.

Clinical and immunologic responses in patients with viral keratoconjunctivitis.

Of 120 individuals suffering from follicular conjunctivitis, with or without keratitis, 56 had epidemic keratoconjunctivitis caused by adenovirus type 8. The remaining 64 patients had keratoconjunctivitis produced by several different viruses, including herpes simplex, adenoviruses types 3, 7, 8, 16, 21, and 29, and others. Positive viral cultures were difficult to obtain after the first week of illness in most viral infections. Serologic tests were far more successful in indetifying causative agents. Hemagglutination-inhibition tests in adenovirus infections proved to be fast, accurate, and more sensitive than other serologic tests. Among the epidemic and nonepidemic adenovirus groups, the degree of corneal involvement in the infections appeared to be correlated with the level antibody against the infectious agent. Patients with low antibody titers had more severe keratitis than those with high titers. This correlation was true for both the epidemic and non epidemic patients.

Clinical and laboratory evaluation of epidemic keratoconjunctivitis due to adenovirus types 8 and 19.

During a community outbreak of epidemic keratoconjunctivitis due to adenovirus types 8 and 19, we compared the clinical and laboratory characteristics of the two viruses. Much of the disease was mild and the keratoconjunctivitis associated with adenovirus type 8 was indistinguishable clinically from that associated with adenovirus type 19. Adenovirus type 8 was isolated only from the conjunctival sac, whereas adenovirus type 19 was frequently cultured from the nose, throat, and conjunctiva. The two adenovirus types were never isolated from the same individual. In a prospective study of ten individuals exposed to known cases, adenovirus type 19 was isolated from two without clinical disease.