Ipsilateral arcuate foramen and high-riding vertebral artery: implication on C1-C2 instrumentation.

BACKGROUND CONTEXT: Several methods for C1-C2 stabilization have been described in the literature. These include C1-C2 transarticular and C1 lateral mass screws. In patients with aberrant anatomy such as a high-riding vertebral artery (VA) or the presence of an arcuate foramen at C1, there exists a higher risk of VA injury. This may lead to excessive bleeding, stroke, and possibly death. There have been several studies determining the incidence of arcuate foramen and high-riding VA occurring individually in the general population, but none have determined their occurrence simultaneously. PURPOSE: To determine the prevalence of ponticulus posticus and high-riding VA occurring simultaneously in the general population. STUDY DESIGN: Radiological study. METHODS: One hundred consecutive computed tomography (CT) scans of the cervical spine were reviewed. Scans that contained an arcuate foramen were identified, and it was indicated whether the foramen was right sided, left sided, or bilateral. In the same group, the thickness of the isthmus and the internal height of the lateral mass of C2 were measured. The VA was considered high riding if the isthmus thickness was less than 5 mm or the isthmus internal height was less than 2 mm. RESULTS: Fourteen out of one hundred (14%) patients had a fully formed arcuate foramen. Of these, six were left sided, three were right sided, and five were bilateral. In addition, there were 24 (24%) patients with partially formed ponticulus posticus. Thirty-two (32%) patients were identified to have a high-riding VA. Of these, 13 were left sided, 9 were right sided, and 10 were bilateral. Five (5%) had an ipsilateral arcuate foramen and high-riding VA. CONCLUSIONS: The arcuate foramen and high-riding VA are common anomalies that are often not recognized. Although ipsilateral high-riding VA and arcuate foramen rarely occur in the general population, proper identification of these anomalies on preoperative CT scan facilitates planning the safest technique for C1-C2 instrumentation.

Activity of continuous infusion plus pulse interleukin-2 with famotidine in patients with metastatic kidney cancer or melanoma previously treated with interleukin-2.

Lymphokine-activated killer (LAK) cells generated by high-dose continuous infusion interleukin-2 (IL-2) are able to nonspecifically lyse melanoma and kidney cancer cells. In vitro famotidine enhances cytotoxicity of LAK against tumor cells, possibly by increasing IL-2 uptake at the IL-2 receptor on lymphocytes. Outpatient IL-2 regimens typically have response rates of 15% or less, with most patients eventually experiencing progressive disease. Second-line therapy is, therefore, needed. We treated 11 patients (6 with metastatic melanoma; 5 having metastatic kidney cancer) who had previously experienced progressive disease on prior IL-2 regimens, with a combination of famotidine 20 mg intravenously (i.v.) twice per day and continuous-infusion IL-2 18 MIU/M2/24 hours x 72 hours, followed 24 hours later by a pulse IL-2 dose (18 MIU/M2 over 15 minutes). Cycles were repeated every 3 weeks. Patient characteristics were: 9 males, median age 63 years (range, 57-75), median Eastern Cooperative Oncology Group (ECOG) performance status: 1; most common metastatic sites: lungs, lymph nodes, and soft tissue/subcutaneous (s.c.); median number of cycles received: 4; most common toxicities were fever, nausea/emesis, hypophosphatemia, and hypomagnesemia. Five (5) patients (3 with melanoma, 2 with kidney cancer) have had partial responses. Two (2) patients with kidney cancer have been converted to complete responders with resection of residual disease, remaining without relapse at 5+ and 20+ months. Responding sites are lungs, lymph nodes, abdominal mass, and s.c. Median duration of response was 9.5 months. Median survival was 12 months. This combination has activity in patients with metastatic kidney cancer or melanoma who have received prior IL-2.

The impact of osteoporosis on patients with maxillofacial trauma.

BACKGROUND: Although maxillofacial injuries in the elderly population frequently result from falls and motor vehicle crashes, the association between osteoporosis and fractures of the maxillofacial region remains poorly defined. OBJECTIVE: To evaluate the relationship between osteoporosis and maxillofacial trauma in the elderly. DESIGN, SETTING, AND MAIN OUTCOME MEASURES: A retrospective review of 59 patients 60 years or older treated for maxillofacial fractures at a trauma center between 1989 and 2000 was performed. The severity of osteoporosis was graded by evaluating the radiographic appearance of the vertebral bodies of each trauma patient using the Saville index. The number of maxillofacial fractures and the severity of osteoporosis in each patient was assessed to determine whether an association between osteoporosis and maxillofacial trauma exists. RESULTS: Of the 59 patients evaluated, 51% were injured by falls and 46% were involved in motor vehicle crashes. Seventy-three percent of the patients had multiple facial fractures. As the severity of osteoporosis worsened, patients were more likely to sustain a greater number of maxillofacial fractures (P=.01). The mechanism of injury had no impact on the relationship between osteoporosis and the number of fractures. CONCLUSIONS: Osteoporosis is an independent risk factor for the development of maxillofacial fractures. Since more than half of these patients are injured by falls, safety measures must be instituted to prevent fall-related maxillofacial injuries in the home and the community.