Preoperative scoring and limits of prognostication: functional outcome after surgical decompression in metastatic spinal cord compression.

OBJECTIVE: To determine whether preoperative parameters correlate with the postoperative functional outcome in para- and tetraplegic patients with lung, kidney, breast and prostate cancer and metastatic spinal cord compression (MSCC). METHODS: Information on 43 patients undergoing decompressive surgery and rehabilitation for MSCC was reviewed, including primary tumor, age, pre- and postoperative ambulation status, mobility subcategory of the Spinal Cord Injury Measure (mSCIM) and the Tokuhashi score. Differences between groups were analyzed by the nonparametric χ(2) test, and correlation coefficients (Spearman's rho) were computed. RESULTS: Preoperative ambulation (p < 0.001), the American Spinal Injury Association Impairment Scale (p < 0.001) and the type of operation (p = 0.02) influenced the postoperative functional outcome. Any positive change in the mSCIM was influenced by preoperative ambulation (p < 0.001). Patients with breast carcinoma showed significantly more positive changes in the mSCIM compared with other tumors (p = 0.002). No correlation was found between the treatment categories of the Tokuhashi score and the preoperative ambulatory status (p = 0.13) or the change in ambulation status (p = 0.29). CONCLUSION: The postoperative functional outcome of MSCC patients shows a linear association between the categories of the Tokuhashi score and the change in ambulation status. We recommend surgical decompression even in a palliative situation (Tokuhashi score 0-8) with the aim of optimizing the short-term rehabilitation outcome.

Autonomic dysreflexia: a possible trigger for the development of heterotopic ossifications after traumatic spinal cord injury? : A clinical longitudinal study.

PURPOSE: The aim of this study was to investigate the influence of the initial American Spinal Injury Association Impairment Scale (AIS) category and the conversion rate in acute traumatic tetraplegic patients on the development of heterotopic ossifications (HO). The second objective was to prove the hypothesis that tetraplegic patients with autonomic dysreflexia (AD) develop HO more often than patients without AD. METHODS: A retrospective analysis from 2002 to 2009 of 330 patients with spinal cord injuries was performed and led to the inclusion of 77 traumatic tetraplegic patients. Clinical data was reviewed to determine the appearance of HO (n = 8) and its possible coincidence with AD during urodynamics. Spearman's correlation coefficient was calculated to test the relationship between HO and initial AIS category or the change in AIS category within 6 weeks. A matched pair (age, neurological level of injury) analysis of two samples (n = 8 with/without appearance of HO; total n = 16) was performed. RESULTS: The appearance of HO was significantly correlated with an initial AIS A compared to incomplete tetraplegia at baseline (p < 0.017). The conversion of AIS A into incomplete tetraplegia was highly correlated with the incidence of HO (p < 0.003). AD showed a positive correlation with HO (r = 0.97, p = 0.001). CONCLUSIONS: An initial AIS A that converts early into an incomplete tetraplegia constitutes a risk factor for the development of HO. Additionally, AD constitutes an important trigger in the development of HO in acute traumatic tetraplegic patients.

Prognostic value of HIF-1α expression during fractionated irradiation.

BACKGROUND AND PURPOSE: Hypoxia and reoxygenation are important determinants of outcome after radiotherapy. HIF-1α is a key molecule involved in cellular response to hypoxia. HIF-1α expression levels have been shown to change after irradiation. The objective of the present study was to explore the prognostic value of HIF-1α expression during fractionated irradiation. MATERIALS AND METHODS: Six human squamous cell carcinoma models xenografted in nude mice were analysed. Tumours were excised after 3, 5 and 10 fractions. HIF-1α expression was quantified by western blot. For comparative analysis, previously published data on local tumour control data and pimonidazole hypoxic fraction was used. RESULTS: HIF-1α expression in untreated tumours exhibited intertumoural heterogeneity and did not correlate with pimonidazole hypoxic fraction. During fractionated irradiation the majority of tumour models exhibited a decrease in HIF-1α expression, whereas in UT-SCC-5 no change was observed. Neither kinetics nor expression levels during fractionated irradiation correlated with local tumour control. CONCLUSION: Our data do not support the use of HIF-1α determined during treatment as a biomarker to predict outcome after fractionated irradiation.

Core decompression combined with implantation of a demineralised bone matrix for non-traumatic osteonecrosis of the femoral head.

INTRODUCTION: Core decompression is the standard surgical procedure in the treatment of early stage non-traumatic osteonecrosis of the femoral head (ONFH). However, there is still a debate whether decompression in combination with supplementary augmentation by bone grafts, growth factors, or cell implementation is superior to conventional decompression alone. This study evaluated patients after core decompression combined with an augmentation by a demineralised bone matrix, and particularly aimed to report long-term conversion rates to total hip replacement (THR). MATERIALS AND METHODS: 14 patients with 18 hips suffering from ONFH (Ficat stage I-IIB) underwent this surgical procedure. All patients underwent radiographic and MRI investigations at baseline and at follow-up periods of 12 and 24 months. The clinical follow-up was done using the Merle d'Aubigné-score for an average period of 9 years after surgery. RESULTS: 14 of the 18 subjects (77 %) achieved at least a good clinical result after 2 years. The Merle d'Aubigné-score improved significantly after 12 (p = 0.0001) and 24 months (p = 0.0002). However, the MRI volumetric analysis showed an increased necrotic bone volume from 3.16 ± 0.54 to 3.88 ± 0.62 cm(3) (p = 0.04). Within 9 years, 13 out of 18 cases (72 %) required further surgery by THR. Only 7 out of 18 subjects (39 %) reported an ongoing postoperative clinical benefit, and would retrospectively redo the same surgical approach again. The five patients that did not require THR were still satisfied after 9 years. CONCLUSIONS: In patients with early- stage femoral head osteonecrosis core decompression combined with the implantation of a demineralised bone matrix leads to a limited, temporary pain relief as seen in core decompression alone. However, long-term results were not encouraging with a high rate of conversion to arthroplasty. Therefore, core decompression with implantation of a demineralised bone matrix may be not appropriate to avoid THR in the long term.

Bone tissue and plasma concentrations of linezolid and vancomycin in rabbits with prosthesis-related infection due to MRSA.

BACKGROUND: Due to its safety profile and ease of oral administration, linezolid became an alternative to vancomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. The aim of our study was to compare bone tissue and plasma concentrations of linezolid and vancomycin in prosthesis-related MRSA infection in a rabbit model. MATERIAL AND METHODS: During implantation of titanium cylinders into the femurs of nine rabbits, a bacterial suspension of MRSA was added to induce infection. Antibiotic treatment was started eight hours later. Antibiotic concentrations in plasma (day one, three and seven) and bone (day seven) were determined by HPLC analysis. RESULTS: At steady state the mean peak and trough plasma levels of linezolid were 29.0 microg/mL and 8.2 microg/ mL and for vancomycin 39.1 microg/mL and 28.2 microg/mL. On day seven the mean peak concentration of linezolid in plasma was 28.5 microg/mL and after six hours 26.3 microg/mL and for vancomycin 53.8 microg/mL and 29.1 microg/mL after six hours. Vancomycin showed a penetration into the infected bone (femur) of 53% of plasma concentration, into the uninfected 28%, linezolid 11% (for both six hours after administration). CONCLUSION: In conclusion, we observed a higher rate of tissue penetration for vancomycin than for linezolid into femur bone in this animal model. As linezolid offers the option for oral treatment of gram-positive organisms, results of further studies comparing vancomycin and linezolid are keenly awaited.

The seasonal fertility of North American bison (Bison bison) bulls.

The objective of this study was to determine the presence and magnitude of seasonal fluctuations in semen quality and other reproductive indices in bison bulls. Testicles from 288 commercially slaughtered bison bulls were collected monthly over a 1-year period. Carcass and testicle weight were determined and measurements of seminiferous tubule lumen, diameter, and epithelial thickness were made. Sperm cell morphology and defects were described and quantified using epididymal semen from each testicle. Twenty-one Plains (Bison bison bison) and Wood bison (Bison bison athabascae) breeding bulls, averaging 6.0 years of age (range 2.5-8.0), from three farms were selected for semen collection and evaluation on the basis of producer co-operation. Semen was collected by electro-ejaculation on four seasonal occasions during a 12-month period. Ejaculate quality was judged on the basis of volume, density, gross and individual motility, morphology, live/dead ratio, and concentration. Sperm cell morphologies were evaluated microscopically and classified according to criteria used for bovine semen. Fecal testosterone was measured at each semen collection using a commercial competitive binding radioimmunoassay. There was an increase in carcass weights over the study period and testis weights were moderately correlated (r=0.44) with carcass weights. However, mean testes weights were heavier (P<0.05) in the summer than in winter, spring, or fall periods. There were no differences in the proportion of normal and abnormal epididymal sperm between seasons but there were seasonal changes in the testicular parenchyma. Seminiferous tubule and lumen diameter, and epithelial thickness were greatest (P<0.05) in summer. Live bulls gained weight between April and November, but lost weight over the winter. Normal sperm cell percentages as well as individual sperm cell motility in electro-ejaculated sperm samples were higher (P<0.05) at the pre-breeding collection relative to other collections, but no change in sperm cell concentrations occurred over the study period. Fecal testosterone concentrations were highest at the pre-breeding period (June) but decreased (P<0.05) in each subsequent collection to reach their lowest levels in the April. While many changes in seen characteristics were not significant, overall results indicate the presence of some reproductive seasonality and increased testicular capacity in the summer breeding season. Bulls showing marginal semen quality in the winter but otherwise carrying desirable genetic traits may warrant another evaluation in late spring prior to being culled from a breeding program.

The onset of puberty in North American bison (Bison bison) bulls.

Prepubertal testicular development was evaluated in young North American bison (Bison bison) bulls over a 12 months period, by following various parameters of semen quality intended to measure sexual maturity level. The study goals were to characterize bison male reproductive development and to define the age and onset of puberty. Semen was collected by electro-ejaculation from 12 bulls once a month for a period of 12 months, from 13 through 24 months of age. Volume, density, gross motility, individual motility, morphology, live/dead ratio, and concentration were used to judge the quality of the ejaculates. Abnormal sperm were classified into categories according to descriptions used for bovine evaluations and guidelines created by the Western Canadian Association of Bovine Practitioners were used for determining satisfactory semen quality. Minimums of 60% progressive motility and 70% normal sperm cells identified samples as satisfactory. Puberty was defined as the point in testicular development where an ejaculate contains a minimum of 50 x 10(6)sperm cells, showing at least 10% progressive motility. Fecal samples collected from bulls prior to electro-ejaculation for testosterone determination by a commercial testosterone specific antibody radioimmunoassay showed no significant changes in mean fecal testosterone concentrations over time. Changes in mean body weights over the study period were calculated, the average body weight at 13 and 24 months of age were 263+/-18.6 and 475+/-52.2 kg, respectively. Under these experimental conditions, age was determined to be the most significant factor in determining the onset of puberty. On average, bulls reached puberty at 16.5+/-2.5 months. There was a significant increase in the number of normal sperm with increasing bull age as well as significant decreases in proximal cytoplasmic droplets and head defects, but no significant changes in midpiece and principal piece defects. There were significant increases with age in individual progressive motility, gross motility, concentration, density, and volume but not in the percent of live sperm. Bison bulls used for breeding should be capable of passing a breeding soundness evaluation by 24 months of age. The commercial bison industry semen tests, and possibly rejects, many developmentally incomplete bulls between 19 and 21 months of age. We suggest that these may actually be developing normally and should not be hastily discarded; it may be worth testing again at 24 months.

Nutrient profiles in retail cuts of bison meat.

The objectives were to determine the nutrient composition and variation in eight cuts of bison meat in bulls and heifers and identify nutrient relationships in the clod and sirloin by principal component analysis. The nutrients analyzed were: energy, protein, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, transfat, cholesterol, vitamin A, Ca, Fe, Na and moisture. Differences were observed in fat components between cuts and bulls had higher (P<0.05) amounts of total, saturated, monounsaturated and polyunsaturated fat in the blade compared to the other cuts. The sirloins had less (P<0.05) cholesterol than all the other cuts in bulls and the clod in heifers. Fat varied more than protein and moisture in all cuts. Four principal components (PC) accounted for 63.9% of the total variation of the nutrient composition. Total, monounsaturated and saturated fats were in PC1 and cholesterol in PC2 showing that cholesterol is independent of other fats. If dietary alterations elicit changes in bison meat fatty acid profiles, it may be possible to reduce cholesterol independent of total, monounsaturated or saturated fat.

[Garden I femoral neck fractures: conservative vs operative therapy]. / Die mediale Schenkelhalsfraktur Typ I nach Garden: konservative vs. operative Therapie. Ergebnisse einer retrospektiven Studie.

INTRODUCTION: Treatment recommendations vary for Garden I fractures of the proximal femur. The aim of our retrospective study was to determine the results of functional treatment of these injuries. MATERIAL AND METHODS: A total of 54 consecutive patients were enrolled, and their data (age, comorbidities, treatment, complications, etc.) were ascertained and stored in a database. Initial treatment consisted in early mobilization and weight bearing in all patients. RESULTS: In 24 cases (44%) no complications at all were observed in the course of conservative treatment. In 28 cases (52%) surgical treatment was necessary due to early fracture dislocation. Analysis of the X-ray images showed that in 9 of these 28 cases the functional treatment had not been clearly indicated, i.e., incomplete impaction of the fragments. When these patients are excluded the success rate of conservative treatment was 53%, as two additional late complications occurred and were treated surgically (1x AVN, 1x nonunion). With reference to the survival rate, score, and patient satisfaction, there was no difference between conservative and operative treatment (p=0.478). The risk of a secondary dislocation increases with the number of risk factors (p=0.008). DISCUSSION: An attempt at functional treatment with close X-ray monitoring is appropriate in these fractures, since this makes it possible to avoid surgery in about half of the patients while achieving functional results comparable to those yielded by surgery.

Design and implementation of a computerized diet order entry system for a hospital.

A computerized diet entry system was developed to control entry of diet orders by hospital ward clerks from an established list of items. Three reporting systems were then designed for delivery of the computerized order to the Nutrition Services Department. One report contains only essential information and is printed instantly upon entry for confirmation of a "stat" diet order. Another report collates diet orders by time periods and then organizes them by wards and sequentially by room number. That report is then used for diet changes prior to meal service. The third report stores advance diet orders and test diet orders and reports them upon the date they are to be served. Diet orders are also collated and retained in the system, in sequential order for each patient, to allow for an instant report of the patient's diet history upon demand. This computerized diet order system has resolved problems regarding receipt of complete information required for a diet order and receipt of a diet order for all patients. An overview of the information support system used by the Nutrition Services Department, which was created from programs developed for other hospital departments, is also presented.

A sequential procedure for implementing a computer-based information system.

A sequential procedure is presented for the foodservice manager to follow when considering initial implementation of a computer-based information system (CBIS). A feasibility study is recommended as a first step to analyze the information desired and resources available in order to determine objectives of the proposed CBIS. Alternative CBIS design plans should then be evaluated against critical success factors to determine the direction of initial CBIS efforts. Application software, which provides needed support, then determines the hardware needed. Information about vendors and the suitability of the CBIS to meet needs should be determined next. The following management procedures are suggested: utilization of project management skills, identification of roles for the project team members, and initiation of a phased implementation strategy. Finally, to ensure control of the CBIS project, evaluation and documentation are advised.