[Degenerative cervical spine diseases: fusion vs. total disc replacement : What can be done when?] / Degenerative Halswirbelsäulenerkrankungen: Fusion vs. bewegungserhaltende Verfahren : Wann ist was sinnvoll?

Motion preserving surgery within the cervical spine may be performed by special implants, for example, c spine disc prosthesis or total disc replacement (cTDR), or by simple decompression of the cervical nerve roots. However, also fusion surgery may be performed with good results. Here, we summarize indications as well as contraindications for motion preserving techniques and indications for fusion surgery. cTDR is indicated in special cases of soft disc herniation, especially in younger individuals without signs of myelopathy. Posterior decompression may be used as an alternative, especially if anterior surgery is not possible. If degeneration is severe, in the presence of kyphosis, severe canal encroachment, instability, and in cases of myelopathy, cervical spine fusion seems to be the better way.

Do phototherapy hoods really protect the neonate?

UNLABELLED: The objective of the current study was to evaluate the protection given to the eyes of neonates by an Amber 300 phototherapy hood during blue-light phototherapy from Drager Phototherapie 800 units, and to make recommendations for clinical practice. Hazard-weighted blue-light radiance of phototherapy lamps was measured inside neonatal incubators, with and without the use of a protective phototherapy hood. The study was carried out in a tertiary referral neonatal unit. No patients were involved. A mannequin was used as model of a jaundiced neonate being treated with blue-light phototherapy. The study shows that hazard-weighted blue-light radiance levels detectable from within the space enclosed by the hood may be several times greater than accepted industrial threshold limits for adults. CONCLUSIONS: Nursing and medical staff must ensure meticulous care in the positioning of infants, so that the caudal edge of the shadow cast by the hood is always at least 30 mm inferior to the infants' lower eyelids. The vulnerability of the neonatal retina and the relatively high levels of blue-light radiance visible from within the shadow of the hood may make it advisable to use more effective eye protection. Triple phototherapy using lamps at the foot-end of the incubator is clearly hazardous and should not be carried out unless the infant's eyes are protected by eye-patches.

[Bone mineral disorders in patients with multiple myeloma]. / Zaburzenia mineralizacji kosci u chorych na szpiczaka mnogiego.

The aim of the study was to evaluate bone mineralization in the patients with multiple myeloma. The examinations were performed in 49 patients (25 men and 24 women). Seven patients were before chemotherapy and 42 patients were treated with chemotherapy. All of them received prednisone. The bone mineral density was measured by dual-energy X-ray absorptiometry with Lunar spine (L2-L4) in AP projection, femoral neck and total body were examined. There was a decrease of bone mineral density in 35 patients in at least one place (T-score more than 2 SD below normal of young healthy persons). There was no correlation between densitometric results and the duration of multiple myeloma, or chemotherapy. The decrease of bone mineral density (expressed es T-score) of lumbar spine (for the patients without spinal degenerative changes) was higher than that of femoral neck (p < 0.05). The decrease of bone mineral density (expressed as T-score) of lumbar spine and femoral neck was more pronounced than that of total body (p < 0.001). Bone densitometry, especially of lumbar spine and femoral neck and less of total body is indicated in the patients with multiple myeloma. The result of this examination may be considered as an independent parameter of disease intensity.

Fibrin sleeve stripping for salvage of failing hemodialysis catheters: technique and initial results.

PURPOSE: To evaluate percutaneous fibrin sleeve stripping (PFSS) to prolong functional patency in failing hemodialysis catheters. MATERIALS AND METHODS: Forty PFSS procedures were performed in 24 catheters in 23 consecutive patients with an inadequate blood flow rate (< 200 mL/min) during hemodialysis. The fibrin sleeve was mechanically stripped off the shaft of the catheter with a snare introduced via the common femoral vein. Durability of PFSS was determined with life-table analysis. RESULTS: Median time from catheter placement to initial failure was 3.5 months (range, 5 days to 22 months). The technical success rate for PFSS was 100%; initial patency was restored in 39 of 40 procedures (98%), and no symptomatic pulmonary embolism occurred. Primary patency after single PFSS was 45% at 3 months and 28% at 6 months (median added patency, 2.8 months). Postprocedure secondary patency with multiple PFSS procedures was 83% at 3 months and 72% at 6 months (P = .01) (overall catheter patency, 90% at 6 months and 81% at 1 year [P < .001]). CONCLUSION: Multiple PFSS procedures can prolong patency in hemodialysis catheters with a fibrin sleeve.

[Effect of calcitonin treatment on bone mineralization in patients with multiple myeloma]. / Wplyw leczenia kalcytonina na mineralizacje kosci u chorych na szpiczaka mnogiego.

The aim of the study was to evaluate the efficacy of half-year treatment of bone mineral disturbances with calcitonin in the patients with multiple myeloma. Thirty five patients (11 men and 24 women) were examined. They were treated among other with prednisone. Nineteen patients (15 patients with normal bone mineral density of lumbar spine and femoral neck and 4 with low bone mineral density who could not be treated with calcitonin) were treated only with chemotherapy. Other 16 patients with low bone mineral density have received also calcitonin (100 units subcutaneous daily) with vitamin D3 and calcium carbonate. Bone mineral density was evaluated with dual energy X-ray absorptiometry in lumbar spine and femoral neck. After treatment with calcitonin there was more pronounced influence on bone mineral density in lumbar spine and femoral neck than after treatment with chemotherapy only but the difference was not statistically significant. Because the bone mineral disturbances in the patients with multiple myeloma is the big problem there is a need for further and longer evaluation of the treatment of these disturbances.

Recent advances in the detection of ovarian cancer: a review.

Epithelial ovarian cancer is one of the more aggressive malignancies among American women today, and its incidence is increasing. The major obstacle in combatting ovarian cancer is the remarkable lack of symptoms in early-stage disease. Symptoms usually occur in advanced stages when tumor dissemination within the peritoneal cavity induces ascites with resultant increasing abdominal girth. Physicians have been unable to reach women who have early-stage ovarian cancer, a time when a high cure rate could be expected. However, during the past few years, significant developments in the areas of serum tumor markers, transvaginal ultrasonography with color flow Doppler analysis, immunodiagnostic techniques, and immunotherapy have been reported. These new modalities show promise for use in the early diagnosis and treatment of ovarian cancer. The authors review some of the new data and discuss patient outcomes when these new modalities are used.

17alpha-Ethyl-20alpha-and -20beta-dihydroprogesterones and other 17alpha-ethyl-substituted pregnanes as potential contragestational agents.

The 17alpha-ethyl-substituted analogs of the two epimeric 20-dihydroprogesterones, allopregnadedione and pregn-5-ene-3,20-dione, were synthesized and evaluated for their possible oral contragestational (postcoital antifertility) activity in the rat. The compounds, though bound strongly to the progesterone receptor in vitro, were inactive preimplantively at 10 mg/kg and postimplantively at 40 mg/kg in vivo.

PIP: 17alpha-20alpha- and 20beta-dihydroprogesterones and other 17alpha-ethyl-substituted pregnanes as potential contragestational agents were investigated in the rat, and the syntheses of 17 alpha-ethyl-substituted analogs of the 2 epimeric 20-dihydroprogesterones, allopregnanedione and pregn-5-ene-3,20 dione are presented. The compounds were administered orally to 5 rats on Days 1-6 of gestation for studies related to effects on implantation or on Days 9-12 of gestation for studies related to drug effects on pregnancy after implantation. Postmortem examination was carried out between Day 14 and Day 21 of gestation. The compounds were strongly bound to the pr ogesterone receptor in vitro but were inactive preimplantively at 10 mg/kg and postimplantively at 40 mg/kg in vivo.