Regional versus general anesthesia for spine surgery. A comprehensive review.

The use of regional anesthesia techniques for intra-operative anesthesia remains very controversial for patients scheduled to undergo spinal interventions. Spine surgery is still mostly performed under general anesthesia. This has to be explained by the patient's position required during surgery, the extent and duration of some procedures, the preference of the surgeon and/or anesthesiologist and a trend which becomes more and more prominent to abandon central nerve blocks in general. The presence of foreign material in the neighborhood of the surgical field may be a reason for surgeons to refuse such techniques. Nevertheless, during the last decade the available literature has increased progressively in support of regional anesthesia for these interventions. The present overview will focus on the feasibility of different regional techniques to be used intra-operatively. These techniques may also be of interest or even intended for prolonged postoperative analgesia and benefit even after a single bolus injection, continuous or intermittent administration. Although all techniques described offered favorable success rates, future research is mandatory to determine their superiority over general intra-operative anesthesia and conventional pain therapy.

Comparative genomic analysis of Fischer F344 rat livers exposed for 90 days to 3-methylfuran or its parental compound furan.

Furan is a naturally forming compound found in heat-processed foods such as coffee, canned meats, and jarred baby food. It is concurrently found with analogues including 2-methylfuran (2-MF) and 3-methylfuran (3-MF), and toxicity studies demonstrate all are potent liver toxins. Toxicity studies found 3-MF is more toxic than either furan, or 2-MF. The present analysis assesses the transcriptional response in liver samples taken from male Fischer (F344) rats exposed to furan or 3-MF from 0 to 2.0 and 0-1.0 mg/kg bw/day, respectively, for 90 days. Transcriptional analyses found decreased liver function and fatty acid metabolism are common responses to both furan and 3-MF exposure. Furan liver injury promotes a ductular reaction through Hippo and TGFB signalling, which combined with increased immune response results in ameliorating perturbed bile acid homeostasis in treated rats. Failure to activate these pathways in 3-MF exposed rats and decreased p53 activity leads to cholestasis, and increased toxicity. Finally, BMD analysis indicate many of the most sensitive pathways affected by furan and 3-MF exposure relate to metabolism - malate dehydrogenase and glucose metabolism with BMDLs of 0.03 and 0.01 mg/kg bw/day for furan and 3-MF exposure, respectively, which agrees with BMDLs previously reported for apical and microarray data.

Genomic analysis of Fisher F344 rat kidneys from a reproductive study following dietary ochratoxin A exposure.

Ochratoxin A (OTA) is a mycotoxin produced by species of Penicillium and Aspergillus, and is found in many commodities including cereal grains, nuts, and coffee. OTA is a renal carcinogen and nephrotoxin at high concentrations, targeting the proximal tubules. This study uses transcriptomics and the previously reported apical data (Bondy et al., 2021) to infer mode-of-action of OTA toxicity in male and female rats exposed to low doses of OTA in utero and throughout development. Our findings support a male-specific activation of the innate and adaptive immune responses in F1 pups to OTA exposure. This was not found in the female F1 pups, and may be due to female-specific increased p38 activity and VDR signaling. Differentially expressed genes related to karyomegaly, MAPK activity, and immune activation appears to develop from in utero exposure to OTA whereas those related to decreased kidney and liver function, and changes to reproductive pathways occur in both rat generations. Together, these transcriptional results confirm that dietary exposure to OTA causes renal toxicity as well as alterations to hepatic and reproductive pathways in rats. In utero exposure of rats to OTA results in sex-specific alterations in immune response pathways, VDR signaling, and p38 activity.

Oral naltrexone maintenance treatment for opioid dependence.

BACKGROUND: Research on the clinical application of oral naltrexone agrees on several things. From a pharmacological perspective, naltrexone works. From an applied perspective, however, this medication is not used since the medication compliance and the retention rates are very poor. OBJECTIVES: To evaluate the effects of naltrexone maintenance treatment versus placebo or other treatments in preventing relapse in opioid addicts after detoxification. SEARCH STRATEGY: We searched the Cochrane Drugs and Alcohol Group Register of Trials (January 2005), Cochrane Central Register of Controlled Trials (CENTRAL - The Cochrane Library Issue 1, 2005), MEDLINE (1973-first year of naltrexone use in humans- January 2005), EMBASE (1974- January 2005), PsycINFO (OVID-January 1985 to January 2004). We inspected reference lists of relevant articles and we contacted pharmaceutical producers of naltrexone, authors and other Cochrane review groups. SELECTION CRITERIA: All randomised and controlled clinical trials which focus on the use of naltrexone maintenance treatment versus placebo, or other treatments to reach sustained abstinence from opiate drugs DATA COLLECTION AND ANALYSIS: Three reviewers independently assessed studies for inclusion and extracted data. One reviewer carried out the qualitative assessments of the methodology of eligible studies using validated checklists. MAIN RESULTS: Ten studies, 696 participants, met the criteria for inclusion in this review. Only two studies described an adequate allocation concealment. The results show that naltrexone maintenance therapy alone or associated with psychosocial therapy is more efficacious that placebo alone or associated with psychosocial therapy in limiting the use of heroin during the treatment (RR 0,72 95% confidence interval 0.58 to 0.90). If we consider only the studies comparing naltrexone with placebo, the difference do not reach the statistical significancy, RR 0.79 (95%CI 0.59 to 1.06). With respect to the number of participants re incarcerated during the study period, the naltrexone associated with psychosocial therapy is more effective than the psychosocial treatment alone; RR 0.50 (95%CI 0.27 to 0.91). No statistically significant benefit was shown in terms of retention in treatment, side effects or relapse results at follow-up for any of the considered comparisons. AUTHORS' CONCLUSIONS: Unfortunately the studies did not provide an objective evaluation of naltrexone treatment in the field of opioid dependence. The conclusions are also limited due to the heterogeneity of the trials both in the interventions and in the assessment of outcomes.

The impact of the needle and syringe-exchange programme in Amsterdam on injecting risk behaviour.

We interviewed a group of 145 injecting drug users (IDUs) in Amsterdam about their drug use, participation in a needle-exchange programme and needle sharing. Approximately 1 year later 60 IDUs were followed up. IDUs who exchange regularly ('exchangers') are older, inject longer and are more often in contact with methadone programmes. Exchanging is associated neither with an increase in injecting nor with lending needles to other IDUs. The risk level of injecting of the exchangers is much lower than that of the non-exchangers. From this it can be concluded that a needle exchange is an effective prevention programme against the spread of HIV infection. However, efforts have to be made to reach the group of younger short-term injectors and those IDUs who are not in contact with methadone-maintenance programmes. Since there are indications that regular injectors in particular exchange, and since young male injectors are more at risk of borrowing independent of exchanging, it is argued that an exchange programme should be complemented with other prevention approaches, i.e. intensive counselling and the spread of leaflets with information on cleaning used needles with bleach.

Naltrexone maintenance treatment for opioid dependence.

BACKGROUND: Despite widespread use of naltrexone maintenance in many countries for more than a decade, the evidence of its effects has not yet been systematically evaluated. OBJECTIVES: To evaluate the effects of naltrexone maintenance treatment in preventing relapse in opioid addicts after detoxification. SEARCH STRATEGY: We searched MEDLINE (1973-first year of naltrexone use in humans-July 2000), EMBASE (1974-July 2000), Cochrane Controlled Trials Register (Cochrane Library issue 2000, 3) and handsearched the "Bolletino per le Farmacodipendenze e l'Alcolismo" (1978 to 1997) and reference lists of relevant articles. We contacted pharmaceutical producers of naltrexone, authors and other Cochrane review groups. Date of most recent searches: July 2000. SELECTION CRITERIA: All controlled studies of naltrexone; treatment of heroin addicts after detoxification. DATA COLLECTION AND ANALYSIS: Reviewers evaluated data independently and analysed outcome measures taking into consideration adherence to and success of the study intervention. Data was extracted and analysed stratifying for the three categories of study quality. Where possible, meta-analysis was performed. MAIN RESULTS: Eleven studies met the criteria for inclusion in this review, even if not all of them were randomised. The methodological quality of the included study varied, but was generally poor. Meta-analysis could be performed to a very low degree only, because the studies and their outcome measures were very heterogeneous. A statistically significant reduction of (re-)incarcerations was found for patients treated with naltrexone and behaviour therapy respect to those treated with behaviour therapy only. The other outcomes considered in the meta-analysis did not yield any significant results. Final conclusions on whether naltrexone treatment may be considered effective in maintenance therapy cannot be drawn from the clinical trials available so far. REVIEWER'S CONCLUSIONS: The available trials do not allow a final evaluation of naltrexone maintenance treatment yet. A trend in favour of treatment with naltrexone was observed for certain target groups (particularly people who are highly motivated), as has been previously described in the literature.

Naltrexone maintenance treatment for opioid dependence.

BACKGROUND: Despite widespread use of naltrexone maintenance in many countries for more than ten years now (e.g., USA since 1984, UK since 1988) a sound documentation of the research on this drug is still missing. OBJECTIVES: To evaluate the effects of naltrexone maintenance treatment in preventing relapse in opioid addicts after detoxification. SEARCH STRATEGY: We searched MEDLINE, EMBASE, CCTR and handsearched the "Bolletino per le Farmacodipendenze e l'Alcolismo"; contact was sought with pharmaceutical producers of naltrexone, with authors and other CRGs; references of obtained studies. Trials were reliably identified and data extracted. Date of most recent searches: June 1998. SELECTION CRITERIA: All studies controlled for naltrexone; treatment of heroin addicts after detoxification with naltrexone. Studies were classified into three categories (high, moderate or low risk of bias) according to their methodological quality. DATA COLLECTION AND ANALYSIS: Reviewers evaluated data independently and analysed outcome measures taking into consideration adherence to and success of the study intervention. Data was extracted and analysed stratifying for the three categories of study quality. Where possible, meta-analysis was performed. MAIN RESULTS: Eleven studies were included in this review, and not all of them were randomised. Meta-analysis could be done to a low degree only, because the studies and their outcomes were very heterogeneous. The result of this quantitative analysis was statistically poor, and so was the methodological quality of the included studies. REVIEWER'S CONCLUSIONS: The available trials do not allow a final evaluation of naltrexone maintenance treatment yet. A trend in favour of treatment with naltrexone was observed for certain target groups, as described in the literature before. A well-done clinical trial is needed in order to get better evidence as soon as possible.

Naltrexone maintenance treatment for opioid dependence.

BACKGROUND: Despite widespread use of naltrexone maintenance in many countries for more than a decade, the evidence of its effects has not yet been systematically evaluated. OBJECTIVES: To evaluate the effects of naltrexone maintenance treatment in preventing relapse in opioid addicts after detoxification. SEARCH STRATEGY: We searched MEDLINE (1973-first year of naltrexone use in humans-July 2000), EMBASE (1974-July 2000), Cochrane Controlled Trials Register (Cochrane Library issue 2000, 3) and handsearched the "Bolletino per le Farmacodipendenze e l'Alcolismo" (1978 to 1997) and reference lists of relevant articles. We contacted pharmaceutical producers of naltrexone, authors and other Cochrane review groups. Date of most recent searches: July 2000. SELECTION CRITERIA: All controlled studies of naltrexone; treatment of heroin addicts after detoxification. DATA COLLECTION AND ANALYSIS: Reviewers evaluated data independently and analysed outcome measures taking into consideration adherence to and success of the study intervention. Data was extracted and analysed stratifying for the three categories of study quality. Where possible, meta-analysis was performed. MAIN RESULTS: Eleven studies met the criteria for inclusion in this review, even if not all of them were randomised. The methodological quality of the included study varied, but was generally poor. Meta-analysis could be performed to a very low degree only, because the studies and their outcome measures were very heterogeneous. A statistically significant reduction of (re-)incarcerations was found for patients treated with naltrexone and behaviour therapy respect to those treated with behaviour therapy only. The other outcomes considered in the meta-analysis did not yield any significant results. Final conclusions on whether naltrexone treatment may be considered effective in maintenance therapy cannot be drawn from the clinical trials available so far. REVIEWER'S CONCLUSIONS: The available trials do not allow a final evaluation of naltrexone maintenance treatment yet. A trend in favour of treatment with naltrexone was observed for certain target groups (particularly people who are highly motivated), as has been previously described in the literature.

Naltrexone maintenance treatment for opioid dependence.

BACKGROUND: Despite widespread use of naltrexone maintenance in many countries for more than a decade, the evidence of its effects has not yet been systematically evaluated. OBJECTIVES: To evaluate the effects of naltrexone maintenance treatment in preventing relapse in opioid addicts after detoxification. SEARCH STRATEGY: We searched MEDLINE (1973-first year of naltrexone use in humans-July 2000), EMBASE (1974-July 2000), Cochrane Controlled Trials Register (Cochrane Library issue 2001.4) and handsearched the "Bolletino per le Farmacodipendenze e l'Alcolismo" (1978 to 1997) and reference lists of relevant articles. We contacted pharmaceutical producers of naltrexone, authors and other Cochrane review groups. Date of most recent searches: February 2003. SELECTION CRITERIA: All controlled studies of naltrexone; treatment of heroin addicts after detoxification. DATA COLLECTION AND ANALYSIS: Reviewers evaluated data independently and analysed outcome measures taking into consideration adherence to and success of the study intervention. Data were extracted and analysed stratifying for the three categories of study quality. Where possible, meta-analysis was performed. MAIN RESULTS: Eleven studies met the criteria for inclusion in this review, even if not all of them were randomised. The methodological quality of the included studies varied, but was generally poor. Meta-analysis could be performed to a very low degree only, because the studies and their outcome measures were very heterogeneous. A statistically significant reduction of (re-)incarcerations was found for patients treated with naltrexone and behaviour therapy in respect to those treated with behaviour therapy only. The other outcomes considered in the meta-analysis did not yield any significant results. Final conclusions on whether naltrexone treatment may be considered effective in maintenance therapy cannot be drawn from the clinical trials available so far. REVIEWER'S CONCLUSIONS: The available trials do not allow a final evaluation of naltrexone maintenance treatment yet. A trend in favour of treatment with naltrexone was observed for certain target groups (particularly people who are highly motivated), as has been previously described in the literature.

Naltrexone maintenance treatment for opioid dependence.

BACKGROUND: Despite widespread use of naltrexone maintenance in many countries for more than a decade, the evidence of its effects has not yet been systematically evaluated. OBJECTIVES: To evaluate the effects of naltrexone maintenance treatment in preventing relapse in opioid addicts after detoxification. SEARCH STRATEGY: We searched MEDLINE (1973-first year of naltrexone use in humans-July 2000), EMBASE (1974-July 2000), Cochrane Controlled Trials Register (Cochrane Library issue 2001.4) and handsearched the "Bolletino per le Farmacodipendenze e l'Alcolismo" (1978 to 1997) and reference lists of relevant articles. We contacted pharmaceutical producers of naltrexone, authors and other Cochrane review groups. Date of most recent searches: December 2001. SELECTION CRITERIA: All controlled studies of naltrexone; treatment of heroin addicts after detoxification. DATA COLLECTION AND ANALYSIS: Reviewers evaluated data independently and analysed outcome measures taking into consideration adherence to and success of the study intervention. Data were extracted and analysed stratifying for the three categories of study quality. Where possible, meta-analysis was performed. MAIN RESULTS: Eleven studies met the criteria for inclusion in this review, even if not all of them were randomised. The methodological quality of the included studies varied, but was generally poor. Meta-analysis could be performed to a very low degree only, because the studies and their outcome measures were very heterogeneous. A statistically significant reduction of (re-)incarcerations was found for patients treated with naltrexone and behaviour therapy in respect to those treated with behaviour therapy only. The other outcomes considered in the meta-analysis did not yield any significant results. Final conclusions on whether naltrexone treatment may be considered effective in maintenance therapy cannot be drawn from the clinical trials available so far. REVIEWER'S CONCLUSIONS: The available trials do not allow a final evaluation of naltrexone maintenance treatment yet. A trend in favour of treatment with naltrexone was observed for certain target groups (particularly people who are highly motivated), as has been previously described in the literature.

Teaching veterinary parasitology.

The history of parasitology and the teaching of veterinary parasitology in South Africa are reviewed briefly. Courses in veterinary parasitology are presented at the faculties of veterinary science at the University of Pretoria and the Medical University of South Africa as well as at the Pretoria Technicon. At the University of Pretoria, the three disciplines of veterinary parasitology, entomology, helminthology and protozoology, are covered in 330 core lectures; from 13 to 40% of the contact time is devoted to practical classes. Teaching veterinary parasitology is both labour intensive and costly, viz. R1700 (US$570) per student per annum. Such costs are justified by the R148.8 million (US$49.6 million) spent every year in South Africa on anthelmintics, ectoparasiticides and vaccines to control parasites. Veterinary parasitology is a dynamic subject and the curriculum must be revised regularly to incorporate new information. Because the parasite faunas are so diverse no single textbook can satisfy the requirements of the various institutions worldwide which teach the subject, with the result that extensive use is made of notes. In Australia and in Europe, ticks and tick-borne diseases are less important than they are in Africa; consequently insufficient space is devoted to them in textbooks to satisfy the requirements of the subject in African countries. Parasite control under extensive and intensive conditions is dealt with adequately at the University of Pretoria, but increasing emphasis will be given to small-scale farming systems, particularly if alternative food animals are to be kept.

In vitro screening of Haemonchus contortus third stage larvae for ivermectin resistance.

The indiscriminate repeated use of ivermectin has resulted in the emergence of ivermectin resistant field strains of Haemonchus contortus in sheep in South Africa. There is a need for a rapid and cost effective in vitro test to detect such strains. Infective H contortus larvae known to be resistant to ivermectin, were incubated in vitro in a diluted concentration of the drug. Subsequently their ability to migrate was compared with that of larvae of isolates known to be susceptible to ivermectin. The criterion used to determine resistance was the ability of the larvae to migrate out of gelled agar after exposure to ivermectin using diluted propylene glycol as the control compound. The results obtained by this technique confirmed the results obtained with critical controlled tests; significant differences between the ivermectin sensitive and resistant isolates were demonstrated, thereby confirming that this in vitro technique may be used as a screening method to identify ivermectin resistant isolates of H. contortus.

Gastro-intestinal helminths of domestic dogs in the Republic of South Africa.

Of the gastro-intestinal helminths found in 1 063 dogs from different parts of the country, Dipylidium caninum, the most prevalent cestode, occurred in 19,7% of the animals. Echinococcus granulosus was present in 10 dogs, 8 of which were from urban areas, and Taenia hydatigena in 69 dogs. Taemia multiceps was recovered from dogs only in the Cape Province and the Orange Free State. Toxocara canis was present in 81 of the necropsies carried out on 253 dogs from the Pretoria municipal area, while Ancylostoma spp. were present in 175 dogs. In the Pretoria area Ancylostoma caninum (11,9%) was more prevalent than Ancylostoma braziliense (6,2%).

Immunization of sheep against the larval stage of Taenia multiceps.

A trial with 200 ewes and 127 lambs showed that vaccination of lambs with 2 doses of Oncosphere Secretory Antigen (OSA) 4 weeks apart, at either 4-8 and 8-12 weeks or at 12-16 and 16-20 weeks of age, was equally effective in protecting them against infestation with the larval stage of Taenia multiceps. In this trial, the lambs of ewes, vaccinated with OSA when they were 90 and again 120 days pregnant, were as susceptible to infestation as the lambs of untreated control ewes. Another trial to provoke passive immunity in lambs gave inconclusive results. In a 3rd trial 2 doses of regular OSA and 2 doses of freeze-dried OSA protected all the lambs in each group, while a single dose of regular OSA protected 9 out of 10 lambs against cerebral lesions.

Surgical transfer of the cysticerci of Taenia hydatigena.

Unattached immature cysticerci of Taenia hydatigena were transferred surgically to the peritoneal cavities of 4 sheep. Mature infective cysticerci were recovered from the recipient sheep 3 and 5,8 months later. A fully developed live cysticercus was present in the muscle layers surrounding the scar of the laparotomy site in 2 of the animals.

Helminths recovered from the bontbok, Damaliscus dorcas dorcas (Pallas, 1776).

A report is given on the helminths collected from 4 bontbok, Damaliscus dorcas dorcas, which died following capture at the Bontebok National Park, Swellendam, and transfer to the National Zoological Gardens, Pretoria. Seven of these helminths are new host records. Lungworms submitted to the institute for identification over the last 2 years are also reported; these were all Dictyocaulus magna. The various scientific and common names that have been applied to the bontbok in the past are reviewed.

Bovine skin lesions of possible filarial origin associated with heavy hornfly infestations (Haematobia meridiana).

Circumscribed, ulcerative skin lesions, usually situated caudal to the scapula, affected cattle in the Republic of Venda during the summer of 1981-82. The occurrence of the lesions was associated with heavy infestations of the hornfly. Haematobia meridiana. Microscopically the lesions were characterized by intense eosinophilic dermatitis. Microfilariae were seen in histological sections of one lesion, but a species identification could not be made. The possible cause of the lesions is discussed.

The effect of gamma radiation on the cysticerci of Taenia solium.

Cysticerci of Taenia solium were exposed to gamma radiation in doses varying from 20-140 krad. Radiation had an adverse effect on the ability of the cysticerci to evaginate in vitro after a time lag of 9 days. This effect was most marked at doses of 100 krad and higher, thus no cysticerci exposed to 140, 120 and 100 krad evaginated after 12, 18 and 21 days, respectively. On Day +24, when 60% of the control cysticerci evaginated, 55%, 50%, 30% and 40% of the cysticerci exposed to 20, 40, 60, and 80 krad, respectively, evaginated in vitro. Cysticerci exposed to radiation doses of 20-120 krad are as infective to golden hamsters as are unirradiated cysticerci. Cestodes resulting from irradiated cysticerci, however, cannot maintain themselves indefinitely, and are excreted or digested at varying times from Day +12 onwards. Moreover, cestodes resulting from such irradiated cysticerci do not grow, but are resorbed, and finally consist of only a scolex. By Day +30 the mean length of the worms resulting from the unirradiated cysticerci is 173,8 mm, while those resulting from cysticerci exposed to 20 and 40 krad consist of scolices only and the hamsters fed material exposed to 60 krad were negative. It appears, therefore, that radiation inhibits the ability of the cells in the neck region to divide and thus form new proglottids. Carcasses infested with cysticercosis can possibly be rendered fit for human consumption by exposure to gamma radiation at doses between 20 and 60 krad.

Occurrence of Taenia solium in a Cape fur seal (Arctocephalus pusillus).

The larval stage of Taenia solium was recovered from the brain, skeletal muscles, heart, lungs and liver of a Cape fur seal collected near Cape Town. This is apparently the second record of the larval stage of this cestode in a marine mammal.

Food fortification: good to have or need to have?

Only very small quantities of vitamins and minerals are needed for human health but deficiencies can have disproportionately large, often life-threatening, effects. Micronutrient deficiencies lead to a vicious cycle of malnutrition and infection in poorly nourished populations. Fortification of staple foods is the cheapest, most efficient and most effective way to supply large populations with essential micronutrients. This paper reviews the case for fortification of flour supplies with iron and folic acid and concludes that it is the best way to provide daily doses of these nutrients to populations in developing countries, especially for women of child-bearing age.