Primary closure of infected spinal wounds

Although postoperative infections of spinal wounds are uncommon, when they occur, they cause considerable morbidity. The classic treatment for deep infected wounds of the spine involves opening the wound, packing it, and permitting secondary closure to occur through granulation. A combined total of 10 patients with infected postoperative spinal wounds (two cervical and eight lumbar) from the Lahey Clinic and the Cleveland Clinic were treated by primary closure. Infection was diagnosed, usually within 2 weeks of operation (average, 10.9 days), by increasing back pain, purulent drainage from the incision, cultures, and subfacial extension of the process. In one patient, an associated disk space infection was observed. Causative organisms were Staphylococcus aureus in five patients and Staphylococcus epidermidis in five patients. At the second operation, the wounds were opened and radically debrided, irrigated, and closed primarily over one or two large drains. Treatment with intravenously administered antibiotics was continued postoperatively; the duration of treatment varied from 10 days to 6 weeks, depending on the presence or absence of involvement of bone or disks. Complete resolution of the infections and primary healing of the wounds occurred in all patients. This technique offers advantages over the traditional technique of secondary wound closure by decreasing the amount of wound care and length of hospitalization and is recommended as the treatment of choice for patients with postoperative spinal wound infections.

Myeloradiculopathy secondary to pseudogout in the cervical ligamentum flavum: case report

A case of cervical myeloradiculopathy secondary to deposits of calcium pyrophosphate dihydrate (Ca2P2O7 2H2O) (CPPD) crystals in the degenerating ligamentum flavum, with marked granulomatous inflammation, is presented. This uncommon clinical presentation of pseudogout (CPPD deposition disease) was confirmed after surgical removal of a compressive cervical ligamentum flavum. The diagnosis of CPPD crystal deposition was determined by polarized light microscopy and energy-dispersive x-ray microanalysis in frozen sections of the biopsy specimen. A review of seven previously reported cases along with the present case failed to reveal trauma as a causative factor.

Spinal cord compression: a complication of silicone-coated Dacron dural grafts. Report of two cases

Two case reports of compression of the cervical spinal cord associated with silicone-coated Dacron dural grafts are presented. In both cases, the cervical spinal cord was distorted and compressed by an intense tissue reaction that encapsulated the synthetic graft. At least two factors are thought to play a role in precipitating this reaction: (1) the introduction of surface contaminants into the wound, and (2) repeated motion at the graft site.

Hemodynamic, renal, and endocrine effects of 4-h infusions of human atrial natriuretic peptide in normal volunteers

A synthetic human atrial natriuretic peptide of 26 aminoacids [human (3-28)ANP or hANP] was infused into normal male volunteers. Six subjects were infused for 4 h at 1-wk intervals with either hANP at the rate of 0.5 or 1.0 microgram/min or its vehicle in a single-blind randomized order. Human (3-28)ANP at the dose of 0.5 microgram/min raised immunoreactive plasma ANP levels from 104 +/- 17 to 221 +/- 24 pg/ml (mean +/- SEM), but it induced no significant change in blood pressure, heart rate, effective renal plasma flow, glomerular filtration rate, or renal electrolyte excretion. At the rate of 1.0 microgram/min, human (3-28)ANP increased immunoreactive plasma ANP levels from 89 +/- 12 to 454 +/- 30 pg/ml. It reduced effective renal plasma flow from 523 +/- 40 to 453 +/- 38 ml/min (P less than 0.05 vs. vehicle), but left glomerular filtration rate unchanged. Natriuresis rose from 207 +/- 52 to 501 +/- 69 mumol/min (P less than 0.05 vs. vehicle) and urinary magnesium excretion from 3.6 +/- 0.5 to 5.6 +/- 0.5 mumol/min (P less than 0.01 vs. vehicle). The excretion rate of the other electrolytes, blood pressure, and heart rate were not significantly modified. At both doses, human (3-28)ANP tended to suppress the activity of the renin-angiotensin-aldosterone system. In 3 additional volunteers, the skin blood flow response to human (3-28)ANP, infused for 4 h at the rate of 1.0 microgram/min, was studied by means of a laser-doppler flowmeter. The skin blood flow rose during the first 2 h of peptide administration, then fell progressively to values below baseline. After the infusion was discontinued, it remained depressed for more than 2 h. Thus, in normal volunteers, human (3-28)ANP at the dose of 1.0 microgram/min produced results similar to those obtained previously with rat (3-28)ANP. It enhanced natriuresis without changing the glomerular filtration rate while effective renal plasma flow fell. It also induced a transient vasodilation of the skin vascular bed.

[Infrared coagulation as an aide in proctology]

The infrared coagulation has being described as a method of treatment for haemorrhoids first and second degree, with results almost as effective as rubber band ligation and sclerosing injection therapy, but with fewer complications. More frequent applications of infrared coagulation may improve results and are often in a six month interval necessary. A major indication exist in bleeding haemorrhoids where the infrared coagulation gives a quick result.

Failure of pentoxifylline for end-stage peripheral vascular disease

In this trial of pentoxifylline, 15 patients with end-stage peripheral vascular disease had symptoms severe enough to warrant operation, but surgery was contraindicated because of anatomically noncorrectable disease, serious medical problems, or refusal. Their mean age was sixty-six years. Each patient received oral pentoxifylline, 400 mg tid, for twelve weeks. Pentoxifylline had no measurable clinical benefit in 14 of the patients. In addition, the authors noted an increased incidence of symptomatic coronary artery insufficiency during the trial period that may or may not have been drug related.

Four-hour infusions of synthetic atrial natriuretic peptide in normal volunteers

Two doses of synthetic atrial natriuretic peptide (0.5 and 5.0 micrograms/min) and its vehicle were infused intravenously for 4 hours in eight salt-loaded normal volunteers, and the effect on blood pressure, heart rate, renal hemodynamics, solute excretion, and secretion of vasoactive hormones was studied. The 0.5 micrograms/min infusion did not alter blood pressure or heart rate, whereas the 5.0 micrograms/min infusion significantly reduced the mean pressure by 20/9 mm Hg after 2.5 to 3 hours and increased the heart rate slightly. Inulin clearance was not significantly changed, but the mean p-aminohippurate clearance fell by 13 and 32% with the lower and higher doses, respectively. Urinary excretion of sodium and chloride increased slightly with the lower dose. With the higher dose, a marked increase in urinary excretion of sodium, chloride, and calcium was observed, reaching a peak during the second hour of the infusion. Potassium and phosphate excretion did not change significantly. A brisk increase in urine flow rate and fractional water excretion was seen only during the first hour of the high-dose infusion. Signs and symptoms of hypotension were observed in two subjects. No change in plasma renin activity, angiotensin II, or aldosterone was observed during either infusion, but a marked increase occurred after discontinuation of the high-dose infusion. In conclusion, the 5 micrograms/min infusion induced a transient diuretic effect, delayed maximal natriuretic activity, and a late fall in blood pressure, with no change in inulin clearance but a dose-related decrease in p-aminohippurate clearance. Despite large amounts of sodium excreted and blood pressure reduction, no counterregulatory changes were observed in the renin-angiotensin-aldosterone system or plasma vasopressin levels during the infusion.

[Foetal pancreas implants in an insulin-dependent patient. Technique and clinical results (author's transl)]

Fragments of foetal pancreatic buds taken before the 10th week of gestation, stored at - 196 degrees C and cultivated on artificial media were implanted in an adult, insulin-dependent diabetic patient. Following a 2 weeks latent period, the clinical symptoms of diabetes regressed within 2 months, although all insulin treatment had been withdrawn. These results have now been maintained for 11 months, but major overloads in carbohydrates are imperfectly controlled.

Effect of Platelet Suppressants on Experimental Arterial Thrombosis

A reproducible model of platelet rich thrombi was produced in canine arteries by a previously described technique of intravascular insertion of metal tubing. The effect of platelet suppressants including sulfinpyrazone and ticrynafen, a clofibrate analog, on the rate and nature of thrombus formation was studied. ADP and epinephrine Induced platelet aggregation of the animal’s platelet rich plasma was monitored during the experiment. Platelet aggregation was impaired after the intravenous administration of either sulfinpyrazone (30 mg/kg body weight) or ticrynafen (100 mg/kg body weight). The rate of thrombus formation was not significantly altered by sulfinpyrazone when compared to the control, but histochemically, the thrombus studied showed a greatly diminished platelet content. In contrast, ticrynafen was able to prevent a complete occlusion of the involved vascular segment and a weak thrombus composed mostly of fibrin was produced instead. This effect of ticrynafen was dose related with minimal changes observed at a dose of 75 mg/kg. The results suggest that this arterial thrombosis model is of value in evaluating antithrombotic agents. They also indicate a potential value of ticrynafen as a therapeutic agent which should be further studied.

Improving cognitive ability in chronically deprived children

Beginning at different ages in their preschool years, groups of chronically undernourished children from Colombian families of low socioeconomic status participated in a program of treatment combining nutritional, health care, and educational features. By school age the gap in cognitive ability between the treated children and a group of privileged children in the same city had narrowed, the effect being greater the younger the children were when they entered the treatment program. The gains were still evident at the end of the first grade in primary school, a year after the experiment had ended.