Endoscopic Spine Surgery

Surgical treatment of the degenerative disc disease has evolved from traditional open spine surgery to minimally invasive spine surgery including endoscopic spine surgery. Constant improvement in the imaging modality especially with introduction of the magnetic resonance imaging, it is possible to identify culprit degenerated disc segment and again with the discography it is possible to diagnose the pain generator and pathological degenerated disc very precisely and its treatment with minimally invasive approach. With improvements in the optics, high resolution camera, light source, high speed burr, irrigation pump etc, minimally invasive spine surgeries can be performed with various endoscopic techniques for lumbar, cervical and thoracic regions. Advantages of endoscopic spine surgeries are less tissue dissection and muscle trauma, reduced blood loss, less damage to the epidural blood supply and consequent epidural fibrosis and scarring, reduced hospital stay, early functional recovery and improvement in the quality of life & better cosmesis. With precise indication, proper diagnosis and good training, the endoscopic spine surgery can give equally good result as open spine surgery. Initially, endoscopic technique was restricted to the lumbar region but now it also can be used for cervical and thoracic disc herniations. Previously endoscopy was used for disc herniations which were contained without migration but now days it is used for highly up and down migrated disc herniations as well. Use of endoscopic technique in lumbar region was restricted to disc herniations but gradually it is also used for spinal canal stenosis and endoscopic assisted fusion surgeries. Endoscopic spine surgery can play important role in the treatment of adolescent disc herniations especially for the persons who engage in the competitive sports and the athletes where less tissue trauma, cosmesis and early functional recovery is desirable. From simple chemonucleolysis to current day endoscopic procedures the history of minimally invasive spine surgery is interesting. Appropriate indications, clear imaging prior to surgery and preplanning are keys to successful outcome. In this article basic procedures of percutaneous endoscopic lumbar discectomy through transforaminal and interlaminar routes, percutaneous endoscopic cervical discectomy, percutaneous endoscopic posterior cervical foraminotomy and percutaneous endoscopic thoracic discectomy are discussed.

Elaeocarpus ganitrus: its beneficial antiparkinsonian effect in MPTP induced motor and non-motor impairments in mice.

Aim: Elaeocarpus ganitrus (Family: Elaeocarpaceae), has shown beneficial role in the treatment of depression, convulsions and asthma. This study was undertaken to evaluate the antiparkinson effect of E.ganitrus. Materials and methods: Swiss albino mice of either sex were divided into 06 groups (n =12). 1st group mice were given 0.5% carboxy methyl cellulose (orally), 2nd group were administered MPTP (2 doses, each dose 20 mg/kg at 2 hr. interval, i.p.). Whereas 3rd, 4th and 5th groups - were administered with E. ganitrus (100, 200, and 400 mg/kg/day, orally), respectively, along with MPTP. Group 6- received Levodopa (30mg/kg, i.p,) along with MPTP. To evaluate anti-Parkinson effect, hanging wire test, tardive dyskinesia test and elevated plus maze test were performed on the1st day and on 8 th day. One way ANOVA followed by post-hoc Tukey test, with p<0.05 was considered statistical significant. Results: E.ganitrus (200 and 400 mg/kg, p.o.) was found to increase the hanging time significantly (p <0.001) in hanging wire test and significantly decreased (p <0.001) the Vacuous Chewing Movements (VCMs) in tardive dyskinesia test as compared to MPTP group. E.ganitrus (200 and 400 mg/kg, p.o.) was found to significantly increase (p <0.001) the no. of entries and time spent in open arm and significantly decreased the no. of entries and time spent in closed arm (p <0.001) compared to MPTP treated group. Conclusion: The results of the present study conclusively showed that E.ganitrus has beneficial effect in MPTP induced experimental model of Parkinson’s disease.

Gum Arabic Enhances Paracellular Transport of Water in Amphibian Everted Small Intestinal Segments.

Gum Arabic (GA) is known for its proabsorbent activity in normal intestine as well as in animal models of diarrhea. The aim of the study was to find the effect of GA on intestinal transport of water and possible route of absorption in frog everted gut sacs. D-Mannitol was used as a marker of paracellular transport to find the route of absorption. Everted gut sacs (n=4,5) were placed in Ringer containing GA (2.5 g/L) with or without D-Mannitol (0.5 g/L), incubated for 1 hour and analysed for change in weights of the sacs and D-Mannitol uptake. There was significant increase in uptake of water and D-Mannitol in the presence of GA compared to controls (P<0.05).Gum Arabic improves water uptake by the intestinal mucosa, possibly by opening the paracellular pathways.

Long-term Safety and Efficacy of Abatacept in Koreans with Rheumatoid Arthritis

OBJECTIVE: The safety and efficacy of intravenous (IV) abatacept in patients with active RA unresponsive to methotrexate have been demonstrated in short-term (ST) studies in global populations and a ST, Phase III study in a Korean patient population. Abatacept's long-term safety and efficacy profile has been established in open-label global studies with treatment up to 5 years. The objective of this study was to determine the long-term safety and efficacy of abatacept in patients with RA from the ST Korean study. METHODS: This was an open-label long-term extension (LTE) of a Phase III, multicenter, randomized, double-blind, placebo-controlled study in which Korean patients who had received IV abatacept or placebo in the ST trial (169 days) were given the option to receive open-label abatacept to Day 1485 with 84 days' follow-up (total 1,569 days, ~4 years). RESULTS: A total of 105 patients were enrolled in the LTE (86.7% female, median age 49.0 years). Abatacept was generally well tolerated. Adverse events were mostly mild or moderate and no new safety signals were identified. Improvement in disease activity (assessed by ACR response and DAS28 [CRP]), physical function (assessed by KHAQ-DI), and quality of life (assessed by SF-36 score) were maintained in patients initially treated with abatacept or observed in patients who had switched to abatacept after placebo in the ST study. CONCLUSION: Long-term treatment with IV abatacept over 1485 days was generally well tolerated in Korean patients with RA. Additionally, the efficacy profile from the ST study was maintained over the LTE.

Long-term Safety and Efficacy of Abatacept in Koreans with Rheumatoid Arthritis

OBJECTIVE: The safety and efficacy of intravenous (IV) abatacept in patients with active RA unresponsive to methotrexate have been demonstrated in short-term (ST) studies in global populations and a ST, Phase III study in a Korean patient population. Abatacept's long-term safety and efficacy profile has been established in open-label global studies with treatment up to 5 years. The objective of this study was to determine the long-term safety and efficacy of abatacept in patients with RA from the ST Korean study. METHODS: This was an open-label long-term extension (LTE) of a Phase III, multicenter, randomized, double-blind, placebo-controlled study in which Korean patients who had received IV abatacept or placebo in the ST trial (169 days) were given the option to receive open-label abatacept to Day 1485 with 84 days' follow-up (total 1,569 days, ~4 years). RESULTS: A total of 105 patients were enrolled in the LTE (86.7% female, median age 49.0 years). Abatacept was generally well tolerated. Adverse events were mostly mild or moderate and no new safety signals were identified. Improvement in disease activity (assessed by ACR response and DAS28 [CRP]), physical function (assessed by KHAQ-DI), and quality of life (assessed by SF-36 score) were maintained in patients initially treated with abatacept or observed in patients who had switched to abatacept after placebo in the ST study. CONCLUSION: Long-term treatment with IV abatacept over 1485 days was generally well tolerated in Korean patients with RA. Additionally, the efficacy profile from the ST study was maintained over the LTE.

Creutzfeldt-Jacob disease: An autopsy case report in tertiary care hospital.

Sporadic Creutzfeldt-Jakob disease (CJD) is the most common prion disease. It is a rare, fatal neurodegenerative disease caused by an infectious protein called prion. The diagnosis can be confirmed only by histological examination of brain tissue. Because of the transmissible nature of the disease, autopsy or brain biopsy cannot be performed at many institutions. Histology shows spongiform changes, neuronal loss, reactive astrocytic proliferation, accumulation of pathologic protein occurring in three general forms: Sporadic, familial, and acquired form, including a variant form of CJD. It clinically presents as predominantly progressive dementia with a rapid onset, myoclonus, cerebellar, pyramidal, extra pyramidal and visual signs. Occurrence of periodical spikes in electro-encephalogram, observation of cortical signal alterations in magnetic resonance imaging (MRI) studies, and detection of protein 14-3-3 in cerebrospinal fluid substantiate diagnosis. Autopsy case is presented of a 50 year old woman with progressive dementia, typical neurological symptoms, MRI findings and confirmation of CJD on histology and immunostaining.

Asymptomatic bacteriuria in school going children.

PURPOSE: The present study was undertaken to determine the prevalence of asymptomatic bacteriuria in school going children of different age groups and sex and to isolate the organisms responsible for asymptomatic bacteriuria and to know their antimicrobial susceptibility pattern. METHODS: A total of 1817 school children were screened by collecting mid-stream urine and isolating the organisms. RESULTS: Asymptomatic bacteriuria was observed in 192 cases (10.57%) with female preponderance over male. The maximum isolates were E.coli (32.8%). Followed by Klebsiella pneumoniae (22.4%) and Staphylococcus aureus (15.1%). CONCLUSIONS: In the present study there was a steady increase in the incidence of asymptomatic bacteriuria in different age groups. Most of the isolates were resistant to one or more antibiotics.