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1.
Ann Oncol ; 22(6): 1295-1301, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21199886

ABSTRACT

BACKGROUND: Prognostic tools in early breast cancer are inadequate. The evolving field of metabolomics may allow more accurate identification of patients with residual micrometastases. PATIENTS AND METHODS: Forty-four early breast cancer patients with pre- and postoperative serum samples had metabolomic assessment by nuclear magnetic resonance. Fifty-one metastatic patients served as control. Differential clustering was identified and used to calculate individual early patient 'metabolomic risk', calculated as inverse distance of each early patient from the metastatic cluster barycenter. Metabolomic risk was compared with Adjuvantionline 10-year mortality assessment. RESULTS: Innate serum metabolomic differences exist between early and metastatic patients. Preoperative patients were identified with 75% sensitivity, 69% specificity and 72% predictive accuracy. Comparison with Adjuvantionline revealed discordance. Of 21 patients assessed as high risk by Adjuvantionline, 10 (48%) and 6 (29%) were at high risk by metabolomics in pre- and postoperative settings, respectively. Of 23 low-risk patients by Adjuvantionline, 11 (48%) preoperative and 20 (87%) postoperative patients were at low risk by metabolomics. CONCLUSIONS: This study identifies metabolomic discrimination between early and metastatic breast cancer. Micrometastatic disease may account for metabolomic misclassification of some early patients as metastatic. Metabolomics identifies more patients as low relapse risk compared with Adjuvantionline. Further exploration of this metabolomic fingerprint is warranted.


Subject(s)
Biomarkers, Tumor/blood , Breast Neoplasms/blood , Breast Neoplasms/pathology , Metabolomics/methods , Neoplasm Micrometastasis , Neoplasm Recurrence, Local/blood , Adult , Aged , Aged, 80 and over , Early Detection of Cancer , Female , Humans , Middle Aged , Prognosis , Risk
2.
Spine (Phila Pa 1976) ; 24(20): 2154-61, 1999 Oct 15.
Article in English | MEDLINE | ID: mdl-10543015

ABSTRACT

STUDY DESIGN: A retrospective review of 42 patients treated at three major medical centers for burst fractures of L3, L4, and L5. This is the largest low lumbar (L3-L5) burst fracture study in the literature to date. The study was designed to assess both radiographic and clinical outcomes in a cohort of patients treated during a 16-year period. OBJECTIVES: The objective of this study was to determine whether conservatively treated patients with low lumbar burst fractures had satisfactory outcomes compared with those in a surgically treated cohort of patients. The study included patients with and without neurologic deficits. SUMMARY OF BACKGROUND DATA: Burst fractures of the low lumbar spine (L3-L5) represent a small percentage of all spine fractures. The iliolumbar ligaments and location below the pelvic brim are two stabilizing factors that are unique to these fractures when compared with burst fractures at the thoracolumbar junction. METHODS: Forty-two (n = 42) patients with low lumbar burst fractures were identified from 1980 through 1996. Medical records, radiographs, and follow-up Dallas Pain Questionnaires were obtained. Loss of anterior vertebral height, kyphotic angulation, and amount of retropulsion were recorded at several phases of treatment. Mean follow-up time was 45.2 months (range, 5-132 months). Twenty patients were treated without surgery (18 were neurologically intact, and 2 had isolated nerve root injury), and 22 underwent surgery (14 had neurologic injury, 8 were intact). RESULTS: No patient showed neurologic deterioration, regardless of treatment. Fracture of the third lumbar segment showed the greatest tendency toward kyphotic collapse and loss of height in the nonoperative group, although this was not reflected in the final functional outcome of both groups. The ability to return to work and achieve a good-to-excellent long-term result was not significantly different among fracture levels or between surgical and nonsurgical treatments. CONCLUSIONS: The results of nonoperative treatment of low lumbar burst fractures were comparable with those of operative treatment. The rate of repeat surgery (41%) and absence of a clearly definable long-term functional or radiographic benefit in patients without neurologic compromise may make surgery less appealing.


Subject(s)
Lumbar Vertebrae/injuries , Spinal Fractures/physiopathology , Spinal Fractures/therapy , Adolescent , Adult , Aged , Braces , Decompression, Surgical , Female , Follow-Up Studies , Humans , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/physiopathology , Male , Manipulation, Spinal , Middle Aged , Range of Motion, Articular , Reoperation , Retrospective Studies , Spinal Fractures/diagnostic imaging , Surveys and Questionnaires , Tomography, X-Ray Computed , Treatment Outcome
3.
Spine (Phila Pa 1976) ; 23(19): 2143-6, 1998 Oct 01.
Article in English | MEDLINE | ID: mdl-9794062

ABSTRACT

More than a century has passed since the publication of the major academic works of the great Russian surgeon Nickolay Ivanovich Pirogoff, yet some of the ideas and surgical problems that challenged him are still clinically important today. Pirogoff's creative activity embraced a number of areas in medicine and was not limited to any particular discipline. A sample listing of his works and achievements would demonstrate his rank as a scientist and a surgeon of great genius.


Subject(s)
Anatomy/history , General Surgery/history , History, 19th Century , Humans , Russia , Spinal Diseases/surgery , Spine/anatomy & histology , Spine/surgery
6.
J Spinal Disord ; 7(5): 380-7, 1994 Oct.
Article in English | MEDLINE | ID: mdl-7819637

ABSTRACT

We reviewed 118 patients who underwent lumbar decompression without fusion for acquired lumbar spinal stenosis between 1980 and 1991. Fifty of these patients (15 men, 35 women) were clinically and roentgenographically reexamined, with quantification of postoperative degenerative changes. The presence of preoperative spondylolisthesis and a postoperative change in spondylolisthesis portended poor outcome. Men had better mean surgical outcome scores than did women, and 6% of the men and 28% of the women underwent further surgery for recurrent stenosis or instability. Women had larger mean postoperative changes in spondylolisthesis than did men. Patients with mild preoperative spondylolisthesis developed a larger slip after the procedure than did those with no preoperative slip. Women and patients with preoperative spondylolisthesis may require changes in existing treatment modalities to improve outcome or alterations in long-term expectations after lumbar decompression for stenosis.


Subject(s)
Spinal Stenosis/diagnostic imaging , Spinal Stenosis/surgery , Aged , Female , Forecasting , Humans , Laminectomy , Lumbosacral Region , Male , Middle Aged , Postoperative Period , Radiography , Sex Characteristics , Spinal Stenosis/complications , Spondylolisthesis/complications , Spondylolisthesis/diagnostic imaging , Treatment Outcome
7.
J Spinal Disord ; 6(1): 5-10, 1993 Feb.
Article in English | MEDLINE | ID: mdl-8439717

ABSTRACT

An anatomical study using six fresh, human cadaveric cervical spine specimens was performed. After the dissection of all soft tissue, flexion-extension radiographs were obtained to verify initial stability. A sagittal plane bone cut was then made, centered on the odontoid and sparing the alar ligaments, the tectorial membrane, and the atlantooccipital (AO) ligaments. Repeat flexion-extension radiographs and photographs were taken to document maintenance of stability of these hemisections. The occipital-atlantoaxial ligaments were then individually and sequentially incised, maintaining all other structures each time. After the sectioning of each ligament, flexion-extension radiographs and photographs were obtained to identify subsequent motion patterns. Both gross anatomical and roentgenographic examinations demonstrated the important stabilizing role of the tectorial membrane in flexion. Additionally, contact between the posterior arch of C1 and the occiput limited hyperextension as a secondary restraint once the tectorial membrane was sectioned. Furthermore, the AO ligaments proved to play an insignificant role in the preservation of AO stability through a flexion-extension arc of motion. Under normal circumstances, the AO articulation is not excessively stressed. However, acute AO injury, as well as the insidious failure of these ligaments, has been documented in several cases involving various pathologies. This study demonstrates a mechanism of instability and highlights the essential role of the tectorial membrane in maintaining upper cervical spine stability.


Subject(s)
Atlanto-Occipital Joint/pathology , Joint Instability/pathology , Atlanto-Occipital Joint/diagnostic imaging , Cadaver , Humans , Joint Instability/diagnostic imaging , Ligaments, Articular/diagnostic imaging , Ligaments, Articular/pathology , Odontoid Process/diagnostic imaging , Odontoid Process/pathology , Radiography
8.
J Neurosurg ; 74(2): 163-70, 1991 Feb.
Article in English | MEDLINE | ID: mdl-1988583

ABSTRACT

Since 1984, a consecutive series of patients with cervical spondylotic myelopathy has been treated by central corpectomy and strut grafting. This report focuses on 40 cases operated on between 1984 and 1987 and followed from 2 to 5 years. The perioperative complication rate was 47.5%, with a 7.5% incidence of persistent sequelae: severe C-5 radiculopathy in one patient, swallowing dysfunction in one, and hypoglossal nerve palsy in one. No single factor (age, duration of symptoms, or severity of myelopathy) was absolutely predictive of outcome; however, syndromes of short duration had the best likelihood of cure. Similar outcomes were associated, individually, with long duration of symptoms, age over 70 years, and severe myelopathy. After factoring a 5% regression of improvement, the long-term cure rate was 57.5% and the failure rate was 15%. Myelopathy worsening was not documented.


Subject(s)
Cervical Vertebrae/surgery , Spinal Osteophytosis/surgery , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/pathology , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Myelography , Postoperative Complications , Spinal Osteophytosis/diagnosis , Spinal Osteophytosis/mortality , Time Factors
9.
Am J Med Genet ; 36(2): 183-95, 1990 Jun.
Article in English | MEDLINE | ID: mdl-2368807

ABSTRACT

We present 5 cases of a short-limb dwarfism syndrome whose manifestations overlap those of atelosteogenesis and oto-palato-digital syndrome Type II. Clinical, radiographic, genetic, and histologic data are presented which demonstrate differences between our patients and previously reported cases of these other conditions. We conclude that the disorder seen in these children represents a distinct chondrodysplasia for which we propose the name atelosteogenesis Type III.


Subject(s)
Bone and Bones/abnormalities , Bone and Bones/diagnostic imaging , Dwarfism/complications , Female , Fibula/abnormalities , Foot Deformities, Congenital/complications , Humans , Infant , Infant, Newborn , Male , Radiography , Syndrome
10.
J Bone Joint Surg Am ; 67(1): 63-6, 1985 Jan.
Article in English | MEDLINE | ID: mdl-3155742

ABSTRACT

Seventy-three patients with lumbar radicular pain syndromes were treated in a prospective, randomized, double-blind fashion with either seven milliliters of methylprednisolone acetate and procaine or seven milliliters of physiological saline solution and procaine. All patients had radiographic confirmation of lumbar nerve-root compression, consistent with the clinical diagnosis of either an acute herniated nucleus pulposus or spinal stenosis. No statistically significant difference was observed between the control and experimental patients with either acute disc herniation or spinal stenosis. Long-term follow-up, averaging twenty months, failed to demonstrate the efficacy of a second injection of epidural steroids administered to the patients whose pain did not respond within twenty-four hours to an injection of either eighty milligrams of methylprednisolone acetate combined with five milliliters of 1 per cent procaine or two milliliters of sterile saline combined with five milliliters of 1 per cent procaine. Therefore, a decision to use epidural steroids must be made with the realization that we failed to demonstrate its clinical efficacy in this study and that reports of serious complications of this procedure have been published.


Subject(s)
Adrenal Cortex Hormones/administration & dosage , Anesthesia, Epidural , Back Pain/drug therapy , Nerve Compression Syndromes/drug therapy , Sciatica/drug therapy , Spinal Nerve Roots , Back Pain/etiology , Clinical Trials as Topic , Double-Blind Method , Female , Follow-Up Studies , Humans , Intervertebral Disc Displacement/complications , Male , Methylprednisolone/administration & dosage , Methylprednisolone/analogs & derivatives , Methylprednisolone Acetate , Middle Aged , Nerve Compression Syndromes/complications , Nerve Compression Syndromes/etiology , Procaine/administration & dosage , Prospective Studies , Random Allocation , Sciatica/etiology , Spinal Stenosis/complications , Time Factors
11.
J Trauma ; 21(9): 811-4, 1981 Sep.
Article in English | MEDLINE | ID: mdl-7277549

ABSTRACT

Ankylosing hyperostosis of the spine is a distinct clinical entity that merits diagnosis and recognition of its structural limitations. The case of multiple thoracic spine fractures presented here emphasizes the potentially increased susceptibility of involved spines to trauma and also suggests the need to caution diagnosed patients from placing their spines at undue risk.


Subject(s)
Bone Diseases/complications , Fractures, Bone/diagnosis , Thoracic Vertebrae/injuries , Diagnosis, Differential , Fractures, Bone/diagnostic imaging , Humans , Male , Middle Aged , Osteoarthritis/diagnosis , Radiography , Spondylitis, Ankylosing/diagnosis , Thoracic Vertebrae/diagnostic imaging
12.
Spine (Phila Pa 1976) ; 6(2): 180-4, 1981.
Article in English | MEDLINE | ID: mdl-7280819

ABSTRACT

Reflex sympathetic dystrophy can be associated with lumbar disc herniations. Both central and peripheral neuroanatomic pathways can be implicated in the development of this syndrome. Clinical findings of vasomotor instability in the leg supported by plain roentgenograms showing osteopenia, bone scan showing increased uptake, and a favorable response with sympathetic blocks suggest the diagnosis. Symptoms should be relieved with appropriate nerve root decompression but may require, in addition, a therapeutic lumbar sympathetic blockade.


Subject(s)
Intervertebral Disc Displacement/complications , Reflex Sympathetic Dystrophy/etiology , Aged , Diagnosis, Differential , Female , Humans , Lumbar Vertebrae/injuries , Reflex Sympathetic Dystrophy/diagnosis , Reflex Sympathetic Dystrophy/surgery
13.
Clin Orthop Relat Res ; (154): 14-7, 1981.
Article in English | MEDLINE | ID: mdl-6451343

ABSTRACT

An explicit and effective plan for evaluation of the failed back allows the diagnosis of nonorthopedic causes for low back pain, whether they be medical or psychosocial in nature. This plan includes the prompt recognition and treatment of those problems which are surgically remediable, such as the recurrent disk herniation or spinal stenosis. Finally, this plan will accurately define those patients for whom there is no cure at the present time, such as those with arachnoiditis and those with low back pain without a definable cause. Careful adherence to this plan will prevent the physician from advising these unfortunate patients who already suffered one unsuccessful operation from undergoing yet another futile exercise and yet not exclude those who will benefit from operative intervention.


Subject(s)
Lumbar Vertebrae/surgery , Back Pain/etiology , Back Pain/surgery , Humans , Sciatica/diagnosis , Spinal Diseases/surgery
15.
Spine (Phila Pa 1976) ; 5(3): 292-4, 1980.
Article in English | MEDLINE | ID: mdl-6446775

ABSTRACT

Two cases of low-back pain and sciatica following total hip replacement are reported. Both patients were operated upon and after lumbar decompression were free of pain. A theory is presented to suggest that the lengthening of the limb after total hip replacement puts excess tension on the spinal nerves and, in conjunction with preexisting degenerative disc disease, will precipitate low-back pain and sciatica.


Subject(s)
Back Pain/etiology , Hip Prosthesis , Postoperative Complications , Sciatica/etiology , Aged , Female , Humans , Male , Middle Aged
18.
Minerva Med ; 68(14): 903-16, 1977 Mar 24.
Article in Italian | MEDLINE | ID: mdl-850552

ABSTRACT

A study of membrane proteins in pernicious anaemia and other haemolitic and anhaemolytic erythropathies is reported. Cellulose acetate and acrylamide gel electrophoresis was carried out and acid, neutral and basic amino acid contents were determined. Relatively specific alterations were noted. Chromatographic analysis of the amino acids suggested that in pernicious anaemia, as in other conditions, structural changes take place in the red cell membrane, though these may be confined to certain sectors. A constant alteration related to the concomitance or otherwise of erythrocyte hyperhaemolysis, however, could not be discerned.


Subject(s)
Anemia, Pernicious/blood , Erythrocytes/metabolism , Hematologic Diseases/blood , Membrane Proteins/blood , Amino Acids/blood , Erythropoiesis , Humans
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