Percutaneous vertebroplasty for treatment of osteolytic metastases of the C2 vertebral body using anterolateral and posterolateral approach.

Percutaneous vertebroplasty (PVP) of C2 vertebral body is a challenging procedure. The aim of this retrospective study was to evaluate the feasibility, safety, and efficacy of PVP for the C2 osteolytic metastases using anterolateral and posterolateral approaches. Ten patients (8 male, 2 female) with C2 metastases were treated with PVP under local anesthesia. Anterolateral route was used under the guidance of fluoroscopy in 9 cases, and posterolateral route was used under the guidance of CT in 1 case. Pain intensity was scored on a scale ranging from 0/10 (no pain) to 10/10 (maximum pain intensity). The mean volume of cement injected was 3 +/- 0.8 mL (range, 2.0-4.0 mL), with average vertebral filling of more than 70%. Cement leakage was detected in 4 treated vertebrae. Pain improvement and spine stability were achieved in all patients. In conclusion, PVP of C2 using anterolateral approach is a feasible and minimal invasive procedure for treatment of patients with C2 osteolytic metastases. Posterolateral approach is a safe and effective option for PVP of C2 when hyperextension of the cervical spine is contraindicated or difficult to achieve.

Diagnosing prosthetic vascular graft infection with the antigranulocyte antibody 99mTc-fanolesomab.

AIM: The objectives of this retrospective investigation were to determine the accuracy of 99mTc-fanolesomab, an antigranulocyte antibody, for diagnosing prosthetic vascular graft infection, ascertain optimum imaging times for this indication, and assess safety of this agent. METHODS: Eighteen patients with 19 prosthetic vascular grafts were included. Indications for graft placement included peripheral vascular disease (8), haemodialysis (7), and aneurysm (4). Patients were imaged 2-5 h and 18-30 h after injection of 555-740 MBq (75-125 microg) 99mTc-fanolesomab. One experienced nuclear physician reviewed images in three separate sessions, early alone, late alone and early plus late images together. When early and late images were read alone, graft activity more intense than native blood pool activity was classified as positive for infection. When early and late images were interpreted together, graft activity which persisted or which increased in intensity over time was classified as positive for infection. Patient records were reviewed for adverse events up to 30 days after injection. RESULTS: Five (26%) prosthetic grafts were infected. Early, late and early plus late imaging were equally sensitive (1.00). Early images were significantly less specific (0.50), than late and early plus late images (0.93) (P<0.05, analysis of proportions). Accuracy of late imaging and early plus late imaging were the same: 0.93. No patient experienced adverse events following radiopharmaceutical injection. CONCLUSIONS: 99mTc-fanolesomab imaging, performed 18-30 h after injection, diagnosed prosthetic vascular graft infection safely and accurately (95%). (Although safety was not an issue in this investigation, following reports of serious, including two fatal, events after administration, 99mTc-fanolesomab was withdrawn from the United States market).

Differential effects of leptin on cancer in vitro.

INTRODUCTION: Leptin, a protein produced by adipocytes, is an important signaling molecule in energy regulation and food intake. Many obese patients have leptin resistance associated with increased circulating leptin. Leptin receptor activation downregulates many regulatory genes, including STAT-3 and PAP 1. Certain cancers are associated with obesity, including breast, prostate, and colon. Recent studies have shown that leptin stimulates proliferation of human colon cancer in vitro. We hypothesized that leptin would have stimulatory effects on other human cancers. MATERIALS AND METHODS: Human cancer cell lines from esophagus (KYSE410 and 150), breast (ZR75-1 and MCF-7), prostate (DU145 and PC-3), and pancreas (PANC-1, Mia-PaCa) were cultured using standard techniques. Leptin (0.4 ng/ml and 4.0 ng/ml) was added for 24 h and 48 h. Cell growth was determined by MTT assay. Statistical analysis was performed using analysis of variance. RESULTS: Cancer cell lines demonstrated dose- and time-related responses to treatment. Leptin caused growth potentiation in breast, esophagus, and prostate cancer (P < 0.05). However, in both Mia-PaCa and PANC-1 pancreatic cancer cells, leptin inhibited growth (P < 0.05). This inhibitory effect peaked in PANC-1 at 48 h (78%). CONCLUSIONS: We have shown for the first time that human cancer cells exhibit differential responses to treatment with leptin, depending upon organ of derivation. Both leptin and leptin antagonism have potential efficacy in cancer therapy, based on cellular origin. Further studies are warranted and ongoing.

Modulation of interleukin-6 in cardiac myoblasts during endotoxemia.

INTRODUCTION: Interleukin (IL)-6 is induced in the heart during endotoxemia. We investigated endotoxin-induced IL-6 in vitro and its modulation by IL-1beta and tumor necrosis factor (TNF)-alpha. Whether lipopolysaccharide (LPS) would stimulate nuclear factor (NF)-kappaB intranuclear translocation was also examined. We hypothesized that IL-6 production is enhanced with LPS and cytokine challenge and that LPS stimulates NF-kappaB intranuclear translocation in a myogenic cell line. METHODS: Rat H9c2 cardiac myoblasts were grown in culture. IL-6 protein was determined by enzyme-linked immunosorbent assay after LPS (10 microg/ml) and in the presence of TNF-alpha or IL-1beta. IL-6 mRNA was amplified using reverse-transcription polymerase chain reaction. Myoblasts were treated with LPS and stained for the p65 subunit of NF-kappaB. RESULTS: LPS stimulated IL-6 protein and mRNA expression (P < 0.05). IL-1beta increased IL-6 when combined with TNF-alpha (P < 0.05). In the presence of LPS, TNF-alpha lowered IL-6 production, which was further reduced upon addition of IL-1beta. LPS activated NF-kappaB showing p65 subunit cellular localization within 30 min. CONCLUSIONS: In cardiac myoblasts, IL-6 is either enhanced or reduced depending on interactions between LPS and cytokine challenge. Enhanced nuclear translocation of NF-kappaB in response to LPS was evident in a myogenic cell line.