Minimally invasive burst fracture fixation in the thoracolumbar region.

Minimally invasive spine surgery is evolving rapidly. Compared with the traditional posterior approach with long and wide exposure, the minimally invasive approach offers significant advantages in treating patients with spine trauma.

[Management of compound high energy injuries of the limbs--lessons and recommendations].

We treated 49 patients with high energy injuries of the limbs between 1.1.94-31.12.97. They had sustained 61 fractures, 50 of which were open; 14 had bilateral injuries, and 3 had lost a limb. All fractures were stabilized on arrival with an A-O tubular external fixator. Soft tissue loss was covered by a combination of split skin graft and tissue flaps following repeated surgical debridement. After 10 days, or when all soft tissue defects were covered, the cantilever external fixation frame was exchanged for a hybrid ring which provided three-dimensional stability and allowed early full weight bearing and joint mobilization. The hybrid ring frame did not interfere with the care of soft tissue injuries. Furthermore, it kept the risk of developing deep infections to a bare minimum. At follow-up after a median of 20 months, 1 patient had developed osteomyelitis but all had returned to independent function.

Novel suicide ligands of tubulin arrest cancer cells in S-phase.

It is presently accepted that the mechanism of action for all anti-tumor tubulin ligands involves the perturbation of microtubule dynamics during the G2/M phase of cell division and subsequent entry into apoptosis [1]. In this report, we challenge the established dogma by describing a unique mechanism of action caused by a novel series of tubulin ligands, halogenated derivatives of acetamido benzoyl ethyl ester. We have developed a suicide ligand for tubulin, which covalently attaches to the target and shows potent cancericidal activity in tissue culture assays and in animal tumor models. These compounds target early S-phase at the G1/S transition rather than the G2/M phase and mitotic arrest. Bcl-2 phosphorylation, a marker of mitotic microtubule inhibition by other tubulin ligands was dramatically altered, phosphorylation was rapid and biphasic rather than a slow linear event. The halogenated ethyl ester series of derivatives thus constitute a unique set of tubulin ligands which induce a novel mechanism of apoptosis.

Synthesis, cancericidal and antimicrotubule activities of 3-(haloacetamido)-benzoylureas.

The four title compounds (not hitherto reported) were synthesized from 3-aminobenzoic acid through its trifluoroacetic acid-acid chloride derivative, reaction with urea and aminolytic deprotection to yield 3-aminobenzoylurea, followed by unconventional haloacetylation. Three key factors were found essential for antitumor activity: (i) the cytotoxic nature of the halogen: I > Br > Cl > F (ID90 0.014->10 microM); (ii) the position of the halogen: only the 3-position (meta) expressed relevant activity; and (iii) the presence of the urea group (1-position). The selectivity of the bromo and iodo compounds were higher than those of vinblastine and paclitaxel in terms of cytotoxicity (ID50 ratios in nonmalignant myocardial fibroblasts and CEM leukemia cells) and therapeutic indices (P338 leukemia bearing mice). Relevant mechanisms of bioactivity were mitotic arrest and apoptosis. Complete inhibition of microtubule assembly occurred in cell-free systems (at 2.8 versus 2.1 microM for vinblastine); in contrast to paclitaxel, the target compounds did not interfere with microtubule disassembly. The strong cancericidal and antimicrotubular activities of the bromine and iodine compounds justify further exploration of their potential in antineoplastic chemotherapy.

Synthesis of diacylamines and the preparation of alpha-amino-acylureas, a new type of alpha-amino acid derivatives.

Sixteen new and one known unsymmetrical open-chain diacylamines were synthesized by sodium methoxide catalyzed acylation of amides with carboxylic esters and acylamino-carboxylic esters, or acylureas with acylamino-carboxylic esters and alpha-amino acid esters.

Neurological deficit in a consecutive series of vertebral fracture patients with bony fragments within spinal canal.

The wide spread availability of computerized tomography has added a new dimension to the anatomical evaluation of vertebral fractures. This diagnostic modality has shown that in these fractures, the protrusion of bone spicules into the spinal canal is often encountered. The clinical significance of this finding and its relation to the need of establishing indications for surgery in these patients is controversial. The neurological outcome of patients with postraumatic bony encroachment of the spinal canal is not well documented in the literature, and therefore the adequate therapeutic approach is neither clear nor is it unanimous. Whether treatment should be aggressively surgical with decompression and/or segmental fusion, or conservative, the goal has to be prevention of secondary injury to the spinal cord. This presentation is a mean 4 year follow up study of 38 consecutive patients with spinal fractures and spinal canal narrowing, who were treated conservatively. The results demonstrate that the initial neurological findings have a very significant prognostic value for the neurological outcome, regardless of the spinal segment involved, the type of injury and spinal canal narrowing as demonstrated by computerized tomograms. We conclude that in trauma patients with vertebral fractures and spicules in the spinal canal without evidence of an initial neurological deficit, a favorable neurological prognosis can be predicted, following conservative management.

Surface stereophotogrammetry of thoracic kyphosis.

The thoracic kyphosis angles of 16 normal individuals, 10 patients with Scheuermann's disease and 11 with adolescent idiopathic scoliosis were measured both radiographically and from Integrated Shape Imaging System (ISIS) scans obtained by surface stereophotogrammetry. There was a high correlation between the two measures. The method of kyphosis measurement from ISIS scans was then used for 30 patients with adolescent idiopathic scoliosis who underwent corrective surgery. A significant reduction in thoracic kyphosis was observed postoperatively. In another group of 28 patients managed conservatively by bracing, some hypokyphosis developed after treatment. However, we found no association between hypokyphosis and curve progression.

Back shape in brace treatment of idiopathic scoliosis.

This preliminary study has shown that bracing may improve the cosmetic appearance of a scoliotic back although the underlying curve remains unchanged. Thirty-two patients treated with the Boston brace for adolescent idiopathic scoliosis were assessed both roentgenographically and by integrated shape imaging system scanning before and after treatment. The mean follow-up time was 16 months. Surface shape improved in 41% of the patients, whereas roentgenographic improvement occurred in only 9%. Roentgenographic measurements should, therefore, be considered in conjunction with corresponding surface shape measurements in the assessment of brace treatment of scoliosis.

Correction of body height in scoliotic patients using ISIS scanning.

Measurement of height in scoliotic patients is complicated by changes in spinal shape in both the coronal and sagittal planes. A method is described by which these changes can be measured and compared with the shape of the normal spine, using an automated stereophotogrammetric technique (ISIS). The resultant height change may be of use in the prediction of respiratory function.

Some observations on the use of computerised tomography in Legg-Calve-Perthes' disease.

The use of computerised tomography in the assessment of hip pathologies in children is an uncommonly used modality. To date, we were unable to find any definite work on the use of CAT scan investigations in LCPD. Ten children with Legg-Calve-Perthes' disease were reassessed by two-plane AP and lateral radiographs and by computerised tomography. The findings strongly suggest that computerised axial tomography is an important modality capable of providing more detailed information on the distorted anatomy, magnitude and severity of the disruptive process in the femoral head. This modality demonstrated the presence of fragmentation and cyst formation in the femoral head even if two-plane radiographs appeared to be normal.

ISIS scanning: a useful assessment technique in the management of scoliosis.

The value of surface topographical measurements in the assessment of curve progression in adolescent idiopathic scoliosis is demonstrated in a group of 51 patients. Cobb angles at the commencement of the study ranged from 10 degrees -55 degrees (mean 34.5 degrees), and the mean follow-up period was greater than 2 years. The surface shape method correctly identified curve evolution in 84% of the patient group. Of these, the eight patients who underwent spinal instrumentation were correctly predicted as candidates for surgery.

Scoliosis surgery and its effect on back shape.

Thirty-four patients with adolescent idiopathic scoliosis were assessed by radiography and the integrated shape imaging system (ISIS) both before and after spinal surgery. Twenty-seven patients underwent Harrington instrumentation, after which lateral indices of curvature were significantly improved, but changes in the transverse plane were less pronounced. Sublaminar wiring was carried out in two patients whose thoracic lordosis was corrected by the surgery. Five patients whose severe deformity had persisted after previous spinal surgery underwent costoplasty, which resulted in a significant improvement in back shape measurements. We conclude that the cosmetic deformity of the back in scoliosis is only partially corrected by operations on the spine itself, whilst costoplasty addresses the problem directly, and improves the surface shape.

[Spondyloepiphyseal dysplasia tarda: bilateral total arthroplasty of the hip]. / Dysplasie spondylo-épiphysaire tardive: arthroplastie totale bilatérale de hanche.

A brother and sister with spondylo-epiphyseal dysplasia tarda developed severe premature osteoarthritis of the hips and were treated with bilateral hip replacement in young adult life. The clinical results are good and the radiographic evaluation showed no evidence of loosening at a mean follow-up of five years.