The effect of surgically implanted metallic bullet fragments on the intervertebral disc using a canine model☆.

Purpose: To characterize the gross, histologic, and systemic changes caused by implantation of metal fragments commonly used in commercial bullets into the intervertebral disc.

Background Context: Long-term complications of retained bullet fragments in the spine have been documented in the literature; however, the impact of different metal projectiles on the intervertebral disc has not been described. This study was performed to assess the local effects of the metallic bullet fragments on the intervertebral disc and their systemic effects regarding metal ion concentrations in serum and solid organs.

Hypothermia in patients with chronic spinal cord injury.

Design: Retrospective analysis of medical records.

Background/objectives: To determine frequency and degree of hypothermic episodes in patients with chronic spinal cord injury (SCI).

Setting: Veterans Administration Medical Center.

Thromboprophylaxis in medical and surgical patients undergoing physical medicine and rehabilitation: consensus recommendations.

Venous thromboembolism (deep venous thrombosis with or without its major complication, pulmonary embolism) commonly occurs in patients undergoing rehabilitative therapy for various surgical or traumatic conditions and in patients with incapacitating medical illnesses. Thromboprophylaxis utilizes medications that interfere with the coagulation process and mechanical measures such as graded elastic stockings and intermittent pneumatic compression. To obtain a range of expert opinion on the optimal use of the numerous antithrombotic modalities now available, a consortium comprising clinical directors at a number of rehabilitative centers in south Florida met to review the literature on thromboprophylaxis in rehabilitation patients and to discuss the strategies followed at their respective facilities.

C-reactive protein and erythrocyte sedimentation rate in patients with heterotopic ossification after spinal cord injury.

Background/objective: Formation of heterotopic ossification (HO) in soft tissue after spinal cord injury (SCI) is associated with various degrees of inflammation. Recent studies have shown that inhibition of inflammatory reaction with nonsteroidal anti-inflammatory drugs is an effective prevention of HO after SCI. The goal of this study was to monitor the activity of the most widely used indicators of acute inflammation--namely, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)--in patients with HO.

Prevention and treatment of heterotopic ossification after spinal cord injury.

Background/objectives: Heterotopic ossification (HO) is a frequent, irreversible complication after spinal cord injury (SCI). The objective of this article is to explain the etiology of HO; present new advances in prevention, diagnosis, and management of this complication; and provide a suggested algorithm for clinical management.

Etiology: Although still hypothetical, trauma and overexpression of bone morphogenic protein(s) in traumatized soft tissue appear to play important roles as initiating factors of HO.

Antifungal penetration into normal rabbit nucleus pulposus.

Study Design: A rabbit model was used to assess the penetration into the nucleus pulposus of 3 commonly used antifungal medications: amphotericin B, amphotericin B lipid complex, and fluconazole.

Objectives: The purpose of this study was to quantitate the penetration of antifungal medications into the normal rabbit nucleus pulposus.

Summary Of Background Data: Fungal infections of the spine are rarely, if ever, treated with medical management alone.

Prevention of heterotopic ossification after spinal cord injury with COX-2 selective inhibitor (rofecoxib).

Study Design: A randomized, prospective, double-blind, placebo-controlled clinical trial.

Objectives: To determine the effect of COX-2-selective inhibitor on the prevention of heterotopic ossification (HO) after spinal cord injury (SCI).

Setting: County and University Teaching Hospital, Miami, FL, USA.

The value of serum creatine kinase in early diagnosis of heterotopic ossification.

Background: Heterotopic ossification (HO) is a complication of spinal cord injury (SCI) characterized by formation of ectopic bone. Early diagnosis is critical, but available diagnostic methods have drawbacks. Serum creatine kinase may be a marker for the development and severity of HO.

Prevention of heterotopic ossification after spinal cord injury with indomethacin.

Study Design: A randomized, prospective, double-blind, placebo-controlled clinical trial.

Objectives: To determine the effect of indomethacin on the prevention of heterotopic ossification (HO) following spinal cord injury (SCI).

Setting: County Hospital, Miami, Florida, USA.

Triiodothyronine stimulates the release of membrane-bound alkaline phosphatase in osteoblastic cells.

Thyroid hormone deficient osteoblastic cells in cell culture released a significantly higher amount of alkaline phosphate (ALP) activity following T3 replacement. T3 increased the release of total and membrane-bound ALP activity in these cells significantly more than T4 or inactive thyroid hormone metabolite, DIT. The effect of T3 on the membrane-bound ALP fraction was dose and time dependent; higher concentrations of T3 and longer incubation time with T3 proportionally increased the enzyme activity.

The effect of etidronate on late development of heterotopic ossification after spinal cord injury.

Forty patients with spinal cord injury (SCI) and heterotopic ossification (HO) were treated with etidronate and followed after therapy to determine the effects of long-term medication on heterotopic bone formation. Eighteen patients had tetraplegia and 22 had paraplegia. Early diagnosis of HO (positive bone scintigraphy and negative radiographic findings of HO) was established by 3-phase bone scintigraphy using 99m technetium-labeled methylene diphosphonate.

A study comparing sterile and nonsterile urethral catheterization in patients with spinal cord injury.

This study was designed to determine the effect of sterile and nonsterile intermittent catheterization on the incidence of urinary tract infection (UTI) in patients after spinal cord injury. The study included 29 patients with neurogenic bladder dysfunction treated with intermittent catheterization. One group of 14 patients was on sterile catheterization; another group of 15 patients was on nonsterile catheterization.

Evaluation and management of heterotopic ossification in patients with spinal cord injury.

Sixty-three patients with paralysis secondary to spinal cord injury (SCI) were screened for heterotopic ossification (HO) by bone scintigraphy 27 +/- 14 (mean +/- SD) days after SCI. There were four female and 59 male patients, 36 had paraplegia and 27 tetraplegia. The age of patients was 28 +/- 9 years.

Treatment of heterotopic ossification after spinal cord injury.

A new protocol in management of heterotopic ossification (HO) was evaluated in 46 patients after spinal cord injury (SCI). A group of 24 paraplegic and 22 tetraplegic patients was involved in a prospective study. Diagnosis of HO was made by bone scintigraphy and radiographic evaluation.

Interaction of cultured rat osteoblasts with 8-methoxypsoralen during irradiation with long-wave ultraviolet light.

Rat osteoblasts in monolayer cell cultures have been irradiated with long-wave ultraviolet light (UVA) in the presence and without 8-methoxypsoralen (8-MOP). In the absence of 8-MOP, the exposures to UVA (3 x 10(-3)W.cm-2) for up to 30 min have not affected cellular viability, the rate of 14C-acetate incorporation, and alkaline phosphatase (AP) activity.

Fracture healing and mast cells.

We analyzed the morphology and localization of mast cells during the course of fracture repair in control rats and in animals with delayed healing of fractures induced by nonsteroidal antiinflammatory drugs (NSAIDs). In the first 2 weeks of fracture healing in control animals, mast cells were found either in the vicinity of blood vessels or in the vascularized tissue proliferating into the cartilaginous portion of subperiosteal callus. In the later stages (6-8 weeks), mast cells were seen in loose connective tissue in bone marrow surrounded with translucent ground substance.

Effect of nonsteroidal antiinflammatory drugs on fracture healing: a laboratory study in rats.

We studied the effects of two nonsteroidal antiinflammatory drugs (NSAIDs) on fracture healing in rats: ibuprofen (30 mg/kg/day) and indomethacin (1 mg/kg/day). Femoral fractures were induced via a three-point bending technique. NSAIDs were administered orally for 4 or 12 weeks.

Increased muscle strength in paralyzed patients after spinal cord injury: effect of beta-2 adrenergic agonist.

The administration of beta-2 adrenergic agonists in experimental animals result in an increased strength of skeletal muscle. In this study, we evaluated whether a beta-2 adrenergic agonist, metaproterenol, had an effect on muscle size and strength in a group of patients with muscular atrophy following spinal cord injury. Ten male subjects were randomly divided into 2 groups and agreed to participate in a prospective, double-blind, placebo-controlled, and crossover study.

Tissue distribution of antibiotics in the intervertebral disc.

Study Design: This study analyzed the distribution of antibiotics within the intervertebral disc of rabbits. Specimens were tested with specific antibodies against antibiotics using an immunofluorescent technique.

Objectives: The results were correlated to provide a rationale for perioperative prophylaxis of infection.

Gentamicin penetration into normal rabbit nucleus pulposus.

Study Design: Radioactively labeled gentamicin was administered to 24 rabbits to assess the concentration of antibiotic in the nucleus pulposus.

Objectives: The purpose of the study was to investigate the pharmacokinetics of gentamicin penetration into normal rabbit nucleus pulposus.

Summary Of Background Data: Disc space infection is a complication of spinal surgery that can be prevented by prophylactic antibiotics.

Evaluation of serum osteoblast mitogenic activity in spinal cord and head injury patients with acute heterotopic ossification.

Study Design: This was a blind, prospective study of the effect of sera from patients with spinal cord and head injuries on osteoblast proliferation.

Objectives: The authors studied whether a humoral factor that stimulates the formation of heterotopic bone is released into the circulation after a neural injury.

Background Data: Other authors have shown that a humoral osteoinductive factor may be released after head and spinal cord injuries.

Morphologic and metabolic changes in rat osteoblast cultures during the dark reaction with 8-methoxypsoralen.

The dark reaction of 8-methoxypsoralen (8-MOP) with cultured rat osteoblasts did not cause significant changes in cellular replication rates or in the synthesis of RNA and proteins. Microscopic examination, however, revealed that the dark reaction resulted in massive accumulation of perinuclear lipids and in the statistically significant enhancement of alkaline phosphatase activity. A sharp, and statistically significant, upsurge of lipid synthesis in osteoblasts preceded microscopically detectable accumulation of lipids and occurred only during the initial, but not during the subsequent stages of the dark reaction.

Penetration of glycopeptide antibiotics in nucleus pulposus.

The penetration of the glycopeptide antibiotics vancomycin and teicoplanin into the nucleus pulposus of rabbits was studied. Blood samples were obtained at 0.5, 1, 4, 8, and 24 hours after intravenous administration of 30 mg/kg vancomycin or 16 mg/kg teicoplanin.

Intravenous disodium etidronate therapy in spinal cord injury patients with heterotopic ossification.

The goal of the present study was to use intravenous etidronate in the acute phase of heterotopic ossification (HO) in an attempt to achieve a high initial drug concentration at the site of the active ectopic ossification. The study included 27 consecutive patients with an acute onset of HO after spinal cord injury (SCI). The three-phase bone scan was used to confirm clinical diagnosis of HO.

Interaction of osteoblasts with extracellular matrix: effect of mast cell chymase.

We studied the effect of mast cell chymase on the interaction between osteoblasts and extracellular matrix. Chymase was purified from mast cell lysate by anion exchange chromatography. Osteoblasts were isolated from rat calvarias by collagenase digestion.