Review of clinical trials of neuroprotection in acute spinal cord injury.

In this paper the authors review the clinical trials of neuroprotection that have been performed for the treatment of acute spinal cord injury (SCI). The biological rationale for the selection of each treatment modality is discussed with reference to current knowledge of the principles in the management of acute SCI as well as the primary and secondary injury mechanisms identified by experimental and clinical studies of the pathophysiology of acute SCI. The trials are evaluated with regard to the availability and use of accurate clinical outcome measures, and the methodologies of the trials are critically evaluated with an emphasis on prospective randomized controlled studies.

Living donor nephrectomy: follow-up renal function, blood pressure, and urine protein excretion.

PURPOSE: To assess the effect of donor nephrectomy on blood pressure, 24-hour urine protein excretion, and renal function. MATERIALS AND METHODS: Of the 198 individuals who donated a kidney between 1991-1996, 101 had their blood pressure, 24-hour urine protein excretion, and serum creatinine concentration levels measured. The mean duration of follow-up was 3.

Psychosocial impact of renal donation.

PURPOSE: To determine the psychosocial effects of donor nephrectomy on a sample of Canadian donors. MATERIALS AND METHODS: Patients donating one of their kidneys for transplantation at the Toronto Hospital between 1991-1996 were asked to complete a 170-item questionnaire designed to assess their psychosocial well-being and the impact of renal donation on various aspects of their lives. Of the 153 donors contacted, 104 (68.

Recurrence of hyperparathyroidism after total parathyroidectomy and autotransplantation in peritoneal dialysis patients.

Objective: To evaluate the effectiveness of total parathyroidectomy (PTX) with autotransplantation in the treatment of secondary hyperparathyroidism (HPT), and to assess recurrence rate of HPT in this peritoneal dialysis (PD) population.

Design: A retrospective study in a single home PD unit.

Patients: Between 1994 and 1998, 19 of 574 patients on PD underwent PTX for treatment of secondary HPT.

Endoscopic bursal resection: the olecranon bursa and prepatellar bursa.

We treated 31 cases of olecranon bursitis and 19 cases of prepatellar bursitis. The average duration of symptoms before surgery was 1.1 years with a range of 3 months to 4 years.

Differences in quality of life across renal replacement therapies: a meta-analytic comparison.

A meta-analysis compared emotional distress and psychological well-being across renal replacement therapies (RRTs) and examined whether differences could be explained by: (1) treatment modalities, (2) case mix, or (3) methodologic rigor. Standard meta-analytic procedures were used to evaluate published comparative studies. Successful renal transplantation was associated with: (1) lower distress (effect size, d = -0.

Prospective audit of cytomegalovirus-negative blood product utilization in haematology/oncology patients.

The transfusion management of immunocompromised patients often requires special blood product use such as cytomegalovirus (CMV)-negative cellular products, which are more costly than standard blood products and occasionally in short supply. We audited the use of CMV-negative products in haematology/oncology patients to determine the appropriateness of their use. A concurrent-prospective audit was conducted of all orders for CMV-negative packed red blood cell (PRBC) and platelet products in 201 haematology/ oncology patients.

Entamoeba histolytica and Entamoeba dispar: epidemiology and comparison of diagnostic methods in a setting of nonendemicity.

Recent studies suggest that stool antigen assays are more sensitive and specific than microscopy for the diagnosis of Entamoeba histolytica infection. One hundred twelve patients presenting at 3 centers with symptoms or risk factors of E. histolytica infection were prospectively enrolled in this study to evaluate new diagnostic tests for infections with E.

Aortic valve replacement with stentless porcine bioprostheses.

The implantation of stentless porcine valves (SPVs) is technically more demanding than implantation of stented bioprosthetic valves. Implantation of the Toronto SPV bioprosthesis requires an,understanding of the relationships between the leaflets and the aortic annulus and sinotubular junction. In addition to proper alignment of the three commissures within the aortic root, the diameter of sinotubular junction should not exceed the external diameter of the porcine aortic valve after completion of the operation.

Preoperative endoscopic retrograde cholangiopancreatography (ERCP) is not necessary in mild gallstone pancreatitis.

Background: The role of preoperative endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis is unclear. Therefore, we designed a study to establish whether ERCP is indicated in these cases.

Method: We studied 55 patients who had been admitted with gallstone pancreatitis.

An evidence-based review of decompressive surgery in acute spinal cord injury: rationale, indications, and timing based on experimental and clinical studies.

Object: The authors conducted an evidence-based review of the literature to evaluate critically the rationale and indications for and the timing of decompressive surgery for the treatment of acute, nonpenetrating spinal cord injury (SCI).

Methods: The experimental and clinical literature concerning the role of, and the biological rationale for, surgical decompression for acute SCI was reviewed. Clinical studies of nonoperative management of SCI were also examined for comparative purposes.

Somatic PKD2 mutations in individual kidney and liver cysts support a "two-hit" model of cystogenesis in type 2 autosomal dominant polycystic kidney disease.

An intriguing feature of autosomal dominant polycystic kidney disease (ADPKD) is the focal and sporadic formation of renal and extrarenal cysts. Recent documentation of somatic PKD1 mutations in cystic epithelia of patients with germ-line PKD1 mutations suggests a "two-hit" model for cystogenesis in type 1 ADPKD. This study tests whether the same mechanism for cystogenesis might also occur in type 2 ADPKD.

Brain perfusion imaging in asymptomatic patients receiving cyclosporin.

Background And Purpose: Cyclosporin has neurotoxic effects in a significant number of transplant patients that are associated with characteristic findings on MR images. Focal abnormalities in cerebral perfusion have been implicated in the pathophysiology of cyclosporin neurotoxicity. In the clinically asymptomatic patient, however, it is not known whether any imaging evidence of cyclosporin's effect on the brain is demonstrable.

What is the relevance of apoptosis to the myocardium?

Direct and indirect evidence from a number of studies demonstrates that apoptosis is an important process in heart failure in humans. It is thought that a proapoptotic shift in conditions occurs during heart failure, involving the entire population of cardiac myocytes. A complex mechanism of programmed cell death has been postulated, involving such factors as Fas, Bax and Bcl-2; tumour necrosis may also play a role.

Hypertonic immunomodulation is reversible and accompanied by changes in CD11b expression.

Background: In a two-hit model of hemorrhagic shock and lipopolysaccharide (LPS), we previously showed that hypertonic saline (HTS) resuscitation reduced lung sequestration of neutrophils and the accompanying injury. This effect was partially attributed to suppressed expression of the surface adhesion molecule CD11b. This study investigates the duration of this protective effect after a single HTS dose and the usefulness of repeated infusions.

Neoadjuvant hormonal therapy in carcinoma of the prostate.

The rising incidence of and mortality from prostate cancer has generated great interest in improving the results of current methods of treatment. It is well-established that large tumour volumes and positive surgical margins are correlated with higher rates of local failure and distant metastasis. Significant decreases in both tumour volume and the rates of positive surgical margins are seen with NHT.

Practical implications of cyclooxygenase-2--specific inhibitors in orthopedics.

Nonsteroidal anti-inflammatory drugs (NSAIDs) lead to severe and unpredictable side effects that are costly for individuals and the economy overall. As baby boomers enter their osteoarthritis years, there will be an increasing demand for safe and effective arthritis therapies. Animal and human data suggest that celecoxib, a cyclooxygenase-2-specific inhibitor, will provide an efficacious treatment without the side effects of conventional NSAIDs.

Morphologic findings in explanted Hancock II porcine bioprostheses.

Background And Aim Of The Study: Heart valve substitutes have been in use for over 30 years. Bioprosthetic heart valves have many advantages, but unfortunately suffer tissue degeneration and calcification. Many approaches, such as antimineralization treatment to prevent or delay these changes, have been tried.

Cell shrinkage regulates Src kinases and induces tyrosine phosphorylation of cortactin, independent of the osmotic regulation of Na+/H+ exchangers.

The signaling pathways by which cell volume regulates ion transporters, e.g. Na+/H+ exchangers (NHEs), and affects cytoskeletal organization are poorly understood.

Nystatin prophylaxis: its inability to prevent fungal peritonitis in patients on continuous ambulatory peritoneal dialysis.

Objective: To evaluate the potential effectiveness of nystatin as prophylaxis for fungal peritonitis (FP) in patients on continuous ambulatory peritoneal dialysis (CAPD).

Design: This historically controlled study was designed to investigate the effectiveness of nystatin in the prevention of FP. For this purpose we compared the incidence of FP among 240 (new and prevalent) CAPD patients between January 1996 and November 1996 (period A) with its incidence in 240 new and prevalent CAPD patients in our program between January 1997 and November 1997 (period B) when nystatin prophylaxis was used.

The futility of pretransplant coronary bypass grafting in asymptomatic patients on peritoneal dialysis.

Objective: To evaluate the validity of recommending coronary artery bypass grafting (CABG) in preparation for renal transplantation in asymptomatic peritoneal dialysis (PD) patients with evidence of reversible myocardial ischemia.

Design: Retrospective review in a single PD unit.

Participants: Ten asymptomatic PD patients who underwent CABG to be placed on the transplant list comprised the study group.

Bioavailability of oral ciprofloxacin in early postsurgical patients.

Objective: To evaluate the absorption of oral ciprofloxacin within 24 hours of laparotomy for major elective surgery or peritonitis.

Design: In this prospective trial, patients were given a 750-mg oral close the morning after major elective surgery (n=15) or surgery for peritonitis (n=7). Healthy volunteers served as controls (n=9).

Angiogenesis correlates with vascular endothelial growth factor expression but not with Ki-ras oncogene activation in non-small cell lung carcinoma.

A total of 195 non-small cell lung carcinoma (NSCLC) specimens were studied for the presence of mutations in their ras family genes, for tumor vascularity, and for their immunostaining pattern with an antibody to vascular endothelial growth factor (VEGF). ras mutation was found in 37 of 104 (34.6%) adenocarcinoma specimens, in 0 of 64 squamous cell carcinomas, and in 2 of 27 (7.

Effects of viral hemorrhagic fever inactivation methods on the performance of rapid diagnostic tests for Plasmodium falciparum.

Blood samples from patients with viral hemorrhagic fever (VHF) pose a serious risk to laboratory workers. Current contingency plans for VHF samples recommend the use of heat, gamma-irradiation, or Triton X-100 to inactivate samples before handling. Malaria is the most important alternative diagnosis to be excluded in cases of suspected VHF.

Decrease in Staphylococcus aureus exit-site infections and peritonitis in CAPD patients by local application of mupirocin ointment at the catheter exit site.

Objective: To evaluate the potential effectiveness of the application of mupirocin ointment at the catheter exit site in preventing exit-site infection and peritonitis caused by Staphylococcus aureus (SA).

Design: This prospective, historically controlled study was done on 181 peritoneal dialysis patients treated between 1 November 1996 and 1 November 1997. They were instructed to apply mupirocin at the catheter exit site daily or three times per week at the conclusion of their exit-site care (Study 1).