Anterior Vertebral Body Tethering for Adolescent Scoliosis with Growth Remaining: A Retrospective Review of 2 to 5-Year Postoperative Results.

Background: Anterior vertebral body tethering (VBT) is an early treatment option for progressive scoliosis in pediatric patients, allowing for continued deformity correction during normal growth. We report postoperative radiographic and clinical outcomes for patients treated with VBT.

Methods: This clinical and radiographic retrospective review of 31 consecutive patients included an analysis of preoperative, perioperative, and postoperative details, including the Lenke classification; Cobb angle measurements of the proximal thoracic, main thoracic, and lumbar curves; the sagittal profile; and skeletal maturity.

Lupus Nephritis: A Treatment Update.

Background: Lupus nephritis (LN) is a common complication in many patients with systemic lupus erythematosus, although renal-limited lupus nephritis has been reported as well. Early diagnosis of lupus nephritis is critical as early detection and effective treatment can improve renal outcomes in such patients.

Objective: The treatment of lupus nephritis is largely determined based on the histological class present on the renal biopsy specimen.

Life threatening nutritional deficiencies in a dialysis patient.

Nutritional deficiencies are very common among the patient on chronic hemodialysis. But they can be easily overlooked or misdiagnosed. Deficiencies of trace elements and phosphorous is rare among this patient population but if neglected can lead to catastrophic effects.

Peritoneal Dialysis in Patients with Abdominal Surgeries and Abdominal Complications.

Peritoneal dialysis (PD) is an excellent treatment option for the patients with end-stage renal disease, having been shown to yield improved patient satisfaction and economic benefit. Many surgeons and physicians believe that patients with prior abdominal surgeries or other abdominal complications are not viable candidates for PD and that prevalent PD patients needing abdominal surgery should be switched to hemodialysis. The purpose of the present review is to address those misconceptions.

The Triad of Sleep Apnea, Hypertension, and Chronic Kidney Disease: A Spectrum of Common Pathology.

Obstructive sleep apnea (OSA), hypertension, and chronic kidney disease (CKD) are different entities and are generally managed individually most of the time. However, CKD, OSA, and hypertension share many common risk factors and it is not uncommon to see this complex triad together. In fact, they share similar pathophysiology and have been interlinked with each other.

Apixaban in Venous Thromboembolism in an Era of New Oral Anticoagulants.

Several new oral anticoagulants (NOAC) have been recently studied and approved for the prevention and treatment of venous thromboembolism (VTE) which includes deep vein thrombosis and pulmonary embolism. Although, NOACs possess several advantages when compared to traditional therapy each has its own limitations; especially in the elderly and in patients with low body weight, renal impairment and in those with high risk of bleeding. Apixaban is a factor Xa inhibitor recently approved for the treatment and prevention of VTE in the United States.

Lipid abnormalities in kidney disease and management strategies.

Patients with kidney diseases continue to experience significant cardiovascular disease (CVD) morbidity and mortality. Although there are many important risk factors playing a role in the pathogenesis of CVD in chronic kidney disease (CKD) patients, dyslipidemia (elevated triglycerides, elevated oxidized low-density lipoprotein and low/dysfunctional low high-density) represents one of the modifiable risk factors. Renal failure patients have unique lipid abnormalities which not only have complex role in pathogenesis of CVD but also cause relative resistance to usual interventions.

Sweet syndrome associated with furosemide.

This case report describes a case of Sweet syndrome (SS) related to use of furosemide in a 46-year-old female who was admitted for treatment of congestive heart failure. Three days after administration of furosemide, the patient had a fever and a skin eruption appeared on her wrists, forearms, and legs. Biopsy of the skin lesion was consistent with SS.

Role of protein kinase C and phosphatases in the pulmonary vasculature of neonatal piglets.

Objective: Persistent pulmonary hypertension of the newborn is characterized by the presence of intense vasoconstriction and vascular remodeling. Protein tyrosine phosphorylation has been recognized as a critical regulatory element in signal transduction, because it is dynamically regulated by the opposing actions of protein tyrosine kinases and protein tyrosine phosphatases. The objectives of this study were to investigate the role of protein kinase C and phosphatases in the neonatal pulmonary vasculature of normoxic and chronically hypoxic piglets.

Intraoperative radiolymphoscintigraphy for detection of occult nodal metastasis in patients with head and neck squamous cell carcinoma.

Objectives: We sought to determine the feasibility and utility of intraoperative radiolymphoscintigraphy as a screening procedure for the detection of occult metastatic disease in selected cases of head and neck squamous cell carcinoma (HNSCC).

Methods: Patients with accessible primary HNSCC and no evidence of metastatic disease who were already undergoing planned surgical resection of the primary tumor and elective neck dissection met the inclusion criteria. Before resection, a hand-held gamma probe was used to find the radiolabeled sentinel lymph node (SLN).

Early angioplasty in patients with acute myocardial infarction complicated by hypotension.

Emergency percutaneous transluminal coronary angioplasty was performed in 62 patients with acute myocardial infarction complicated by hypotension. All patients were treated within 12 hours of the onset of chest pain. Angioplasty was completely successful (residual lesion less than or equal to 50%) in 48 patients, partially successful (patent vessel greater than 50% residual lesion) in four patients, and unsuccessful in 10 patients.

The effect of muscle-sparing versus standard posterolateral thoracotomy on pulmonary function, muscle strength, and postoperative pain.

Increased interest in alternative approaches to thoracotomy has developed because of the considerable morbidity associated with the standard posterolateral technique. We conducted a prospective, randomized, blinded study of 50 consecutive patients to compare postoperative pain, pulmonary function, shoulder strength, and range of shoulder motion between the standard posterolateral and the muscle sparing thoracotomy techniques. Pulmonary function (forced expiratory volume in 1 second and forced vital capacity), shoulder strength, and range of motion were measured preoperatively and at 1 week and 1 month postoperatively.

Cost effectiveness and accuracy of renal scans in the management of patients undergoing renal transplantation.

Following renal allograft transplantation, renal scans are frequently performed to evaluate anatomical and functional causes for allograft dysfunction. In our retrospective study of 20 patients, renal scans were found to be more expensive compared to renal biopsies $68,688 vs $7,421, and, in only one patient was aggressive anti-rejection therapy instituted based solely on the renal scan results. The 95% confidence interval for the proportion of correct diagnosis by renal scan was 0.

Plasma levels of atrial natriuretic factor in nonhibernating and hibernating marmots.

Plasma atrial natriuretic factor (ANF) was measured in 16 marmots at various times of the year. Nonhibernating males (n = 6) had an average plasma concentration of 56 +/- 8 pg/ml; nonhibernating females (n = 6) had an average plasma concentration of 61 +/- 4 pg/ml. During hibernation an additional group of females (n = 4) showed an average of 25 +/- 5 pg/ml.

Primary carcinoma of the gallbladder: TNM staging and prognosis.

In order to investigate the lethality of carcinoma of the gallbladder and several of the coexisting features, a retrospective analysis of 53 patients with this disease was undertaken. Abdominal pain, obstructive jaundice, and a right upper quandrant mass were present in approximately one-half of the patients. Laboratory and radiological data were frequently nonspecific and did little to identify the diagnosis.

Effect of increasing intraabdominal pressure and volume on left ventricular function in continuous ambulatory peritoneal dialysis (CAPD).

To determine the effect of increasing intraabdominal pressure on left ventricular (LV) systolic function in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), we studied 15 patients who had been on CAPD for at least 2 months. The study protocol included measurement of echocardiographic LV internal dimensions in diastole and systole, LV wall thickness and mass, LV ejection time, the mean velocity of circumferential fiber shortening (mean Vcf), heart rate, BP, and intraabdominal pressure. Measurements were obtained at baseline (OL) and following intraperitoneal infusion of 1-L increments of dialysate solution (up to 4 L) in both the recumbent and standing positions.

Bone mineral content in term infants fed human milk, cow milk-based formula, or soy-based formula.

Bone mineral content (BMC) of the midportion of the humerus was measured with the Norland model 278 bone densitometer in 31 term infants fed human milk (9 inants), cow milk-based formula (11 infants), or soy protein-based formula (11 infants) over the first year of life. Serum and urine minerals, vitamin D, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D were measured to ensure that intake of minerals and vitamin D was not limiting. Mineralization was similar in all three groups.

Effects of anesthetics on cardiovascular responses of the marmot Marmota flaviventris.

The effects of pentobarbital (30 mg/kg), urethan (2 g/kg), chloralose/urethan (50 mg/kg, 500 mg/kg), and thiobutabarbital (Inactin, 100 mg/kg) on the mean arterial pressure (BP) and heart period (HP) of Marmota flaviventris were examined. Anesthesia significantly decreased BP by 22-27 mm Hg and HP by 123-151 msec. In a series of paired studies with eight marmots it was found that pentobarbital increased the BP response to phenylephrine and almost abolished the baroreflex HP responses to phenylephrine and nitroglycerin.

Secondary and metastatic tumors of the orbit.

We have presented three cases of metastatic tumor to the orbit. The first case illustrated metastatic tumor that originated from a cutaneous basosquamous cell carcinoma. This lesion, first reported by MacCormac as being morphologically intermediate between basal and squamous cell carcinoma, has become a topic of some controversy.