Syndromic approach to Parkinson's disease: role of functional imaging.

Current evidence from monogenic Parkinson's disease (PD) supports the view that PD is a clinical syndrome, rather than a single disease entity, and that the heterogeneity of PD indeed reflects different pathogenesis. Recent developments in functional imaging have enabled the in vivo assessment of cellular and molecular pathology of PD with respect to temporal and topographical patterns. We propose that this new technology will be useful for linking monogenic and sporadic PD, and thus, for classifying PD based on the pathogenesis.

Clinical experience and applications of drug-eluting stents in the noncoronary vasculature, bile duct and esophagus.

Objective: To review the use of drug-eluting stents outside the coronary artery.

Findings: The vast majority of research and clinical data on drug-eluting stents are from their use in coronary artery atherosclerosis; however, these devices can be used outside the coronary circulation in both vascular and nonvascular structures. In noncoronary arteries the principle indication for drug-eluting vascular stents is the same as in the coronary circulation, prevention of restenosis.

En bloc marginal excision of a multilevel cervical chordoma. Case report.

The purpose of this case report is to demonstrate that an en bloc resection with negative surgical margins can be successfully achieved in a case of a seemingly unresectable C-2 chordoma if appropriate preoperative staging and planning are performed. The management of chordomas is controversial and challenging because of their location and often large size at presentation. Because chordomas are malignant and will aggressively recur locally if intralesional resection is conducted, wide or true en bloc resection is generally recommended.

Comparison of operative and nonoperative treatment for thoracolumbar burst fractures in patients without neurological deficit: a systematic review.

Object: Despite extensive published research on thoracolumbar burst fractures, controversy still surrounds which is the most appropriate treatment. The objective of this study was to evaluate the scientific literature on operative and nonoperative treatment of patients with thoracolumbar burst fractures and no neurological deficit.

Methods: In their search of the literature, the authors identified all possible relevant studies concerning thoracolumbar burst fracture without neurological deficit.

Changing face of spine trauma care in North America.

Study Design: An evidence-based review and summary of literature from multiple disciplines involved in spine trauma.

Objectives: To outline epidemiologic, clinical, and research issues influencing spine trauma in a longitudinal perspective. In addition, to provide guidance to clinicians and researchers to ensure that philosophies pertaining to the betterment of spine trauma care are understood and supported.

Intrahepatic cholangiocarcinoma presenting as the Budd-Chiari syndrome: a case report and literature review.

Intrahepatic cholangiocarcinoma, an increasingly recognized primary tumour of the liver, is associated with a very poor prognosis. A patient with this tumour who presented with Budd-Chiari syndrome (the first to the authors' knowledge in Western literature and only the third patient overall) secondary to extensive thrombosis in his inferior vena cava extending from the right atrium down to his iliac vessels is described. Neither curative nor palliative intervention was deemed to be an option in this patient, who deteriorated rapidly while on anti-coagulants.

Motor recovery, functional status, and health-related quality of life in patients with complete spinal cord injuries.

Study Design: A retrospective cohort with cross- sectional follow-up.

Objectives: The primary objective was to determine motor recovery in patients with complete traumatic spinal cord injury (SCI). Secondary objectives included: 1) determining which factors predict local recovery, 2) assessing functional status using the Functional Independence Measure (FIM), and 3) assessing generic health-related quality of life using the Short Form-36 (SF-36).

The surgical management of primary tumorsof the spine: initial results of an ongoing prospective cohort study.

Study Design: Prospective cohort study.

Objectives: To prospectively validate the application of appendicular surgical oncology principles to the treatment of primary bone tumors of the spine at a quaternary care spine center using local recurrence, survival, and health-related quality of life as outcome measures.

Summary Of Background Data: There is clear evidence that violating the margins of a sarcoma or other malignancy during surgical resection will risk local recurrence and diminish overall survival.

Disorders of the small airways: high-resolution computed tomographic features.

Several infectious and noninfectious processes may affect predominantly or exclusively the small airways and result in reversible or irreversible abnormalities. Small-airway diseases can be considered as synonymous with bronchiolitis and can be classified into three main categories: (a) obliterative (constrictive) bronchiolitis, (b) cellular bronchiolitis, and (c) respiratory bronchiolitis. The introduction of high-resolution computed tomography (HRCT) has led to a considerable improvement in our ability to diagnose small-airway diseases.

Venovenostomy for outflow venous obstruction in patients with upper extremity autogenous hemodialysis arteriovenous access.

Outflow venous obstruction is a common problem in patients with autogenous upper extremity hemodialysis access. Surgical revision to divert blood flow into the patent vein is sometimes possible to restore unobstructed flow. The result of this type of procedure is not yet well known.

Pulmonary candidiasis after hematopoietic stem cell transplantation: thin-section CT findings.

Purpose: To retrospectively evaluate thin-section computed tomographic (CT) findings in hematopoietic stem cell transplant (ie, bone marrow transplant) patients with histopathologically proved pulmonary candidiasis.

Materials And Methods: Ethical approval was obtained from the institutional review board of each of the three institutions; informed consent was not required. The study included 17 hematopoietic stem cell transplant recipients with proved pulmonary candidiasis.

Willingness to pay to assess patient preferences for therapy in a Canadian setting.

Background: Adult outpatient parenteral antibiotic therapy (OPAT) programs have been reported in the literature for over 20 years, however there are no published reports quantifying preference for treatment location of patients referred to an OPAT program. The purpose of this study was to elicit treatment location preferences and willingness to pay (WTP) from patients referred to an OPAT program.

Methods: A multidisciplinary, single centre, prospective study at a 1000-bed Canadian adult tertiary care teaching hospital.

Predictive value of lymph node and tumor matrix metalloproteinase expression in the analysis of metastatic periampullary tumors.

Background And Objectives: Matrix metalloproteinases (MMP) are endogenous peptidases capable of degrading various components of the basement membrane. The ability of malignant epithelial cells to degrade extracellular matrix and basement membrane is an important step in the process of metastatic invasion. In this study, we prospectively compared the outcome of patients undergoing laparotomy for resection of periampullary malignancies with lymph node and tumor MMP expression to determine if there was a correlation between metalloproteinase expression and patient outcome.

A case of congenital cutis laxa (generalized elastolysis).

Cutis laxa (generalized elastolysis) is characterized by sagging folds of loose skin on the face and trunk. Although grouped with hyperelastic skin conditions such as Ehlers-Danlos syndrome, cutis laxa shows an almost total lack of skin elasticity. Because it is a generalized state, it may present as an abnormality in the connective tissue of more than one organ system.

Passive stent coatings in the drug-eluting era.

Advances in coronary stent technology, both in terms of stent design and function, have significantly improved the safety and efficacy of percutaneous coronary intervention, including marked reduction in restenosis. This has led to its use in increasingly challenging clinical and lesional subsets, with potential for increased risk of stent-associated thrombosis. In this article we outline the development of passive stent coatings, and evaluate the ongoing role of such coatings in the contemporary era of antiproliferative drug-eluting stents.

Parkinson's disease: in vivo assessment of disease progression using positron emission tomography.

Over the past two decades, positron emission tomography (PET) has provided valuable insights into the mechanisms of nigrostriatal degeneration in Parkinson's disease (PD). Furthermore, it allows the in vivo assessment of disease progression and the evaluation of treatment interventions. In this review, we shall discuss some of the issues and concerns that arise with the use of PET as a surrogate marker of disease progression in Parkinson's disease.

Ligation and partial excision of the cauda equina as part of a wide resection of vertebral osteosarcoma: a case report and description of surgical technique.

Study Design: A case report.

Objectives: To describe the unique challenges and novel surgical approach to treatment of vertebral osteosarcoma involving the dura as a margin.

Summary Of Background Data: Osteosarcoma of the vertebral column is a rare, malignant osseous tumor, carrying a poor prognosis.

Problems created in attenuation-corrected SPECT images by artifacts in attenuation maps: a simulation study.

Unlabelled: The importance of accurate attenuation correction, especially for imaging of the thorax region, is widely acknowledged. Appropriate compensation methods have been developed and introduced into clinical practice. Most of these methods use attenuation maps obtained using various transmission scanning systems.

Anterior cervical plate fixation: a biomechanical study to evaluate the effects of plate design, endplate preparation, and bone mineral density.

Study Design: A biomechanical study using multidirectional flexibility testing in a human cadaveric cervical spine model of a flexion-distraction injury.

Objectives: To compare the immediate postoperative stabilizing effect of dynamic and rigid anterior cervical plates and to assess the confounding effects of bone mineral density (BMD) and endplate preparation technique.

Summary Of Background Data: Dynamic plate designs presumably increase load sharing between the plate and graft, but their effect on spinal stabilization has not been assessed in a traumatic flexion-distraction model.

Prevalence of eye strain among radiologists: influence of viewing variables on symptoms.

Objective: To determine the prevalence of and factors contributing to eye strain among radiologists, we examined the influence of the viewing method (PACS vs hard-copy film), age, case volume, technique, work habits, and workstation design on symptoms.

Materials And Methods: An Internet-based survey was sent to 2,700 radiologists randomly selected from the membership database of the Radiological Society of North America. Questions included demographic information, viewing method, work habits, and workstation design.

Hepatic injury, liver monitoring and the beta-interferons for multiple sclerosis.

This review explores the salient issues surrounding liver injury and liver monitoring associated with beta-interferon (IFNB) treatment for multiple sclerosis (MS). Post-marketing studies have found a higher proportion of IFNB-treated MS patients with elevated aminotransferases than reported in the pivotal clinical trials. Although the risk of severe liver injury appears small, the true incidence is unknown.

Effect of formulary policy decisions on antimicrobial drug utilization in British Columbia.

Background: Formularies are used routinely for management of drug expenditures yet evaluations of their impact remain rare. The objective of this study was to analyse the impact of addition or deletion of antimicrobials from the provincial formulary on drug utilization.

Methods: We obtained data from the British Columbia PharmaNet database on all outpatient oral antimicrobial prescriptions from 1996 to 2000 and converted them to their defined daily dose (DDD) equivalents according to the ATC system.