Surgery in the degenerative cervical spine

Degenerative changes of the cervical spine include changes of the bony and discoligamentous structures that can create mechanical alterations of the anatomy. Compressive syndromes and deformation or instability represent basic indications for surgery. In the upper cervical spine, osteoarthritis of the C1-C2 facet manifests with suboccipital pain syndrome caused by generally unilateral degenerative changes of the atlantoaxial facet. Fixation and atlantoaxial fusion represent the treatment of choice. In rare instances the presence of os odontoideum is responsible for atlantoaxial instability. Narrowing of the lateral recess in the subaxial spine produces radicular symptoms. The clinical symptoms should be supported with imaging methods such as computed tomography or magnetic resonance imaging. Selective decompression produces satisfactory results. Spondylotic cervical myelopathy requires the addition of neurophysiologic investigations. Posterior decompression with laminoplasty or anterior decompression procedures with corpectomy of the involved segments represent therapeutic options with comparable results. In the presence of axial neck pain, the exact location of the painful segment challenges clinicians and radiologists. Only in cases in which the clinical findings correlate with the radiologic changes should surgical fusion be considered as a last therapeutic means to resolve the painful condition.     

The Universidad Austral de Chile Medical School: a regional commitment

The Universidad Austral de Chile Medical School was created in 1966. Its general goal was to train a general physician with capacities to integrate biological, psychological and social issues, to deal with prevalent diseases as well as with the non referable casualties, to analyze health situations and to manage health teams. From its beginning, it incorporated anthropological and the public health contents to medical curriculum. Moreover, the formal teaching formation was reduced to 5 years, increasing the internship cycle to 2 years, with an important practice on primary health care in regional hospitals, that included a research project on health administration. A revision of the School curriculum showed the need of a better horizontal and vertical integration of medical education. Consequently, global courses were organized to gather knowledge that, until now, was delivered in a fragmented form. Our Medical School has a major impact in the southern region of the country and over 60% of its graduates have settled in this zone, improving its physician/inhabitant relationship and the number of specialists.     

Randomised trial of interferon alpha-2a as adjuvant therapy in resected primary melanoma thicker than 1.5 mm without clinically detectable node metastases. French Cooperative Group on Melanoma

BACKGROUND: Owing to the limited efficacy of therapy on melanoma at the stage of distant metastases, a well-tolerated adjuvant therapy is needed for patients with high-risk primary melanoma. Our hypothesis was that an adjuvant treatment with low doses of interferon alpha could be effective in patients with localised melanoma. METHODS: After resection of a primary cutaneous melanoma thicker than 1.5 mm, patients without clinically detectable node metastases were randomly assigned to receive either 3x10(6) IU interferon alpha-2a, three-times weekly for 18 months, or no treatment. The primary endpoint was the relapse-free interval. FINDINGS: 499 patients were enrolled, of whom 489 were eligible. When used as part of a sequential procedure, interferon alpha-2a was of significant benefit for relapse-free interval (p=0.038). A long-term analysis, after a median follow-up of 5 years, showed a significant extension of relapse-free interval (p=0.035) and a clear trend towards an increase in overall survival (p=0.059) in interferon alpha-2a-treated patients compared with controls. There were 100 relapses and 59 deaths among the 244 interferon alpha-2a-treated patients compared with 119 relapses and 76 deaths among the 245 controls. The estimated 3-year-relapse rates were 32% in the interferon alpha-2a group and 44% in controls; the 3-year death rates were 15% and 21%, respectively. Only 10% of patients experienced WHO grade 3 or 4 adverse events. Treatment was compatible with normal daily life. INTERPRETATION: Adjuvant therapy of high-risk melanoma with low doses of interferon alpha-2a for 18 months is safe and is beneficial when started before clinically detectable node metastases develop.     

A role for tumor necrosis factor receptor type 1 in gut-associated lymphoid tissue development: genetic evidence of synergism with lymphotoxin beta

Lymphotoxin alpha (LTalpha) signals via tumor necrosis factor receptors (TNFRs) as a homotrimer and via lymphotoxin beta receptor (LTbetaR) as a heterotrimeric LTalpha1beta2 complex. LTalpha-deficient mice lack all lymph nodes (LNs) and Peyer's patches (PPs), and yet LTbeta-deficient mice and TNFR-deficient mice have cervical and mesenteric LN. We now show that mice made deficient in both LTbeta and TNFR type 1 (TNFR1) lack all LNs, revealing redundancy or synergism between TNFR1 and LTbeta, acting presumably via LTbetaR. A complete lack of only PPs in mice heterozygous for both ltalpha and ltbeta, but not ltalpha or ltbeta alone, suggests a similar two-ligand phenomenon in PP development and may explain the incomplete lack of PPs seen in tnfr1-/- mice.     

Post-traumatic atlanto-axial arthrosis

To date no investigation has proven accurate and reliable for assessing mandibular invasion by carcinoma prior to surgery. This prospective study compared a new imaging modality, single photon emission computed tomography (SPECT), with clinical examination and high resolution CT scanning to evaluate the sensitivity and specificity of each method in detecting mandibular invasion by squamous cell carcinoma. Twenty-nine patients (21 men, 8 women) with an oral cavity/oropharyngeal carcinoma were studied. All underwent primary surgery and/or radiotherapy where indicated. Resected mandibles were decalcified and examined for tumour infiltration. Imaging studies were read independently by two experienced observers. Clinical examination predicted bone invasion with a sensitivity of 90% and a specificity of only 25%. CT had a sensitivity of 89% and a specificity of 57% while SPECT imaging had a sensitivity of 100% and a specificity of 29%. Using Fisher's exact test and the Kappa statistic for pairwise comparisons between each method, SPECT imaging was complementary to CT in the pre-operative assessment of mandibular invasion.     

Internal bags with barrier layers for foods packed in recycled paperboard: recent progress

Internal bags for packaging dry foods into boxes of recycled paperboard, collected in Dresden and Zurich in June 2013, were investigated with regard to the layer composition and the barrier efficiency against substances migrating from the recycled fibers. The layers were identified by microtome cuts and Fourier transform infrared spectroscopy, often after wet-chemical separation of the layers. The barrier efficiency was tested with five surrogate substances and classified between 1 and 5, with class 1 having no significant barrier effect, 4 being a virtually tight barrier consisting of polymeric material and 5 including an aluminum foil. Merely 17 of the 87 bags (20 %) consisted of paper or polyethylene that constituted insignificant barriers. Bags of oriented polypropylene, substantially reducing migration (class 2), were encountered in 32 % of the packs; those with more efficient, but still incomplete barriers (class 3) in 16 % and virtually tight barriers (classes 4 and 5) in 32 % of the products. This is a strong move toward efficient barriers compared to the findings in 2010. Efficient or tight barriers were found for nearly all food types, which suggests that there are no important technical obstacles against the inclusion of a barrier layer into all bags to protect the food against contamination from the recycled paper board.     

Food contamination from epoxy resins and organosols used as can coatings: analysis by gradient NPLC

Normal phase LC with gradient elution enabled the analysis of a broadened range of oligomers of BADGE (Bisphenol-A diglycidyl ether) and Novolak compounds in canned foods, such as sea foods in oil, meat products and soups. A major component released from Bisphenol-A resins was identified as the cyclo-(Bisphenol-A monoglycidyl ether) dimer and was commonly present in foods at concentrations of around 1 mg/kg. For the epoxy Novolaks, concentrations of the three- to six-ring compounds often far exceeded those of BFDGE (Bisphenol-F diglycidyl ether) and reached 20 mg/kg in foods. A two-step acylation is proposed for the detection of epoxy components.     

PVC plasticizers/additives migrating from the gaskets of metal closures into oily food: Swiss market survey June 2005

Foods with at least a few percent of free oil packed in glass jars with metal closures were analyzed for migration of additives, primarily plasticizers, from the gasket of the lid. One hundred and fifty-eight samples were collected in June 2005, i.e., some 10 months after the problem of excessive migration into oily food was communicated to the industry. In a first step, the composition of the additives in the gaskets was determined. Then the compounds found in the lid were measured in the jar content. Sixty-four percent of the gaskets contained epoxidized soy bean oil (ESBO) as principal plasticizer, 22% a phthalate, and 6% substantial amounts of di(2-ethylhexyl) adipate (DEHA). Concentrations in the food reached 1,170 mg/kg for ESBO, 270 mg/kg for diisononyl phthalate (DINP), 740 mg/kg for diisodecyl phthalate (DIDP), 825 mg/kg for di(2-ethylhexyl) phthalate (DEHP), and 180 mg/kg for DEHA. Further, elevated concentrations of plasticizers not authorized by the EU were found: diisononyl-cyclohexane-1,2-dicarboxylate (DINCH), 2-ethylhexyl palmitate and stearate, as well as epoxidized linseed oil (ELO). The few samples complying with the European rules contained little or well emulsified oil; some others were probably of very recent production (beginning of shelf life). It is concluded that there was still no lid reliably complying with the European rules (EU and national legislation).