Reduction in leg pain and lower-extremity weakness with Oxiplex/SP Gel for 1 year after laminectomy, laminotomy, and discectomy

Object

Although good surgical technique is effective in reducing postoperative epidural fibrosis, compression or tethering of the nerve root may cause recurrent radicular pain and physical impairment. The implantation of a bioresorbable gel on the dura may further decrease the amount of scar formation after surgery and thus improve the patient's ability to perform activities of daily living (ADL). This study is a 12-month evaluation of the safety and effectiveness of Oxiplex/SP Gel (FzioMed, Inc., San Luis Obispo, CA) in the reduction of pain and radiculopathy after lumbar discectomy.

Methods

A pilot randomized single-blind multicenter clinical trial was conducted to evaluate the performance of Oxiplex/SP Gel in patients who underwent surgery for unilateral herniation of the lumbar disc at L4–5 or L5–S1. Eighteen patients with severe leg pain and lower-extremity weakness (11 women and seven men) were randomly assigned intraoperatively to receive the gel at the conclusion of surgery (treatment group) or to undergo surgery alone (control group). Self-assessment questionnaires (Lumbar Spine Outcomes Questionnaire) to assess pain, symptoms, and ADL were completed preoperatively and at scheduled postoperative intervals (30 days, 90 days, 6 months, and 12 months).

The authors examined the spine and lower extremities of patients scheduled for discectomy to assess neurological function and pain. Treated patients received sufficient Oxiplex/SP Gel (1–3 ml) to coat the nerve root and fill the epidural space. Postoperative clinical evaluations were performed at 30 and 90 days. Patients completed the self-assessment questionnaires at baseline and were contacted by telephone or mail for the completion of the postoperative self-assessment questionnaires.

Surgical procedures were well tolerated; no device-related adverse events and no clinically significant laboratory results were reported. The 11 patients with severe leg pain and lower-extremity weakness who were treated with Oxiplex/SP Gel had a reduction in those symptoms at 30 days, 90 days, 6 months, and 12 months after discectomy, compared with the seven control patients who underwent surgery only.

Conclusions

Oxiplex/SP Gel was easy to use and safe in patients who underwent unilateral discectomy. A greater benefit in clinical outcome measures was seen over the 12-month follow-up period in gel-treated patients.

ADAPT-treated porcine valve tissue (cusp and wall) versus Medtronic Freestyle and Prima Plus: crosslink stability and calcification behavior in the subcutaneous rat model

BACKGROUND AND AIM OF THE STUDY

The study aim was to compare the crosslink stability and calcification behavior of porcine tissue (cusp and wall), treated with a new antimineralization process (ADAPT) with that of commercially prepared Freestyle and Prima Plus bioprosthetic tissues.

METHODS

Porcine aortic roots were divided into two groups: (i) tissue zero pressure-fixed with 0.625% glutaraldehyde (GA) for seven days and stored in 0.25% GA (as control); and (ii) tissue exposed to the ADAPT process for four days and stored in 0.25% buffered GA. These groups were compared with Freestyle and Prima Plus tissues (cusp and wall). Crosslink stability was assessed by shrinkage temperature and resistance to pronase degradation. Calcification behavior was assessed histologically (Von Kossa staining) and by atomic absorption spectrophotometry of explanted tissue after eight weeks. in a subcutaneous rat model.

RESULTS

Crosslink stability and calcification potential of ADAPT-treated porcine valve cusps were comparable to those of Freestyle and Prima Plus cusps (p = NS). ADAPT-treated porcine wall tissue showed improved crosslink stability (p <0.05) and significantly (p <0.001) reduced calcification (-95.95%) compared to control (-0.00%), Freestyle (-47.87%) and Prima Plus (-51.95%) tissues.

CONCLUSION

The ADAPT process is effective in reducing calcification in both porcine cusp and wall tissues in a subcutaneous rat model, and further suggest that enhanced crosslinking plays an important role in minimizing aortic wall calcification.

K-Y jelly as an aide to cryotherapy in the management of odontogenic keratocysts

We describe a technique of cryotherapy for the management of odontogenic keratocysts using K-Y jelly as an aide.

Herpes simplex and aphthous ulcerations: presentation, diagnosis and management--an update

The most common pathologic alterations seen by dentists are oral mucosal ulcerations, particularly those related to the herpes simplex virus and those produced by the autoimmune phenomenon known as recurrent aphthous stomatitis. Because the general frequency and clinical similarity of these conditions often make it difficult to distinguish one from the other, therapeutic intervention may be inappropriate. An improved understanding of the virologic and local immunologic alterations within the oral mucosa has led to a better understanding of these conditions and to the development of improved treatment strategies within the general practice setting for a significant number of otherwise healthy patients.

Concerning the wound-healing properties of Sphagnum holocellulose: the Maillard reaction in pharmacology

Sphagnum wound dressings can be 3-4 times as absorbent as cotton equivalents, but they also react chemically with proteins of all kinds. This reactivity gives them the potential of immobilizing whole bacterial cells as well as the enzymes, exotoxins, and lysins secreted by the most invasive pathogens. Once immobilized, enzymes and (by inference) exotoxins and lysins are rapidly inactivated by a Maillard reaction. The complex pectin in Sphagnum is structurally similar to known, immunostimulatory pectins from other plants, including some that are traditionally used for wound healing.

Release profiles of theophylline from microspheres consisting of dextran derivatives and cellulose acetate butyrate: effect of polyion complex formation

The objective of this study was to evaluate the utility of mixtures among oppositely charged dextran derivatives as constituents of a controlled release microsphere. Carboxymethyldextran (CMD) and dextran sulfate (DS) were used as polyanions, and [2-(diethylamino) ethyl] dextran (EA) and [2-hydroxypropyltrimethylammonium] dextran (CDC) as polycations. The microspheres consisting of hydrophilic and hydrophobic polymers were prepared by emulsion-solvent evaporation method. The mixtures, CMD/EA, CMD/CDC, DS/EA, and DS/CDC, were used as hydrophilic polymers, because they can interact with each other to form polyion complexes for the improvement of sustained-release performances. Cellulose acetate butyrate and theophylline were used as a model hydrophobic polymer and a model drug, respectively. The yield of microspheres was excellent (more than 95%). According to observation, by scanning election microscopy (SEM) microspheres were spherical with a rough surface. The in vitro drug release from microspheres was examined in the JP XIV first fluid, pH 1.2, and second fluid, p H 6.8, at 37 degrees C, and 100 rpm. In the DS/CDC system, drug release was depressed by formation of a polyion complex and not affected by pH of dissolution medium. The release rate was modulated by the ratio of hydrophilic and hydrophobic matrix. This particulate system, in which the polyion complex matrix is strengthened by a hydrophobic polymer, is a promising formulation for drug delivery.

Use of cellulose powder for the treatment of seasonal allergic rhinitis

This study was designed to determine whether a unique cellulose powder extract could prevent the classic hay fever attack from occurring among volunteers who have suffered for some years. Nasaleze enhances nasal mucus, which allows the filtration of allergens, to ensure that only clean air reaches the lungs. One hundred two volunteers were recruited and, using a simple 5-point scoring system to grade their general well-being and severity of any hay fever attacks, the overall average score was 3.85, indicating that Nasaleze was able to control hay fever very well. Rapid relief of symptoms was also demonstrated, sometimes within minutes after inhalation. Overall, 77% of volunteers reported a significant reduction in the number of challenges throughout the study period and most graded Nasaleze as more effective and reported fewer side effects than with a wide range of chemical treatments.

Dialysis filter type determines the acute effect of haemodialysis on endothelial function and oxidative stress

BACKGROUND

Endothelial function of large arteries is impaired in chronic haemodialysis patients and oxidative stress due to the dialysis procedure has been suggested as a causal factor. However, it is not clear whether different types of dialysis membranes affect endothelial function differently. Therefore we determined endothelium-dependent, flow-mediated dilatation (FMD) of the brachial artery as well as markers of oxidative stress immediately before and after haemodialysis (HD) with either a cellulosic cuprophane or a synthetic polysulphone dialyser in a blinded, randomized, cross-over study.

METHODS

Twelve haemodialysis patients (age 55+/-3 years, time on dialysis 20+/-2 months, mean fluid change -1782+/-21 ml, systolic/diastolic blood pressure 139/75 mmHg) were included. Using a multi-gate-pulsed Doppler system (echo-tracking device) brachial artery FMD and nitroglycerine-induced, endothelium-independent vasodilatation (NMD) were measured. Patients were randomized to HD with either a polysulphone or a cuprophane membrane and were crossed over to the other filter. Investigators were blinded to the type of membrane used. Serum concentrations of oxidized LDL (oxLDL) and alpha-tocopherol as markers of oxidative stress were measured before and after each dialysis session.

RESULTS

Data are given as mean+/-SEM. Treatment with polysulphone filter HD did not significantly affect FMD (baseline 9.3+/-2.0% vs after HD 9.6+/-1.8%). After dialysis with a cuprophane membrane FMD decreased from 9.4+/-2.1 to 7.4+/-1.8% (P<0.05). NMD was not significantly affected by HD irrespective of the membrane material used. Serum levels of oxLDL were not changed by either treatment; however, alpha-tocopherol concentrations fell significantly after dialysis with the cuprophane filter (baseline 18.0+/-2.3 after HD 16.6+/-1.3 micro g/ml, P<0.05), while alpha-tocopherol levels remained unchanged when the polysulphone membrane was used.

CONCLUSIONS

The type of dialysis filter membrane determines the acute effect of haemodialysis on arterial endothelial function. Differences in biocompatibility and oxidative stress may account for the observed differential effects, since the decrease of FMD after dialysis with a cellulosic cuprophane membrane-but not with a synthetic polysulphone membrane-was associated with a reduction in serum vitamin E.

Reduction of radiculopathy and pain with Oxiplex/SP gel after laminectomy, laminotomy, and discectomy: a pilot clinical study

STUDY DESIGN

Safety using Oxiplex/SP Gel during single-level discectomy for reduction of symptoms associated with unilateral herniation of the lumbar disc was investigated by self-assessment questionnaire and magnetic resonance imaging.

OBJECTIVE

To evaluate the safety and assess the efficacy parameters of Oxiplex/SP Gel.

SUMMARY OF BACKGROUND DATA

Animal studies demonstrated that Oxiplex/SP Gel (CMC/PEO) reduced epidural fibrosis after lumbar surgery.

METHODS

Surgeons examined spine and lower extremities of patients scheduled for discectomy to assess neurologic function and pain. Treated patients received sufficient Oxiplex/SP Gel (1-3 mL) to coat the nerve root and fill the epidural space. The control condition was surgery alone. At baseline, then 30 days, 90 days, and 6 months after surgery, patients completed self-assessment questionnaires concerning leg pain, lower extremity weakness, functional disability, daily living activities, symptoms, and radiculopathy. Magnetic resonance imaging was performed at baseline and 90 days after surgery. At 30 and 90 days after surgery, patients underwent physical examination, wound inspection, and laboratory tests.

RESULTS

The surgical procedures were well tolerated by the 23 patients treated with Oxiplex/SP Gel and the 11 control patients. There were no unanticipated adverse events, no clinically significant laboratory results, and no significant differences detected by magnetic resonance imaging. Treated patients had greater reduction in outcome measures at 30 days. The differences in scores were attenuated at 90 days and 6 months. A subgroup, the patients with significant leg pain and weakness at baseline (11 patients treated with Oxiplex/SP Gel and 7 control patients), had greater reduction in outcome measures than the control patients throughout the study.

CONCLUSIONS

Oxiplex/SP Gel was easy to use and safe for patients undergoing unilateral discectomy. Greater benefit in clinical outcome measures was seen in gel-treated patients, especially those with severe leg pain and weakness at baseline.

Effect of membrane composition on cytokine production and clinical symptoms during hemodialysis: a crossover study

BACKGROUND

Intradialytic symptoms including hypotension have been reported during dialysis and it has been suggested that these are related to the release of cytokines like IL-1beta and TNFalpha by blood mononuclear cells when they get activated either due to contact with the dialyzer membrane or by compliment activation.

OBJECTIVE

To study the relationship between hemodialysis symptoms, cytokine production, and dialyzer membrane composition.

METHOD

In a randomized prospective crossover study, 20 ESRD patients on maintenance hemodialysis were studied over cuprophan (CU) and polysulfone (PS) low flux dialyzer membranes for three weeks each undergoing a biweekly dialysis schedule of 4 h sessions. Serial IL-1beta and TNFalpha levels were measured over 0, 15, 240 min during the first use of the dialyzer for all patients on both membranes. Intradialytic symptoms were monitored in a total of 240 dialysis sessions.

RESULTS

IL-1beta levels increased from 16.6 +/- 2.2 to 64.8 +/- 25.1 pg/mL on CU and 21.5 +/- 3.7 to 103.5 +/- 30.7 pg/mL on PS membrane over the 4-h dialysis session. Similarly TNFalpha increased from 42.8 +/- 4.5 to 354.9 +/- 80.4 pg/mL on CU and 117.1+/- 53.7 to 387.0 +/- 78.0 pg/mL on PS membrane. IL-1beta levels increased significantly with PS membrane while TNFalpha rise was significant with both the membranes. Nausea was the most common symptom occurring in 138 dialysis sessions (57.5%). Vomiting, chest pain, fever, chills, and breathlessness occurred significantly more during dialysis with CU membrane as compared with PS membrane (P < 0.01). Nausea, cramps, back pain, itching, restlessness, post dialysis fatigue, and hypotension did not differ between the two membranes. The mean rise in the cytokine levels during the first 15 min of sessions where the symptoms occurred, when compared with the mean rise in sessions where the symptoms did not occur, did not reveal any significant difference. Cytokine release did not correlate with the occurrence of intradialytic symptoms.

CONCLUSION

Both CU and PS membranes increase circulating cytokine levels. More intradialytic clinical symptoms are seen in dialysis with CU as compared with PS membrane but the rise in cytokines IL-1beta and TNFalpha does not appear to be responsible for them.

The effect of treatment with gum Arabic on gentamicin nephrotoxicity in rats: a preliminary study

In the present work we assessed the effect of treatment of rats with gum Arabic on acute renal failure induced by gentamicin (GM) nephrotoxicity. Rats were treated with the vehicle (2 mL/kg of distilled water and 5% w/v cellulose, 10 days), gum Arabic (2 mL/kg of a 10% w/v aqueous suspension of gum Arabic powder, orally for 10 days), or gum Arabic concomitantly with GM (80mg/kg/day intramuscularly, during the last six days of the treatment period). Nephrotoxicity was assessed by measuring the concentrations of creatinine and urea in the plasma and reduced glutathione (GSH) in the kidney cortex, and by light microscopic examination of kidney sections. The results indicated that concomitant treatment with gum Arabic and GM significantly increased creatinine and urea by about 183 and 239%, respectively (compared to 432 and 346%, respectively, in rats treated with cellulose and GM), and decreased that of cortical GSH by 21% (compared to 27% in the cellulose plus GM group) The GM-induced proximal tubular necrosis appeared to be slightly less severe in rats given GM together with gum Arabic than in those given GM and cellulose. It could be inferred that gum Arabic treatment has induced a modest amelioration of some of the histological and biochemical indices of GM nephrotoxicity. Further work is warranted on the effect of the treatments on renal functional aspects in models of chronic renal failure, and on the mechanism(s) involved.

Cross-linked hyaluronan used as augmentation substance for treatment of glottal insufficiency: safety aspects and vocal fold function

OBJECTIVE

To examine safety aspects and vocal fold function after vocal fold augmentation with a cross-linked hyaluronan derivative (hylan B gel) as compared with bovine collagen. STUDY DESIGN; A prospective, randomized trial.

METHODS

Eighty-three patients with glottal insufficiency were treated with injection augmentation with hylan B gel and bovine collagen and were examined at 1, 6, and 12 months after treatment. Seventy patients with unilateral vocal fold paresis (n = 35) or atrophy (n = 35) were randomly assigned to receive either hylan B gel (n = 47) or collagen (n = 23) injections into one vocal fold. Thirteen patients with glottal insufficiency caused by scar defects or paresis resulting from malignant disease were included in a nonrandomized group and were treated only with hylan B gel. Evaluations were made from patients' subjective ratings (visual analogue scales), digitized videostroboscopic measurements, phonetograms, maximum phonation time, and phonation quotients.

RESULTS

Twelve months after injections, the patients' self-ratings were significantly improved for both the hylan B gel and the collagen groups. In addition, the videostroboscopic measurements showed significantly improved glottal closure for both groups. However, for the hylan B gel group, vibration amplitude and glottal area variations were preserved, and this group showed significantly less resorption at the injected vocal fold edge. Furthermore, maximum phonation time had increased significantly for the hylan B gel patients (collagen, nonsignificant). No serious adverse events were observed; three patients injected with hylan B gel had temporary inflammation at the injection site, which resolved without sequelae.

CONCLUSIONS

The results showed that both hylan B gel and collagen can be safely used for injection treatment of glottal insufficiency. Both treatments resulted in significantly improved voice as rated by the patients. However, the patients treated with hylan B gel showed better vocal fold status and longer maximum phonation time at 12 months after treatment as compared with patients treated with collagen.

Arachidonate cascade, apoptosis, and vitamin E in peripheral blood mononuclear cells from hemodialysis patients

BACKGROUND

Lipid peroxidation and oxidative stress are enhanced in peripheral blood mononuclear cells (PBMCs) from hemodialysis (HD) patients because of upregulation of the 5-lipoxygenase pathway of the arachidonate cascade. 5-Lipoxygenase activity is specifically inhibited by vitamin E both in vitro and in vivo regardless of its administration route.

METHODS

The effect of arachidonate cascade enzymes and vitamin E on oxidative stress and apoptosis was investigated in PBMCs from 16 maintenance HD patients treated for at least 6 months with cuprammonium rayon membranes in a two-step crossover study: after a 4-week treatment with vitamin E-coated cuprammonium rayon membranes and again after a 4-week treatment with oral vitamin E. Control PBMCs were obtained from 16 healthy volunteers.

RESULTS

Membrane lipoperoxidation, cellular luminescence, membrane fluidity, and leukotriene B(4) content were significantly greater in PBMCs from HD patients; lipoxygenase was upregulated, but prostaglandin H synthase (PHS) was not affected. Regardless of administration route, vitamin E partially controlled lipid peroxidation and oxidative stress through direct inhibition of 5-lipoxygenase. Cultured PBMCs from HD patients showed a significant increase in apoptotic cells compared with controls. Vitamin E markedly reduced cell luminescence, membrane fluidity, and apoptosis, whereas the PHS inhibitor indomethacin was ineffective. Similar results were obtained with control PBMCs induced to apoptosis by hydrogen peroxide.

CONCLUSION

Reported data suggest that the 5-lipoxygenase branch of the arachidonate cascade is only responsible for membrane peroxidation, oxidative stress, and apoptosis of PBMCs of HD patients, and administration of vitamin E may be helpful in the control of oxidative stress-related disease in these subjects.

A clinical and SEM evaluation of the efficiency of sofscale gel and hand scaling and hand scaling alone

The purpose of this study is to compose between hand scaling with abd without the calculus solvent gel (sofscale) and ultrasonic instrumentation at clinical and SEM level. 30 patients belonging to the age group of 17-50 year were selected. Patients selected were subjected to three different scaling modalities namely hand scaling (control), hand scaling using sofscale (Experimental quadrant A) and ultrasonic scaling (Experimental quadrant B), in three different quadrants. Case report forms were used to document the tooth sensitivity, soft tissue pain after scaling, patient preference of instrumentation, ease of calculus removal, patient comfort, soft tissue irritation, time taken for scaling, Bleeding while scaling, pre and post operative sulcus bleeding index. In addition to the clinical criteria, the teeth treated were extracted and evaluated using the scanning electron microscope to show potential effects on cemntal surfaces. No difference in tooth sensitivity was appreciated between control and experimental quadrant A. There was a higher degree of tooth sensitivity when treated with ultrasonic. Patients in control group appreciated a higher degree of soft tissue pain. Hand scaling using softscale produced a lesser amount of pain and treatment with ultrasoincs was the least painful. Most of the patients preferred ultrasonic scaling (70%) Calculus removal was easier. Hand scaling using sofscale gel results in more patient comfort when compared to hand scaling alone. There was no significant difference in patient comfort between handscaling using sofscale and ultrasonic scaling. The percentage of reduction of sulcus bleeding index showed no difference between the 3 scaling modalities SEM evaluation revealed that there was no significant difference the 3 scaling modalities in relation to residual calculus, cleaning efficiency and damage to the root surface. This study concluded that treatment with sofscale gel appears to be safe and effective method for removal calculus as this did not damage cemental surfaces, nor did it cause any damage to soft tissue. "Your tratar is your calcified hate. Not only the microflora in your oral cavity but also your muddled thoughts, your obstinate squinting backward, the way you regree when you mean to progress, in other words, the tendency of your diseased gums to form germ catching pockets, all that, the sum of dental picture and psyche, betrays you, it is stored up violence, full of murdero us designs" Gunter Grass.

Anti-HIV-1 activity of cellulose acetate phthalate: synergy with soluble CD4 and induction of "dead-end" gp41 six-helix bundles

BACKGROUND

Cellulose acetate phthalate (CAP), a promising candidate microbicide for prevention of sexual transmission of the human immunodeficiency virus type 1 (HIV-1) and other sexually transmitted disease (STD) pathogens, was shown to inactivate HIV-1 and to block the coreceptor binding site on the virus envelope glycoprotein gp120. It did not interfere with virus binding to CD4. Since CD4 is the primary cellular receptor for HIV-1, it was of interest to study CAP binding to HIV-1 complexes with soluble CD4 (sCD4) and its consequences, including changes in the conformation of the envelope glycoprotein gp41 within virus particles.

METHODS

Enzyme-linked immunosorbent assays (ELISA) were used to study CAP binding to HIV-1-sCD4 complexes and to detect gp41 six-helix bundles accessible on virus particles using antibodies specific for the alpha-helical core domain of gp41.

RESULTS

1) Pretreatment of HIV-1 with sCD4 augments subsequent binding of CAP; 2) there is synergism between CAP and sCD4 for inhibition of HIV-1 infection; 3) treatment of HIV-1 with CAP induced the formation of gp41 six-helix bundles.

CONCLUSIONS

CAP and sCD4 bind to distinct sites on HIV-1 IIIB and BaL virions and their simultaneous binding has profound effects on virus structure and infectivity. The formation of gp41 six-helical bundles, induced by CAP, is known to render the virus incompetent for fusion with target cells thus preventing infection.

Local delivery of antimicrobials: a new era in the treatment of adult periodontitis

This article discusses the principles, products, and techniques currently available for local delivery of antimicrobials in the treatment of adult periodontitis. Four principles provide the scientific basis for the treatment of periodontitis: it is caused by bacteria; it cannot be cured, but it can be controlled; clinicians cannot remove all the plaque and calculus; and periodontitis reinfects. This article stresses how the local delivery of antimicrobials can help the clinician achieve the goals of arresting the disease and maintaining the disease in the arrested or controlled state. Rationales for reevaluating the treated patient and treatment options are presented. Local-delivery systems are reviewed, stressing those available in the United States. Pharmacokinetics, multicenter randomized trials, and techniques are presented.

Injectable fillers for facial soft tissue enhancement

Soft tissue augmentation materials have been advocated for correction of post-surgical or post-traumatic facial defects, as well as for age-related folds and wrinkles. While autogenous tissues may be the safest option, they require a second operative site. Animal-derived or synthetic materials have been advocated since the late 19th century, and have waxed and waned in popularity. In recent years, we have gained a better understanding of the physical events that occur when material is placed within or below the skin. With this knowledge, we stand at the threshold of a new era, where soft tissue fillers can be designed and customized to suit the individual patient. This article will review the major materials that have been or are now advocated for use as soft tissue fillers, and will detail their relative strengths and weaknesses in order to give the clinician a better perspective when considering a material for soft tissue augmentation.

Cytokine removal with a large pore cellulose triacetate filter: an ex vivo study

OBJECTIVE

To test the hypothesis that hemofiltration using a new large pore cellulose triacetate hemofilter can achieve effective ultrafiltration of cytokines.

DESIGN

Ex-vivo study.

SETTING

Laboratory of Intensive Care Unit in tertiary hospital.

SUBJECTS

Six healthy volunteers.

INTERVENTIONS

Blood from 6 volunteers was incubated for 4 hours with 1 mg of endotoxin and then circulated through a closed hemofiltration circuit with a large pore cellulose triacetate hemofilter (nominal cut-off point: 60 kilodaltons). Hemofiltration was conducted at 1 L/h or 6 L/h of ultrafiltrate (UF) flow at the start of extra-corporeal circulation, and after 2 and 4 hours. Samples were taken from the arterial, venous and UF sampling ports.

MEASUREMENTS AND MAIN RESULTS

IL-Ibeta, IL-6, IL-8, IL-10, TNFalpha, and albumin were measured. Sieving coefficients (SC) above 0.6 were achieved for IL-Ibeta and IL-6 and SCs above 0.3 were achieved for IL-8 and TNF-alpha at 1 L/h. Sieving coefficients of all cytokines (except IL-10, p=0.22) were reduced when the ultrafiltration rate was increased from IL/h to 6 L/h (p<0.01), but the increase in ultrafiltration rate resulted in an overall increase in the clearance of all cytokines (p<0.001). The highest SC for albumin was 0.07 at 4 hours at 1 L/h, and fell to 0.01 at 6 L/h. The SCs for IL-8 fell at 4 hours (p<0.01), but the SCs for other cytokines did not change. No adsorption of cytokines and albumin was observed.

CONCLUSION

High volume hemofiltration (HVHF) using a new large pore cellulose triacetate filter achieved cytokine clearances greater than those reported with currently available hemo filters.

Neutral proteases in crevicular fluid as an indicator for periodontal treatment intervention

PURPOSE

To longitudinally determine if early therapeutic intervention, based on a positive neutral protease activity (NPA) assay score could effectively arrest the progress of periodontal disease destruction.

MATERIALS AND METHODS

63 periodontal sites which had previously undergone probing attachment loss were identified from among 31 previously treated adult periodontitis patients who were monitored during periodontal maintenance for an average of 3 yrs. Clinical levels of gingival inflammation and attachment levels and NPA assay data were collected at the beginning of each maintenance visit. When a site tested negative with the assay, routine Supportive Periodontal Therapy (SPT) was followed during the same appointment, while sites exhibiting a positive NPA score received more aggressive periodontal treatment.

RESULTS

During the study period, 51 of 63 sites displayed at least one positive NPA score. Our protocol of administering periodontal treatment rendered at the visit showing a positive NPA score revealed that only 1 of the 51 sites lost > or = 1 mm attachment during the study period. The remaining 50 positive assay sites showed an overall gain of > or = 1 mm of probing attachment over the course of the study. 12 of 63 sites consistently tested negative for neutral protease enzyme activity and remained stable, although 9 of these sites exhibited bleeding on probing (BOP) at least once during this study. Initial group mean probing attachment measurements were 5.6 mm for NPA negative and 5.7 mm for NPA positive sites.

Cost implications of introducing an alternative treatment for patients with osteoarthritis of the knee in a managed care setting

OBJECTIVES

To illustrate the current cost of treating osteoarthritis (OA) of the knee and to demonstrate potential savings associated with the new treatment modality of viscosupplementation in a managed care setting.

STUDY DESIGN

Pharmacoeconomic model with inputs obtained from peer-reviewed medical literature, clinical trial data, clinical expert opinion, and claims data.

METHODS

A spreadsheet-based model was developed to define a treatment pathway for OA of the knee, illustrate the current costs of treating patients with the condition, and demonstrate the potential savings associated with introduction of Hylan G-F 20. A hypothetical cohort of patients categorized as having mild, moderate, or severe OA of the knee was followed over a 3-year time period. The analysis was conducted from the perspective of a managed care plan with a large Medicare population.

RESULTS

The 3-year savings associated with adding 1 or more courses of Hylan G-F 20 therapy to the standard treatment pathway for OA of the knee was $8,810,771. The total savings per OA patient receiving Hylan G-F 20 was $4706. The number of total knee replacements (TKRs) avoided was 808. The model was highly sensitive to the durability of Hylan G-F 20; increasing and decreasing durability within a reasonable range resulted in 3-year savings of $9,131,879 and $2,012,082, respectively.

CONCLUSIONS

Hylan G-F 20 has proven to be an effective treatment for patients with OA of the knee. Appropriate use of Hylan G-F 20 could delay the need for TKRs and generate savings in the managed care setting.

[Use of lyophilized cellulose in peripheral nerve lesions with loss of substance]

Lyophilized cellulose was analysed to verify the degree of inflammatory reaction and axon realignment in the sciatic nerve after loss of neural substance. Ten mongrel dogs were divided into: Group 1 - 1 cm section of sciatic nerve which was replaced at lesion site; Group 2 nerve section without fragment replacement. The section site was involved with lyophilized cellulose. Group 3 -1 cm fragment section sutured epineurally. Motor response started at eighth week. Moderate fibrotic reaction to cellulose was seen in Group 1 and 2 animals. Groups 1 and 3 showed coaptation between the nerve and nerve graft with ongoing axons. In Group 2, 1 dog showed regrowth of axons through the empty space. It was concluded that lyophilized cellulose caused moderate fibrous reaction when implanted in peripheral nerve lesions with loss of substance; it can act as envelop protection in those lesions mainly if a neural graft is inserted.

Videographic assessment of the embolic characteristics of three polymeric compounds: ethylene vinyl alcohol, cellulose acetate, and liquid urethane

BACKGROUND AND PURPOSE

Aneurysms have been clinically and experimentally treated with various surgical and endovascular methods, including endovascular polymer instillation. Additional tools may help to identify advantages and disadvantages of polymeric aneurysm treatment. We assessed the value of high-resolution videography to compare in vitro embolization characteristics of ethylene vinyl alcohol copolymer (VIN), cellulose acetate polymer (ACE), and urethane copolymer (UCO).

METHODS

In a "neck-up" glass aneurysm model, solutions of 8% and 12% VIN, 8% and 12% ACE, and 8% UCO were introduced through a microcatheter into a xanthan gum solution at three flow rates: full physiological (62 cm/s), half physiological, and flow arrest. Each formulation was then introduced into a "neck-down" aneurysm model at flow arrest, for a total of 20 experiments. Results were tabulated for six different categories: outflow tail formation, inflow-zone polymer-mass deformation, inflow-zone migration, detachment tail formation, adherent mass pullout, and conjectural net effect.

RESULTS

Of the 20 experiments, nine had unacceptable results because of potential clinical complications. The results were unacceptable in four of eight VIN experiments, four of eight ACE experiments, and one of four UCO experiments. VIN performance was more dependent on flow arrest than the more viscous ACE. The growth of the ACE solutions was most circumferential, with balloonlike growth characteristics, little inflow-zone effects, and fewer outflow tails than seen with VIN. All compounds had the potential for partial catheter adhesion and catheter-adhesing tails. UCO had the highest percentage of favorable results and the lowest percentage of unfavorable results.

CONCLUSION

Videographic analysis allows detailed assessment of the dynamic embolization characteristics of polymers, revealing potential advantages of compounds such as UCO.