Nonsteroidal Anti-inflammatory Medications Research Articles

An Atypical Endoscopic Presentation of Zollinger-Ellison Syndrome

Zollinger-Ellison syndrome (ZES) is a rare condition characterized by gastrointestinal (GI) ulceration due to a gastrin-secreting tumor and hyper-secretion of gastric acid. Recent studies have shown thickened gastric folds and duodenal ulcers as the two most common endoscopic findings occurring in up to 80.3% and 15.3% of patients. We present a case of ZES with atypical endoscopic findings. A 52 year-old female with type 2 diabetes and hypertension presented with peri-umbilical pain. She described 7 out of 10, dull, aching pain with brown, mucus-like emesis. In the emergency department (ED), she was diagnosed with diverticulitis, prescribed antibiotics, and discharged. Due to severe nausea she did not finish the medications. She returned to the ED in 5 days with worsening pain. A CT abdomen/pelvis with contrast showed a 6.5x4.6x5.5 cm lobular enhancing mass lateral to the 4th part of the duodenum with multiple enlarged lymph nodes and wall thickening of the duodenum, suspicious for malignancy. Gastroenterology was consulted. Push enteroscopy showed severe LA class D esophagitis, and a normal stomach. The proximal duodenum had erosions and small clean based ulcers. Distal to the duodenal bulb, circumferential ulcers were seen with overlying eschar on each duodenal and proximal jejunal fold. There was a high suspicion for ZES given the CT and endoscopic findings. Fasting serum gastrin level was 3804 pg/mL (normal).Figure 1Figure 2Figure 3GI ulcerations are common endoscopic findings in ZES with 91-93% having peptic or duodenal ulcers when diagnosed. ZES is usually characterized by solitary ulcers < 1cm in diameter, with the majority in the 1st part of the duodenum. However, it is not uncommon for ulcers to be located in the distal duodenum or jejunum. Circumferential ulcers of the small bowel are often related to non-steroidal anti-inflammatory medications, or thiazide potassium-chloride use. In this case of Zollinger-Ellison we found multiple, circumferential ulcers extending from the duodenal bulb to the jejunum, which has not been previously reported endoscopically.

Risk of cancer of unknown primary after hospitalization for autoimmune diseases.

Cancer of unknown primary (CUP) is a heterogeneous syndrome diagnosed at metastatic sites. The etiology is unknown but immune dysfunction may be a contributing factor. Patients with autoimmune diseases were identified from the Swedish Hospital Discharge Register and linked to the Swedish Cancer Registry. Standardized incidence ratios (SIRs) were calculated for subsequent CUP and compared with subjects without autoimmune diseases. A total of 789,681 patients were hospitalized for any of 32 autoimmune diseases during years 1964-2012; 2,658 developed subsequent CUP, giving an overall SIR of 1.27. A total of 16 autoimmune diseases were associated with an increased risk for CUP; polymyositis/dermatomyositis showed the highest SIR of 3.51, followed by primary biliary cirrhosis (1.81) and Addison's disease (1.77). CUP risk is known to be reduced in long-time users of pain-relieving nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin. For patients with ankylosing spondylitis and with some other autoimmune diseases, with assumed chronic medication by NSAIDSs, CUP risks decreased in long-term follow-up. The overall risk of CUP was increased among patients diagnosed with autoimmune diseases, which call for clinical attention and suggest a possible role of immune dysfunction in CUP. The associations with many autoimmune diseases were weak which may imply that autoimmunity may not synergize with CUP-related immune dysfunction. However, long-term NSAID medication probably helped to curtail risks in some autoimmune diseases and CUP risks were generally higher in autoimmune diseases for which NSAIDs are not used and for these CUP appears to be a serious side effect.

Surgical treatment of lumbar disc herniation: MIS, endoscopic, and percutaneous techniques

Lumbar disc herniation is one of the most common causes of low back pain and may be accompanied by numbness, weakness, tingling, and radiating pain in the legs. Majority of patients with radiculopathy secondary to lumbar disc herniation may be successfully treated with non-operative management including physical therapy, home exercise, counseling, and non-steroidal anti-inflammatory medications. However, surgical management of lumbar disc herniation has also been demonstrated as an efficacious treatment modality. The purpose of this paper is to characterize the indications, techniques, outcomes, and the complications associated with the surgical treatment of lumbar disc herniation treated with minimally invasive techniques.

Heterotopic Ossification: Basic-Science Principles and Clinical Correlates

➤ Heterotopic ossification occurs most commonly after joint arthroplasty, spinal cord injury, traumatic brain injury, blast trauma, elbow and acetabular fractures, and thermal injury.➤ The conversion of progenitor cells to osteogenic precursor cells as a result of cell-mediated interactions with the local tissue environment is affected by oxygen tension, pH, availability of micronutrients, and mechanical stimuli, and leads to heterotopic ossification.➤ Radiation and certain nonsteroidal anti-inflammatory medications are important methods of prophylaxis against heterotopic ossification.➤ Well-planned surgical excision can improve patient outcomes regardless of the joint involved or the initial cause of injury.➤ Future therapeutic strategies are focused on targeted inhibition of local factors and signaling pathways that catalyze ectopic bone formation.

Autologous Platelet-Rich Plasma Preparations: Influence of Nonsteroidal Anti-inflammatory Drugs on Platelet Function.

BackgroundAutologous platelet-rich plasma (PRP) has been widely used for the treatment of sports injuries. It has been associated with improved healing and regeneration of soft tissues in elite athletes. Athletes are commonly receiving nonsteroidal anti-inflammatory drugs (NSAIDs). As yet, the effect of these drugs on platelet function in PRP formulations has not been taken into consideration.HypothesisThe function of platelets in PRP produced under the influence of NSAIDs is inhibited and may lessen a possible healing effect on the site of injury.Study DesignControlled laboratory study.MethodsPRP was collected from patients receiving NSAIDs after elective orthopaedic surgery, and platelet function was evaluated using light transmission aggregometry (LTA). Results were compared with those obtained from healthy volunteers without a history of NSAID intake during the previous 2 weeks. Two different systems for blood collection and PRP production (Arthrex ACP double-syringe system and standard 4.5-mL sodium citrate blood collection tubes) were used and compared regarding the quality of PRP that was produced.ResultsFor both groups, the baseline platelet counts of whole blood and the platelet counts of PRP formulations were found to be in the normal range. Both collection systems for PRP produced comparable results without significant differences between the groups. Platelet function testing with LTA revealed significantly impaired platelet aggregation in both PRP preparations, obtained from patients taking NSAIDs, irrespective of the type of NSAID (P < .001). All subjects from the control group showed normal platelet aggregation patterns when tested with LTA.ConclusionAutologous PRP produced from subjects after NSAID medication shows significantly impaired platelet function and may result in lower quality regarding the content of bioactive compounds.Clinical RelevanceIf required, the administration of NSAIDs should be performed after blood collection for preparation of autologous PRP; otherwise, the therapeutic effect may be limited.

Surgical Management of Freiberg's Infraction: A Systematic Review.

Avascular necrosis of the second metatarsal head was first described by Freiberg in 1913. Conservative treatment includes nonsteroidal anti-inflammatory medication, reduced activity, padding, orthotics, and immobilization. Should conservative treatment fail, a wide variety of surgical procedures exist; however, the optimal procedure is unknown. This systematic review was undertaken to determine which surgical procedure allows for the best resolution of symptoms and return to activity. Included studies were restricted to articles published in English language peer-reviewed journals that consecutively enrolled patients of all ages, with Freiberg's infraction of any stage, who underwent operative treatment, and had a mean follow-up of greater than or equal to 12 months duration. Eighty-five publications were identified, of which 38 (44.7%) met all the inclusion criteria. Surgical techniques and outcomes were grouped into joint sparing and joint destructive procedures. A total of 70 joint destructive procedures were performed with a combined mean follow-up time of 15.0 months. A greater than 70% resolution of pain and full return to activity was reported. A total of 257 joint sparing procedures were performed with a combined mean follow-up of 30.4 months. A greater than 90% resolution of pain and full return to activity was reported. Results of this systematic review reveal that the results of joint sparing procedures are reported more often and appear to have a better prognosis for symptom resolution and return to activity. Smillie stage was not consistently reported, making it difficult to determine its effect on procedure selection. Therapeutic, Level IV: Systematic review of Level IV studies.

Best Practices During Hip Arthroscopy: Aggregate Recommendations of High-Volume Surgeons

To survey surgeons who perform a high volume of hip arthroscopy procedures regarding their operative technique, type of procedure, and postoperative management. We conducted a cross-sectional survey of 27 high-volume orthopaedic surgeons specializing in hip arthroscopy to report their preferences and practices related to their operative practice and postoperative rehabilitation protocol. All participants completed the survey in person in an anonymous fashion during a meeting of the American Hip Institute. All surgeons perform hip arthroscopy with the patient in the supine position, accessing the central compartment of the hip initially, using intraoperative fluoroscopy. All surgeons perform labral repair (100%), with the majority performing labral reconstructions (77.8%) and gluteus medius repairs (81.5%). There is variability in the type of anchors used during labral repair. Most surgeons perform capsular closure in most cases (88.9%), inject either intra-articular cortisone or platelet-rich plasma at the conclusion of the procedure (59%), and prescribe a postoperative hip brace for some or all patients (59%). There is considerable variability in rehabilitation protocols. All surgeons routinely prescribe postoperative heterotopic ossification prophylaxis to their patients, with most surgeons (88.9%) prescribing a nonsteroidal anti-inflammatory medication for 3 weeks. Forty percent of the respondents use the modified Harris Hip Score as the most important outcome measure. Consistent practices such as use of intraoperative fluoroscopy, heterotopic ossification prophylaxis, and labral repair skills were identified by surveying 27 hip arthroscopy surgeons at high-volume centers. Most of the surgeons performed routine capsular closure unless underlying conditions precluded capsular release or plication. The survey identified higher variability between surgeons regarding postoperative rehabilitation protocols and use of intra-articular pharmacologic injections at the end of the procedure. These data may provide surgeons with a set of aggregate trends that may help guide training, clinical practice, and research in the evolving field of hip arthroscopy.

Two-year follow-up of low-level laser therapy for elderly with painful adhesive capsulitis of the shoulder.

IntroductionThis paper reports on the medium-term mean 2-year prospective follow-up of a patient cohort of 35 unselected elderly patients with mean age of 65 years who visited our tertiary referral pain center for painful adhesive capsulitis of the shoulder managed with low-level laser therapy (LLLT).Materials and methodsAll patients in this prospective cohort study had documentation of the diagnosis by contrast-enhanced magnetic resonance imaging before study entry and all had failed to respond to a combination of conventional physical therapy and nonsteroidal anti-inflammatory medications for not fewer than 4 weeks. LLLT, at a wavelength of 810 nm emitted from a GaAIAs semiconductor laser device with 5.4 J per point and a power density of 20 mW/cm2, was employed to irradiate six predetermined anatomic points and two acupuncture points. The treatment regimen consisted of three sessions of treatment per week for 8 consecutive weeks. Each treatment session lasted 180 seconds. Serial clinical assessment was undertaken using the Constant–Murley shoulder score.ResultsA total of 50 painful shoulder joints were treated, as a number of elderly presented with bilateral symptoms. All but four painful shoulders showed significant improvement in Constant–Murley shoulder score at the end of 8-weeks’ LLLT treatment and, surprisingly, the improvement was found maintained at follow-up assessments at 1 year and 2 years.ConclusionWe conclude that LLLT is a viable option in the conservative treatment of shoulder pain arising from adhesive capsulitis of the shoulder in the elderly, with a positive clinical result of more than 90% and with clinical efficacy both in the short-term and the medium-term.

Safety and Efficacy of Continuous Epidural Anesthesia Following Scoliosis Surgery in Respiratory-Impaired Neuromuscular Children: A Pilot Study

Study DesignRetrospective comparative study. ObjectiveTo identify the usefulness of epidural anesthesia for postoperative pain without opioid in respiratory-impaired children with neuromuscular scoliosis. Summary of Background DataSafety and adequate postoperative pain control is the most important concern in respiratory-impaired children. In general, after a massively invasive operation analgesia is performed with continuous intravenous infusion of opioid. However, the opioid side effect of respiratory depression could be critical for these patients. MethodsThe authors compared a group of 5 patients with continuous epidural anesthesia (Epi[+]) and a group of 5 patients without epidural anesthesia (Epi[−]). Spinal correction was performed under general anesthesia. At the end of surgery, for patients in the Epi[+] group, an epidural catheter was inserted by a surgeon. Nonsteroidal anti-inflammatory medication was prescribed regularly for postoperative pain; additional medications were permitted following the same protocol in both groups. Via the epidural catheter, 0.2% ropivacaine was continuously infused at 4 to 6ml/hour for 3 days. The researchers compared the numeric rating scale, the frequency of use of an additional painkiller, the day patients were able to leave the bed, and the duration of the hospital stay. ResultsThe numeric rating scale in the Epi[+] group was significantly lower than in the Epi[−] group each day; the frequency of using an additional painkiller was also lower in the Epi[+] group than the Epi[−] group. In addition, the researchers could find no complications including respiratory depression related to epidural anesthesia. ConclusionsContinuous epidural anesthesia could be effective and safe in children with neuromuscular scoliosis. It could control postoperative pain from scoliosis surgery without opioids, which may cause pulmonary depression. This pilot study indicates the need for further investigations to confirm the potential benefits of this method.

G357 Chronic recurrent multifocal osteomyelitis (crmo): the value of whole body mri demonstrated by a series of 13 adult and 34 paediatric patients

Aim To assess the role of whole-body MRI (WB MRI) in the diagnosis and management of patients with Chronic Recurrent Multifocal Osteomyelitis (CRMO). CRMO is a benign and non-infective autoinflammatory bone disorder characterised by multiple and recurrent inflammatory bone lesions. No universal diagnostic criteria exist. Methods Retrospective review of CRMO cases diagnosed at this hospital between 2008 to 2014. Cases were identified from patient records, and clinical information was collated from radiology and histopathology records and individual case notes. Results Forty seven CRMO patients were identified who had had WB MRI, of these 34 were paediatric patients up to the age of 18 years. The number of WB MRI scans per case ranged from 1 to 5 [mean 1.5]. WB MRI identified multifocal lesions in 30 patients. The clavicle, tibia and femur were most frequently involved. All cases were managed with non-steroidal anti-inflammatory medication or bisphosphonates. No children required steroid or anti-TNF treatment or surgical resection. Conclusions In the absence of specific diagnostic criteria, WB MRI in combination with clinical assessment can aid in the diagnosis of CRMO. WB MRI has almost entirely replaced bone biopsy in the diagnosis of CRMO at our institution.

Septic Arthritis and Acute Rheumatic Fever in Children

Joint pain and raised inflammatory markers are features of both acute rheumatic fever (ARF) and septic arthritis, often posing a diagnostic challenge to clinicians. Important differences in the presenting serological inflammatory marker profile may assist patient diagnosis, however, as clinical experience suggests that ARF is associated with a higher erythrocyte sedimentation rate (ESR), whereas other serological markers may be similarly elevated in these 2 conditions. The goal of this study was to determine the diagnostic value of serological inflammatory markers and white cell count (WCC) in children presenting with acute joint pain secondary to ARF or septic arthritis. Data were obtained from the Auckland regional rheumatic fever database and hospital computer records between 2005 and 2012. Records of all patients under the age of 16 years who were admitted with a new diagnosis of ARF or septic arthritis were analyzed. The diagnosis of ARF was defined on the basis of the New Zealand modification of the Jones Criteria, and the diagnosis of septic arthritis was defined on the basis of joint fluid cytology and culture. Baseline characteristics, serological inflammatory markers, and serum WCC were compared between the ARF and septic arthritis patient groups. Children with ARF displayed significantly higher ESR, higher serum C-reactive protein, and lower serum WCC than children with septic arthritis on presentation to hospital. In children presenting with monoarthritis, an ESR>64.5, serum WCC<12.1×109/L, and age above 8.5 years were found to be significant independent predictors of ARF. Children with all 3 predictors had a 71% risk for ARF and a 29% risk for septic arthritis. A significant proportion (30%) of children with the final diagnosis of ARF initially presented with monoarthritis; 14% of these children (5/34) had received nonsteroidal anti-inflammatory medication before hospital presentation, and 74% of these children (25/34) had abnormal echocardiograms on admission. ARF and septic arthritis are important diagnoses to consider in children presenting with acute joint pain in New Zealand. A significant proportion of patients with ARF initially present with acute monoarthritis. Serological inflammatory markers and WCC on presentation differ significantly between children with ARF and septic arthritis.

Pilot study for detection of early changes in tissue associated with heterotopic ossification: moving toward clinical use of Raman spectroscopy

Over 60% of combat-wounded patients develop heterotopic ossification (HO). Nearly 33% of them require surgical excision for symptomatic lesions, a procedure that is both fraught with complications and can delay or regress functional rehabilitation. Relative medical contraindications limit widespread use of conventional means of primary prophylaxis, such as nonspecific nonsteroidal anti-inflammatory medications and radiotherapy. Better methods for risk stratification are needed to both mitigate the risk of current means of primary prophylaxis as well as to evaluate novel preventive strategies currently in development. We asked whether Raman spectral changes, measured ex vivo, could be associated with histologic evidence of the earliest signs of HO formation and substance P (SP) expression in tissue biopsies from the wounds of combat casualties. In this pilot study, we compared normal muscle tissue, injured muscle tissue, very early HO lesions ( < 16 d post-injury), early HO lesions ( > 16 d post-injury) and mature HO lesions. The Raman spectra of these tissues demonstrate clear differences in the Amide I and III spectral regions of HO lesions compared to normal tissue, denoted by changes in the Amide I band center (p < 0.01) and the 1340/1270 cm−1 (p < 0.05) band area and band height ratios. SP expression in the HO lesions appears to peak between 16 and 30 d post-injury, as determined by SP immunohistochemistry of corresponding tissue sections, potentially indicating optimal timing for administration of therapeutics. Raman spectroscopy may therefore prove a useful, non-invasive and early diagnostic modality to detect HO formation before it becomes evident either clinically or radiographically.

Acupuncture in patients with a vertebral compression fracture: a protocol for a randomized, controlled, pilot clinical trial.

Objectives:A vertebral compression fracture (VCF) is characterized by back pain and fracture of a vertebral body on spinal radiography. VCFs of the thoraco lumbar spine are common in the elderly. In general, appropriate analgesics should be prescribed to reduce pain and, thus, promote early mobilization. The ideal treatment approach for VCFs has not been determined. In Korea, acupuncture and herbal medication have been used to treat VCFs for many years. There is empirical evidence that acupuncture might benefit patients with a VCF. However, no randomized, controlled, clinical trials evaluating the efficacy and the safety of acupuncture for treating a VCF have been published. Therefore, we designed a randomized, controlled, pilot, clinical trial to obtain information for the design of a further full scale trial.Methods:A five week protocol for a randomized, controlled, pilot, clinical trial is presented. Fourteen patients will be recruited and randomly allocated to two groups: a control group receiving interlaminar epidural steroid injections once a week for three weeks, and an experimental group receiving interlaminar epidural steroid injections plus acupuncture treatment (three acupuncture sessions per week for three weeks, nine sessions in total). The primary outcomes will be the pain intensity (visual analogue scale and PainVisionTM system). The secondary outcome measurements will be the answers on the short form McGill pain questionnaire and the oswestry disability index. Assessments will be made at baseline and at one, three, and five weeks. The last assessment (week five) will take place two weeks after treatment cessation. This study will provide both an indication of feasibility and a clinical foundation for a future large scale trial. The outcomes will provide additional resources for incorporating acupuncture into existing treatments, such as nonsteroidal anti-inflammatory medications, narcotics and vertebral augmentation. This article describes the protocol.

Aspirin and nonsteroidal anti-inflammatory drugs after but not before diagnosis are associated with improved breast cancer survival: a meta-analysis

The association between nonsteroidal anti-inflammatory drugs (NSAIDs) and breast cancer survival is still controversial. The aim of our meta-analysis was to assess the survival benefit of NSAIDs. A literature search was conducted in PubMed and EMBASE (to September 2014). A meta-analysis was performed with hazard ratios (HRs) and 95% confidence intervals (CIs) as the effect measures. Subgroup analyses were based on time of NSAID use (before and after diagnosis), medication type (aspirin and other nonaspirin NSAIDs), and study design (cohort and case-control studies). There were 16 eligible studies. Use of NSAIDs after diagnosis was significantly inversely associated with relapse/metastasis (HR 0.69, 95% CI 0.59-0.80) and tended toward potentially protective effects on all-cause mortality, although significance was not reached (HR 0.79, 95% CI 0.61-1.02). In cohort studies, the association between post-diagnostic use of NSAIDs and breast cancer survival was stronger with reduced heterogeneity (breast-cancer-specific mortality: HR 0.65, 95% CI 0.48-0.89, I(2) = 65.3%; all-cause mortality: HR 0.73, 95% CI 0.57-0.92, I(2) = 83.2%; relapse/metastasis: HR 0.73, 95% CI 0.61-0.86, I(2) = 48.3%). Aspirin use after diagnosis was significantly associated with breast-cancer-specific mortality (HR 0.69, 95% CI 0.50-0.96) and relapse/metastasis (HR 0.75, 95% CI 0.56-1.00), and tended toward a protective effect on all-cause mortality, although significance was not reached (HR 0.79, 95% CI 0.60-1.03). Including cohort studies only, we obtained similar results and post-diagnostic use of aspirin was significantly associated with all-cause mortality (HR 0.72, 95% CI 0.56-0.93). NSAIDs and aspirin after but not before diagnosis were associated with improved breast cancer survival, including breast-cancer-specific mortality, all-cause mortality, and relapse/metastasis.

Hypertrophic osteodystrophy in a dog imaged with CT

A seven-month-old male neutered cross-breed dog presented with non-specific signs of lethargy, pyrexia and pain on manipulation of the limbs, which progressed over a period of 24 hours to a...

Abstract T P100: Optimal Duration of Dual Antiplatelet Therapy for Symptomatic Intracranial Stenosis

BACKGROUND: There is limited data on the optimal duration of dual antiplatelet therapy in combination with aggressive optimization of risk factors for secondary stroke prevention in patients with symptomatic intracranial stenosis. METHODS: Consecutive patients presenting to Emory University Hospital with high-grade (70-99%) symptomatic intracranial stenosis from January 1, 2011 to December 31, 2013 and evaluated within 30 days of the index event (stroke or TIA) were eligible for this analysis. All patients underwent treatment with aspirin plus clopidogrel for a target duration of 12 months along with aggressive medical management based on the SAMMPRIS protocol; all patients were given an H2 blocker as gastrointestinal prophylaxis for the duration of their aspirin and clopidogrel treatment. Clinical and safety outcomes of our cohort were compared with the medical arm of the SAMMPRIS trial cohort (n=227). RESULTS: Of 25 patients who met inclusion criteria, mean age was 65 +/- 14 years, 77% male, 58% white, 92% with hypertension, 100% with dyslipidemia, 15% with coronary artery disease, and 73% had stroke as their symptomatic event; baseline characteristics were similar between the Emory cohort and the SAMMPRIS cohort except for active smoking at the time of symptomatic event (Cohort 8%, SAMMPRIS 30%) and basilar site of symptomatic stenosis (Cohort 44%, SAMMPRIS 22%). Achievement of blood pressure and LDL cholesterol targets were similar between our cohort and SAMMPRIS cohort. At 1 year, rates of stroke, myocardial infarction or vascular death were 0% in our cohort vs 16% in the SAMMPRIS cohort (p = 0.03). At 1 year, major bleeding occurred in only 1 (4%) patient who had gastrointestinal bleeding requiring transfusion while taking concomitant non-steroidal anti-inflammatory medication. CONCLUSIONS: A prolonged course of dual antiplatelet therapy with aspirin and clopidogrel for at least 12 months in combination with aggressive medical management based on the SAMMPRIS protocol may be associated with reduced rates of stroke, myocardial infarction, and vascular death compared to dual antiplatelet therapy for 3 months.

Hemostatic Agents in Spine Surgery: A Critical Analysis Review.

Blood loss during spine surgery is one of the most difficult challenges facing the surgeon, with effects ranging from decreased visualization of the operative field to life-threatening hemorrhage. Specific considerations for intraoperative bleeding include the potential for development of acute stroke from vertebral artery transection to spinal cord ischemia. Additionally, the need for perioperative transfusion of blood products has been associated with longer hospital stays and increased cost1. Management of blood loss begins in the preoperative period with discontinuation of medications known to increase the risk of bleeding, including aspirin, other nonsteroidal anti-inflammatory medications, and anticoagulants. The reasons for taking these medications and their discontinuation should be discussed with both the patient and the patient’s primary care physician or cardiologist. At the time of the operation, a collaborative effort between the anesthesiologist and the surgeon is undertaken to manage appropriate hemostasis. This …

Nonsteroidal anti-inflammatory medications are cytostatic against human vestibular schwannomas

Vestibular schwannomas (VSs) are the most common tumors of the cerebellopontine angle. Significant clinical need exists for pharmacotherapies against VSs. Motivated by previous findings that immunohistochemical expression of cyclooxygenase 2 (COX-2) correlates with VS growth rate, we investigated the role of COX-2 in VSs and tested COX-2 inhibiting salicylates against VSs. COX-2 was found to be aberrantly expressed in human VS and primary human VS cells in comparison with control human nerve specimens and primary Schwann cells (SCs), respectively. Furthermore, levels of prostaglandin E2, the downstream enzymatic product of COX-2, were correlated with primary VS culture proliferation rate. Because COX-2 inhibiting salicylates such as aspirin are well tolerated and frequently clinically used, we assessed their repurposing for VS. Changes in proliferation, cell death, and cell viability were analyzed in primary VS cultures treated with aspirin, sodium salicylate, or 5-aminosalicylic acid. These drugs neither increased VS cell death nor affected healthy SCs. The cytostatic effect of aspirin in vitro was in concurrence with our previous clinical finding that patients with VS taking aspirin demonstrate reduced tumor growth. Overall, this work suggests that COX-2 is a key modulator in VS cell proliferation and survival and highlights salicylates as promising pharmacotherapies against VS.

Site-specific targeting of platelet-rich plasma via superparamagnetic nanoparticles.

Background:Muscle strains are one of the most common injuries treated by physicians. Standard conservative therapy for acute muscle strains usually involves short-term rest, ice, and nonsteroidal anti-inflammatory medications, but there is no clear consensus regarding treatments to accelerate recovery. Recently, clinical use of platelet-rich plasma (PRP) has gained momentum as an option for therapy and is appealing for many reasons, most notably because it provides growth factors in physiological proportions and it is autologous, safe, easily accessible, and potentially beneficial. Local delivery of PRP to injured muscles can hasten recovery of function. However, specific targeting of PRP to sites of tissue damage in vivo is a major challenge that can limit its efficacy.Hypothesis:Location of PRP delivery can be monitored and controlled in vivo with noninvasive tools.Study Design:Controlled laboratory study.Methods:Superparamagnetic iron oxide nanoparticles (SPIONs) can be visualized by both magnetic resonance imaging (MRI) (in vivo) and fluorescence microscopy (after tissue harvesting). PRP was labeled with SPIONs and administered by intramuscular injections of SPION-containing platelets. MRI was used to monitor the ability to manipulate and retain the location of PRP in vivo by placement of an external magnet. Platelets were isolated from whole blood and incubated with SPIONs. Following SPION incubation with PRP, a magnetic field was used to manipulate platelet location in culture dishes. In vivo, the tibialis anterior (TA) muscles of anesthetized Sprague-Dawley rats were injected with SPION-containing platelets, and MRI was used to track platelet position with and without a magnet worn over the TA muscles for 4 days.Results:The method used to isolate PRP yielded a high concentration (almost 4-fold increase) of platelets. In vitro experiments showed that the platelets successfully took up SPIONs and then rapidly responded to an applied magnetic field. Platelets without SPIONs did not respond to the magnetic field. In vivo experiments showed that the SPION-containing platelets can be noninvasively maintained at a specific site with the application of a magnetic field.Conclusion:PRP may be a useful product in the clinical treatment of muscle injuries, but one problem with using it as a therapeutic tool is retaining PRP at the site of injury. This study proposes a potential solution, with findings that support this method at the cell, whole muscle, and in vivo levels. Controlling the location of PRP will allow the clustering of PRP to enrich the target area with growth factors and will prevent loss of platelets over time at the site of injury.

Low Back Pain Radiating to the Left Buttock as a Form of Onset of Multiple Myeloma: A Rare Case Report

Low back pain (LBP) is a common presentation in patients with multiple myeloma. However, LBP that is increased or unrelieved by rest may indicate for malignancy and a patient's young age may mislead and delay diagnosis. Here, we presented a 43 year-old-female who complained of low back pain with radiation to left buttock. The symptom got worsen at night and not improved after took nonsteroidal anti-inflammatory medication. X-ray of lumbarsacral spine revealed ostelytic lesion over sacral bone. Magnetic resonance (MR) imaging studies of lumbarsacral spine showed an infiltrative tumor involving the left-sided sacral bone. Accordingly, left sacral laminectomy with removal of tumor was performed and pathological result revealed plasmacytoma. In addition, bone marrow biopsy demonstrated increased plasma cells with 35% of all nucleated cells. The final diagnosis was multiple myeloma.