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Objective: Gastrointestinal toxicity is one of the most common side effects of anticancer therapy. Measurement of intestinal permeability represents one of the potential methods of noninvasive laboratory assessment of gastrointestinal toxicity. The aim of the present study was to investigate intestinal permeability and vitamin A absorption in patients with chemotherapy-induced diarrhea (CID)., Methods: We have assessed intestinal permeability, by measuring absorption of lactulose, mannitol, xylose, and vitamin A absorption, in 11 patients with CID, 10 healthy controls, and 24 untreated patients with gastrointestinal tumors. Urinary lactulose, mannitol and xylose were measured by capillary gas chromatography and serum retinol and retinyl esters were determined by high performance liquid chromatography. The results obtained in patients and controls were compared by Mann-Whitney U test., Results: Lactulose/mannitol and lactulose/xylose ratios were increased and retinol esters (retinyl palmitate and retinyl stearate) were decreased significantly in patients with CID., Conclusions: Measurements of intestinal permeability and vitamin A absorption may represent sensitive tools in the assessment of CID.

Objective: The detection of sentinel nodes is performed in various types of malignant disease. The aim of this study was to evaluate the results of the radiodetection of sentinel nodes, based on the use of Tc-colloid, during the surgical treatment of rectal cancer., Methods: In 2003-2004, 42 patients (24 males and 18 females; average ages of 62.4 and 67 years, respectively) were examined during rectal carcinoma surgical procedures. Miles abdominoperineal rectal resection was performed in nine cases; 33 patients underwent low anterior rectum resection by total mesorectal excision. On the day of the operation, a transanal submucosal infiltration of colloid labelled with radioactive 99mTc was performed; infiltration was performed strictly peritumorally. After the operation, radiodetection of the surgical specimens (using a hand-held gamma probe) was performed. The areas of higher radioactivity were marked. The specimens were then examined by a histopathologist. The nodes found closest to the marked areas were considered to be 'sentinel nodes'. The results of scintigraphy and postoperative radiodetection were checked by histological examination. All the discovered lymph nodes were examined by haematoxylin and eosin staining; when this was negative, immunohistochemical examination with cytokeratin was used for the sentinel nodes., Results: In 36 of the 42 patients, the data obtained by scintigraphy and radiodetection were in agreement with histopathological proof of a sentinel node. The sensitivity of the method in this group of patients was 86% (95% confidence limits: 70.75-94.05)., Conclusions: The scintigraphic method of detection of sentinel nodes in total mesorectal excision is not therapeutic, but diagnostic, and demonstrates a high level of reliability. It can be used to indicate the nodes that should be examined to detect the presence of possible micrometastases immunohistochemically. However, this method cannot be used for all detected nodes as it is very demanding. In the evaluated group of patients, there were no intraoperative or postoperative complications caused by this diagnostic method.

Patients with lumboradicular pain syndromes with or without sensomotor symptoms and signs often present with discrepancies in clinical and neuroradiologic (magnetic resonance imaging, computed tomography, myelogram) findings that make it difficult to identify a particular nerve root responsible for the patient's complaints. However, two questions usually are discussed for patients with relative indications for surgery: 1) positive predictors for an operation: who are the good candidates for surgery?; and 2) which level or nerve root should be approached to perform minimally invasive surgery? When imaging and clinical findings are not in complete agreement, the surgeon may need additional tests to make important decisions regarding surgery. Neurophysiologic tests can provide such information. However, the surgeon's expectation cannot be satisfied fully because of unanswered questions related to sensitivity, specificity, and positive predictive value of a particular electrophysiologic study.

A pair of functional radiographs, taken at each end of the range of motion, are used to determine spinal motions. Graphic construction and computer-assisted methods are available for the radiographic analysis. The later provides many more motion parameters. A study of lumbar spine lateral radiographs was conducted to determine errors in the motion parameters due to spinal level, radiographic quality, and errors in the two digitizing instruments. Significant differences were found in the errors due to the two digitizers when the same radiographic pair was redigitized several times. There were only minimal differences, however, between the digitizers when the radiographic films were remarked and redigitized. The error ranges (2 x SD) for the motion parameters were 1) rotation = +/- 1.25 degrees; 2) translation of the inferior posterior vertebral body corner = +/- 0.86 degrees; and 3) coordinates for the center of rotation = +/- 4.3 mm. Both the spinal level and radiographic quality affected the magnitude of errors in all motion parameters.

Fifty-one patients suffering from soft tissue injury of the cervical spine underwent clinical and psychometric examination. Clinical interview evaluated subjective complaints and formal testing of self-estimated cognitive impairment, divided attention, and speed of information processing. Results indicated at least two different syndromes: 1) the "cervicoencephalic syndrome," characterized by headache, fatigue, dizziness, poor concentration, disturbed accommodation, and impaired adaptation to light intensity; and 2) the "lower cervical spine syndrome," which is accompanied by cervical and cervicobrachial pain. When comparing patients with either of these two syndromes, those suffering from cervicoencephalic syndrome had significantly poorer results when tested for divided attention. Speed of information processing was reduced to a comparable extent in both syndromes. These findings were not related to the length of the post-traumatic interval. Reduced processing of working memory is assumed, which may account for more global cognitive problems as well as secondary neurotic reaction.

The purpose of this study was to examine the mechanical function of the C1-C2 capsular ligaments. Physiologic torques of up to 1.5 Nm were applied to human fresh cadaveric specimens (C0-C1-C2-C3) in three dimensions, and the three-dimensional motion of C1 relative to C2 was recorded. Two groups of cadaveric specimens were used to study the effect of two different sequential ligamentous transections. In the first group (n = 4), the transection of the left capsular ligament was followed by transection of the right capsular ligament. In the second group (n = 10), the transection of the left capsular ligament was preceded by transection of the left and right alar and transverse ligaments. The greatest changes in motion occurred in axial rotation to the side opposite the transection. In the first group, left capsular transections resulted in a significant increase in axial rotation range of motion to the right of 1 degree. After the right capsular ligament was transected, there was a further significant increase of 1.8 degrees to the left and 1.0 degree to the right. Lateral bending to the left also increased significantly by 1.5 degrees after both ligaments were cut. In the second group, with the nonfunctional alar and transverse ligaments, transection of the left capsular ligament resulted in greater increases in range of motion: 3.3 degrees to the right and 1.3 degrees to the left. Lateral bending to the right also increased significantly by 4.2 degrees.

The purpose of this study was to determine the clinical validity of functional flexion-extension roentgenograms of the lumbar spine in a defined patient population. One hundred and one adults with low-back pain or functional disorders underwent passive functional flexion-extension examinations. Their roentgenograms were analyzed using a computer-assisted method to determine segmental motion parameters such as rotation and translation of the lumbar vertebrae. The patient population was broken down into five groups with similar pathologies or physical conditions, and their motion parameters compared to a normal population and to each other. It was found that all of the patient groups exhibited significantly hypomobile motion, spread equally among all levels, in comparison to the normal population, except for the group of high-performance athletes, who had significant hypermobility. The uniform spread of hypomobility limits the ability to distinguish with any confidence between the four pathologic groups by their motion. Thus, we believe that the analysis of the segmental motion of the lumbar spine using passive flexion-extension roentgenograms does not aid in differentiating the underlying pathologic condition of patients with low-back pain, and that no useful information can be derived form this procedure, especially in relation to the need for surgical intervention.

Magnetic stimulation of the motor cortex, motor roots, and proximal nerve trunks was performed in 46 healthy adults and in 73 consecutive patients with disorders of the lumbar spine. In combination with neurography and F-wave recordings, the fractionated stimulation of the motor pathways allowed calculation of conduction times of the pyramidal tract fibers, of the motor roots (ie, caudal fibers), and of the motor fibers of the lumbosacral plexus. Normal values for motor conduction times to the quadriceps, anterior tibial, and extensor digitorum brevis muscles were established. Patients had clinical and radiologic diagnoses of spinal stenosis (n = 43) and nerve root compression syndromes (n = 30). Motor conduction times to lower limb muscles were significantly delayed (above mean normal value +/- 2 x SD) in 65% of the patients with spinal stenosis and 50% of the patients with nerve root compression syndromes. Conduction slowing could be localized within the motor root and caudal fiber segment of the motor pathways in 80% of the patients in whom F-waves could be recorded. This method can be used to verify, quantify, and locate lesions of the motor pathways in conditions such as compression of the spinal cord, the caudal fibers (spinal stenosis), or the motor root passing through the intervertebral canal.

Care must be exercised in interpreting the clinical and radiologic findings when assessing patients with cervical spondylosis and involvement of neural structures for surgery. If the clinical picture cannot logically be explained by the radiologic findings, further investigation is indicated to exclude a coexistent disorder. Investigations may include electrophysiologic tests, transcranial magnetic stimulation, cerebrospinal fluid (CSF) analysis, and magnetic resonance imaging (MRI). Only then can the indication for surgical intervention be properly determined.

Measurements of motor-evoked potentials by means of fractionated magnetic stimulation of motor pathways to the upper limbs was performed as part of the clinical assessment in 268 patients with cervical spine disorders. Seventy-two percent of the 127 patients with degenerative changes of the cervical spine, 67% of the 55 patients with rheumatoid arthritis (RA), and 57% of the 51 patients with trauma of the cervical spine showed a pathologic delay of central motor latency (CML). The data suggest that this method has a high sensitivity and therefore is recommended in the diagnosis of cervical spine disorders in patients with suspected compression of neural structures.

Painless transcranial magnetic stimulation has been performed on 53 healthy adults in order to obtain normal values of central motor pathway conduction times to cervical segments innervating upper limb muscles. Central motor latency was 5.1 msec when recording from the biceps brachii and 5.2 msec when recording from the abductor pollicis brevis or abductor digiti minimi muscles. The plexus motor latency as the conduction time between the cervical motor root and the proximal nerve trunks in the axillary region was 2.2 msec and 2.6 msec when recorded from the abductor pollicis brevis and abductor digiti minimi muscles, respectively. Conduction times higher than mean latency + 2 standard deviation may indicate a pathologic conduction slowing. Magnetic stimulation of the motor system is a new painless neurophysiologic technique enabling examination of the central motor pathways in awake subjects. With respect to spinal cord diagnostics, this method is useful in conditions such as compression of the spinal cord or of the motor root in the intervertebral foramen or canal.

In December 1973 a technician was accidentally irradiated when attempting to bring under control a sealed 60Co source (110 TBq) which had been lodged in the head of a medical irradiation unit during a replacement operation. In the early period after the accident, severe skin changes on the left hand, epilation in a small area of the left temporal region and minor deviations in peripheral blood developed. In the following years, repeated surgery due to secondary skin defects of the left hand resulted in the loss of the fingers 2-5. Since 1975, changes in the lens of the left eye began to appear leading gradually to the deterioration of visual acuity. Later, opacities of the lens of the right eye were found. The patient's psychological and emotional attitude about the accident changed in the course of time. The factors influencing the psychic state of the patient are identified.