Faculty Bibliography

STUDY DESIGN: A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society Questionnaire (SRS 24). OBJECTIVE: To evaluate the patient based outcome of the surgical treatment of adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: A paucity of information exists with respect to patient measures of outcome regarding the surgical treatment of adolescent idiopathic scoliosis. To our knowledge, no prospective outcome study on this topic thus far exists. METHODS: Using the SRS 24 questionnaire, seven scoliosis centers agreed to prospectively assess outcome for surgically treated patients with adolescent idiopathic scoliosis. Data were collected before surgery and at 24 months after surgery. Data were analyzed using paired and independent samples t test for all seven SRS 24 questionnaire domains (Pain, General Self-Image, Postoperative Self-Image, Postoperative Function, Function From Back Condition, General Level of Activity, and Satisfaction) using Statistical Package for Social Science. The domains were analyzed with respect to the total cohort, gender, curve magnitude, and type of surgery using independent-samples t tests. RESULTS: A total of 242 patients were included in our analysis. A baseline preoperative pain level of 3.68 of 5 was found. This improved to 4.63 after surgery, representing an improvement of 0.95 points. Surgical intervention was associated with improving outcome when compared with preoperative status. Pain, General Self-Image, Function From Back Condition, and Level of Activity all demonstrated statistically significant improvement as compared with preoperative status (P < 0. 001). Overall, patients were highly satisfied with the results of surgery. CONCLUSION: Preoperative pain exists in our adolescent scoliosis population. Pain scores were improved in our study population at the 2-year postsurgical follow-up. Statistically significant improvements were likewise seen in the General Self-Image, Function From Back Condition, and Level of Activity domains. The present study demonstrates the ability of surgery to improve the outcome of patients afflicted with adolescent idiopathic scoliosis

The centers' new director, Dr. Julie L. Gerberding, said some of the problems presented by the West Nile outbreak were similar to those the agency would confront in a biological attack, in that communities were threatened by a seemingly novel microbe. She said the agency was drawing useful lessons from its experiences with West Nile, and applying lessons it had learned in the anthrax outbreak. There is wide agreement in and out of the agency that lack of openness was a major problem in the anthrax outbreak. Particularly embarrassing to C.D.C. workers, hundreds of whom were investigating the anthrax outbreak, was that the government's leading scientific spokesman on the attack was the director of a rival agency, Dr. Anthony S. Fauci of the National Institute of Allergy and Infectious Diseases. Dr. Gerberding said she had also reorganized the centers' schedule of scientific and administrative meetings to avoid the duplication that she said was ''extremely disruptive'' in the anthrax outbreak. And she said she would streamline the operation of the agency's headquarters, which was so cumbersome that members of the anthrax investigating team often learned about developments in the case from news reporters

Three of the four recipients of organs from a single donor who had West Nile virus also developed West Nile encephalitis, strengthening the possibility that the virus can be transmitted through organ transplants or blood, federal health officials said last night. The new tests do not necessarily prove that the three patients acquired West Nile encephalitis from the organ transplants. Because the three recipients lived in Georgia and Florida, where infected mosquitoes have transmitted the virus to humans and birds, a remote possibility exists that all three acquired the West Nile virus through insect bites. Dr. [Jesse Goodman] said he was not aware that blood centers had conducted research to randomly test donated blood for the West Nile virus. A concern is that most people infected with West Nile virus have no symptoms but could have the virus in their blood when they donate. But unlike H.I.V. and hepatitis, West Nile virus is an acute infectious disease and chronic carriers have not been detected, Dr. Goodman said

Because blood is involved in the natural transmission of West Nile -- through mosquito bites -- doctors have theorized that West Nile could be transmitted through transfusions and organ transplants. Two weeks ago, health officials said they reminded the nation's blood banks to enforce a standard procedure -- rejecting donations from patients with fever and flulike symptoms, which could be symptoms of mild West Nile fever. Dr. [Jesse Goodman] said he would not expect people who have recovered from an infection to have West Nile virus in their blood for long because by the time symptoms develop, the virus is difficult to detect. In such cases, evidence of West Nile infection is based on detecting the specific antibodies that a patient's immune system develops in response to the infection. ''It is very important to recognize that unlike H.I.V. or hepatitis, West Nile virus is an acute infectious disease and we are unaware of any kind of chronic carrier state,'' Dr. Goodman said. He also said: ''If I were a person with severe chronic disease and I needed an organ transplant, concern about this would be right at the bottom of my list of things that I was worried about. Similarly, if I needed a transfusion this would be at the bottom of the list of my concerns. If I lived in an area where West Nile was circulating, which is much of the country at the moment, my greatest concern about West Nile would be to take precautions to minimize my risk of being bitten by mosquitoes.''

West Nile virus is naturally transmitted through mosquito bites. This year, the U.S. is experiencing its worst outbreak of West Nile fever since the virus was first detected in this hemisphere, in 1999 in New York City. Over the weekend, the total number of cases has risen to 638, including 31 deaths. The theoretical possibility of transmitting West Nile Virus through blood transfusions and questions about the nation's blood supply were put to a real test in recent days because of the detection of West Nile infection in one recipient of the donor's organs. That recipient has encephalitis, or inflammation of the brain. Three other recipients, in Georgia and Florida, of the same donor's organs are suspected of developing West Nile fever. Preliminary tests of a patient who died with encephalitis after receiving a kidney from the donor show evidence of infection with a mosquito-borne virus. Further tests are needed to prove it is West Nile virus

One of the four recipients died about four weeks after the transplant. Pathology tests show the recipient had encephalitis, or inflammation of the brain and central nervous system. Tests are planned to determine if the recipient was infected with West Nile virus, which can cause encephalitis. On Friday, Dr. Julie L. Gerberding, the director of the CDC, said that 'transmission of the West Nile virus through blood and organs is biologically plausible' and that 'a leading hypothesis that we are investigating is that it is related to the organ transplant.' Meanwhile, scientists at the CDC are conducting laboratory tests on the organ donor's brain for evidence of West Nile virus or a closely related virus

Three of four patients who received organs from one donor have apparently developed encephalitis and tests show that one recipient is infected with the West Nile virus, raising suspicion that the virus can be transmitted through organ transplants, federal health officials said yesterday. One of the four recipients died about four weeks after the transplant. Standard pathology tests from an autopsy show that the recipient had encephalitis, or inflammation of the brain and central nervous system. Tests are planned to determine if the recipient was infected with West Nile virus, which causes encephalitis. One of the four organ transplant recipients developed a mild fever that resolved. Tests are planned to determine whether that recipient had a mild case of West Nile fever. Most people infected with the virus develop a mild flu-like illness or experience no symptoms

A method to produce highly purified thrombin from salmon blood is described, and a series of biochemical, cell biologic, and biophysical assays demonstrate the functional similarities and some differences between salmon and human thrombins. Salmon thrombin with specific activity greater than 1000 units/mg total protein can be prepared by modifications of the methods used for purification of human thrombin. Using a synthetic substrate based on the human fibrinogen A-alpha polypeptide sequence as an indicator of enzymatic activity, salmon and human thrombin preparations contain similar specific activities per mass of purified protein. Salmon thrombin activates human fibrinogen and initiates the formation of fibrin clots whose structure and rheologic properties are indistinguishable from those of human fibrin clotted by human thrombin. Salmon thrombin also activates human platelets. Approximately 10 times higher activities are needed for the same rate of platelet aggregation compared to human thrombin, and some aspects of platelet activation, most notably phosphatidylserine exposure, are diminished relative to the effects of human thrombin. This latter finding suggests that salmon thrombin may not activate all of the receptors that are targets of human thrombin, although it does appear to activate signals that are sufficient to produce normal rates of activation and aggregation as measured by conventional aggregometry. Together with the recent purification of salmon fibrinogen and its application in mammalian wound healing, the availability of salmon thrombin allows the formulation of biological sealants devoid of any exogenous mammalian proteins and so may aid the design of materials with increased safety from infectious disease transmission.

We demonstrated recently that uninjured C-fiber nociceptors in the L4 spinal nerve develop spontaneous activity after transection of the L5 spinal nerve. We postulated that Wallerian degeneration leads to an alteration in the properties of the neighboring, uninjured afferents from adjacent spinal nerves. To explore the role of degeneration of myelinated versus unmyelinated fibers, we investigated the effects of an L5 ventral rhizotomy in rat. This lesion leads to degeneration predominantly in myelinated fibers. Mechanical paw-withdrawal thresholds were assessed with von Frey hairs, and teased-fiber techniques were used to record from single C-fiber afferents in the L4 spinal nerve. Behavioral and electrophysiological data were collected in a blinded manner. Seven days after surgery, a marked decrease in withdrawal thresholds was observed after the ventral rhizotomy but not after the sham operation. Single fiber recordings revealed low-frequency spontaneous activity in 25% of the C-fiber afferents 8-10 d after the lesion compared with only 11% after sham operation. Paw-withdrawal thresholds were inversely correlated with the incidence of spontaneous activity in high-threshold C-fiber afferents. In normal animals, low-frequency electrocutaneous stimulation at C-fiber, but not A-fiber, strength produced behavioral signs of secondary mechanical hyperalgesia on the paw. These results suggest that degeneration in myelinated efferent fibers is sufficient to induce spontaneous activity in C-fiber afferents and behavioral signs of mechanical hyperalgesia. Ectopic spontaneous activity from injured afferents was not required for the development of the neuropathic pain behavior. These results provide additional evidence for a role of Wallerian degeneration in neuropathic pain.