Two Cases of Use of Cement Augmented Screws for Osteosynthesis of the Spine

With this report we decided to present the initial experience with the use of cement augmented screws in Cotrel-Dubousset fixation in cases of patients with degenerative spines in combination with severe osteoporosis. We present two patients who underwent treatment at UMHAT "Sv. Georgi ”, Plovdiv. The first is a 75-year-old woman who underwent right hip arthroplasty in 2002 with a Muller prosthesis. 14 years later (in 2016) due to implant ablation, a revision of the joint with a cementless, revision modular endoprosthesis of Metrimed was performed. In 2022, due to secondary degenerative scoliosis, the patient began to complain of pain in the lumbar spine, which required decompression and posterior fixation with cement augmented screws. The second patient was a 72 years old female and in September 2021 suffered an osteoporotic fracture at L4 level. Balloon kyphoplasty was performed at the same level. However, due to leakage of cement into the vertebral canal, it was necessary to decompress the canal and apply again the mentioned fixation system. The visual analog scale (VAS) was used to assess the effect of response to therapy. Both patients had no symptoms of nerve compression. Fenestrated screws were used in both cases.

Two Cases of Use of Cement Augmented Screws for Osteosynthesis of the Spine

With this report we decided to present the initial experience with the use of cement augmented screws in Cotrel-Dubousset fixation in cases of patients with degenerative spines in combination with severe osteoporosis. We present two patients who underwent treatment at UMHAT "Sv. Georgi ”, Plovdiv. The first is a 75-year-old woman who underwent right hip arthroplasty in 2002 with a Muller prosthesis. 14 years later (in 2016) due to implant ablation, a revision of the joint with a cementless, revision modular endoprosthesis of Metrimed was performed. In 2022, due to secondary degenerative scoliosis, the patient began to complain of pain in the lumbar spine, which required decompression and posterior fixation with cement augmented screws. The second patient was a 72 years old female and in September 2021 suffered an osteoporotic fracture at L4 level. Balloon kyphoplasty was performed at the same level. However, due to leakage of cement into the vertebral canal, it was necessary to decompress the canal and apply again the mentioned fixation system. The visual analog scale (VAS) was used to assess the effect of response to therapy. Both patients had no symptoms of nerve compression. Fenestrated screws were used in both cases.

Does dihydropyrimidine dehydrogenase level modify plasma antioxidant capacity in colorectal cancer patients treated with fluoropyrimidines?

Introduction: Colorectal cancer is the third most common cancer type worldwide. Fluoropyrimidines and their prodrug-based regimens are widely applied as primary medications. The main enzyme responsible for the rate-limiting step in pyrimidine and for the 5-fluorouracil catabolism is dihydropyrimidine dehydrogenase (DPD).Aim: We aimed to screen DPD level and the changes of plasma antioxidant capacity of colorectal cancer patients on 5-fluorouracil regimen. Materials and methods: Human DPD Elisa Kit based on sandwich enzyme-linked immune-sorbent assay and spectrophotometric methods (FRAP and ABTS) were used in the study.Results: No statistically significant changes in plasma scavenging activity according to the results obtained in the ABTS system have been observed after evaluating all patients and considering DPD concentration. A decrease of the ferric reducing ability of patients’ plasma taken after the administered treatment was found. The increase of DPD level is accompanied by a decrease in the p values and therefore the statistical significance of the differences increases.Conclusions: Based on the aforementioned observations, it could be concluded that some aspects of plasma antioxidant capacity and individuals’ antioxidant status might be involved in the pathogenesis of the disease and could be altered by the activity of some enzymes. The cancer therapy in question, by the specificity of its mechanism of action, can modify patient’s oxidative status

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk