River Oaks Hospital

To determine whether there are extracranial pathophysiologies in CM patients whose headaches are marked by distinct muscle tenderness and occipital pain.

An in vivo animal experimental study. To investigate the hydroxyapatite (HA) coating in a modified fusion cage in improving the results of cervical intervertebral fusion and the role of combination of IGF-I and TGF-β1 treatment in a goat cervical spine interbody fusion model. Thirty-two goats were divided into 4 groups (n=8 for each) and underwent C3-4 discectomy and intervertebral fusion by the following methods: group 1, autologous tricortical iliac crest bone graft; group 2, cage only; group 3, cage coated with HA; group 4, cage coated with HA+IGF-I and TGF-β1. Radiography was performed preoperatively, postoperatively, and after 1, 2, 4, 8, and 12 weeks. At the same time points, disk space height, intervertebral angle, and lordosis angle were measured. At 12 weeks postoperatively, the goats were killed and fused segments were harvested. Biomechanical study was performed in flexion, extension, axial rotation, and lateral bending with a nondestructive stiffness method to determine the range of motion and stiffness. All cervical fusion specimens underwent histomorphologic studies. All 3 cage-treated groups showed significantly higher values for disk space height, intervertebral angle, and lordosis angle compared with the autologous tricortical iliac group at 1, 2, 4, 8, and 12 weeks after surgery (P<0.05). The stiffness of hat-shaped cervical intervertebral fusion cage coated with HA+IGF-I and TGF-β1 in flexion, extension, and lateral bending was significantly greater than that of the other groups (P<0.05), and the stiffness of hat-shaped cervical intervertebral fusion cage coated with HA in extension, axial rotation, and lateral bending was significantly greater than that of fusion with the bone graft and cage-only groups (P<0.05). Histomorphologic evaluation showed better fusion in 3 cage groups than in the bone graft group. In group 4 of the cage coated with HA+IGF-I and TGF-β1, a slightly more advanced bone matrix formation was shown than in groups without coating. HA coating can improve the fusion effect of the cervical intervertebral cage, and IGF-I and TGF-β1 can enhance bone fusion.

Publication of The Red Book is an occasion for considering Jung as a poet in the tradition of epic. His close familiarity with Dante’s Divine Comedy, as evidenced by references in The Red Book as well as later in many of The Collected Works, offers an opportunity to consider Jung as epic poet. Although the author has no desire to match “Liber Primus,” “Liber Secundus,” and “Scrutinies” to Dante’s three canticas—Inferno, Purgatorio, and Paradiso—nonetheless, Jung’s three sections of The Red Book resonate on many levels with Dante’s three canticas that structure his Divine Comedy. The human quest to descend to the Underworld to confront the dead is part of the epic hero’s journey, as is, with Dante and Jung, the crafting of their experiences in a new poetic mode while remaining part of the tradition of epic. The Red Book as literary epic places Jung, with Dante, in the generic tradition of epic exploits and their poetic expression.

A 52-year-old receptionist presents with an ulcer on her ankle of 1 year's duration. Narcotic analgesics once or twice a day and leg elevation reduce the pain. She has not had diabetes and does not smoke. Physical examination reveals an ulcer above the medial malleolus, with a clean bed of granulation and surrounded by hyperpigmented skin. Pedal pulses are easily palpable. How should she be evaluated and treated?

Venoplasty and stenting of the iliac vein now constitute the “method of choice” in the treatment of iliocaval chronic venous obstruction.1, 2, 3, 4, 5, 6, 7, 8 The importance of venous outflow obstruction in the pathophysiology of chronic venous disorders has been increasingly recognized, and it is apparent that reflux alone cannot explain the symptoms and signs in many patients. Although it is well known that the combination of reflux and obstruction creates the worst scenario, iliofemoral outflow obstruction alone may play a larger role in the pathophysiology of chronic venous disorders than previously thought. The iliac vein is the common outflow tract of the lower extremity and chronic obstruction of this segment appears to result in more severe symptoms than does lower segmental blockage. Distal obstructions appear to be better compensated by collateral formation than proximal lesions. Therefore, the iliocaval venous segment has become the most important target area for balloon dilation and stenting.