Lumbalgia mecánica crónica en pacientes con vértebras limbus anterior: revisión de la literatura y presentación de tres casos clínicos / Chronic mechanical low back pain in patients with anterior limbus vertebra: a review of the literature and a study of three cases

La vertebra limbus es un hallazgo radiológico de prevalencia desconocida y significado incierto. Se trata de un defecto óseo que afecta al margen de los cuerpos vertebrados, con un fragmento desprendido de morfología triangular y bordes escleróticos. Se produce como consecuencia de una herniación intraósea del núcleo pulposo a través del anillo apofisario vertebral, antes de la fusión completa del cuerpo vertebral. En este artículo se describe tres casos clínicos de pacientes jóvenes (de 19, 20 y 22 años), reclusos en el Centro Penitenciario de Jóvenes (Barcelona, España), diagnosticados de lumbalgía mecánica crónica, y portadores de vértebras limbus lumbar. Nuestros hallazgos, y la revisión sistemática de la escasa literatura disponible, ponen en duda algunas convicciones actuales sobre la vértebra limbus.

The limbus vertebra is a radiological finding of unknown prevalence and uncertain significance. This is a bone defect which affects themargin of the vertebral bodies, with a triangular-shaped detached fragment and sclerotic margins. This occurs as a result of an intraosseus herniation of the nucleus pulposus through the vertebral apophyseal ring before the complete fusion of the vertebral body. In this paper we describe the clinical cases of three young patients(aged 19, 20 and 22), in mates of the Young Offenders Institute of Barcelona, Spain, who were diagnosed with chronic mechanical lowback pain and suffered from lumbar limbus vertebrae. Our findings, and the systematic review of the limited literature available, question some of the current beliefs about limbus vertebrae.

Dietary intake increases serum levels of carboxymethil-lysine (CML) in diabetic patients.

INTRODUCTION: Advanced glycation end products are produced endogenously, in association with hyperglycemia and oxidative stress. They can also be generated during cooking or food processing and, once absorbed, alter protein function and promote inflammation. METHODS: We selected 40 healthy male subjects, 17 patients with type 2 diabetes of both sexes and 15 patients with type 1 diabetes of both sexes. Each participant underwent both a food frequency questionnaire (FFQ) and 24-hour dietary recall specially adapted for measuring CML intake, anthropometry, measurement of blood pressure and biochemical parameters in blood and urine. RESULTS: Serum CML levels were significantly higher in patients with diabetes compared to healthy subjects (p 0.04), showing a direct relationship between dietary intake and serum levels of CML in T2D patients (r 0.53 p 0.03). sCML levels correlated positively with length of diabetes mellitus, and inversely with body mass index (BMI). The most important dietary factor contributing to raise CML levels in these patients with diabetes was the consumption of milk powder. CONCLUSION: Serum levels of CML were found to be higher among diabetic subjects, associated to length of diabetes as expected, but also with the ingestion of foods containing higher amounts of ML. The consumption of milk powder in this group is a major determinant of increased serum levels.

[Diagnosis and treatment of bladder schistosomiasis from penitentiary primary care: case report]. / Diagnóstico y tratamiento de la esquistosomiasis vesical desde la atención primaria penitenciaria: a propósito de un caso.

We describe a case of a patient from Senegal with voiding symptoms and microscopic hematuria diagnosed and treated for bladder schistosomiasis in the medical services of the Youth Prison in Barcelona. According to our information in the Medline database no bladder schistosomiasis cases have been seen in primary care outside endemic areas. Patients can be diagnosed and treated before referral to specialized care for further study of possible complications.

[Incidence of suicide in Catalan prisons: a descriptive and comparative study]. / Incidencia del suicidio en las prisiones de Cataluña: análisis descriptivo y comparado.

INTRODUCTION: The prevention of suicide in prison is one of the most important challenges facing prison health care services in developed countries. The aim of this study is to analyse the incidence of suicide in Catalan prisons and accumulate data about a number of variables that have also been studied in other prison populations. MATERIALS AND METHODS: Retrospective study of suicide cases in prisons administrated by the Catalan Regional Government (Generalitat de Catalunya) between 1990 and 2005 (n=65). Comparative study of incidence with European countries using published data. RESULTS: The average annual incidence for the period is of 59/100.000, multiplying by eight the level corresponding to the general population. CONCLUSIONS: Entry into prison is the most important event trigger for suicide. Other data open the way to new research.

[The range of congenital malformations associated with cleft lip and palate]. / Leque das malformações congénitas associadas às fissuras lábio alvéolo palatinas.

The congenital malformations associated to cleft lip and cleft palate cover a wide range of pathologies with incidence and acuteness that vary according to the authors. In the 284 patients followed and/or referred to the Cleft Consultation of Dona Estefânia Hospital, 78 had associated malformations (27.5%). In three cases there was consanguinity in parents. A familial incidence of cleft and/or other congenital malformations was found in 13 and 10 patients respectively. Thirty patients had malformative syndromes. In the remaining 48, 127 associated congenital malformations (M.C.A.) were identified, in accordance with the Smith criteria, 81 major and 46 minor. The most frequent associated malformations are those of the face (25.9%) and of the cardiovascular system (16.5%). The multiple anomalies (of various systems) are the most frequent (47.9%), followed by the isolated anomaly (29.1%) and the multiple of one system (22.9%). In what concerns the association of syndromes with the type of cleft, primary, secondary or total palate, those of the secondary were the most frequent, particularly that of the Pierre Robin sequence (S.P.R.)--19 in 36 secondary cleft palate.

Characterisation of the lpdA gene from Neisseria meningitidis by polymerase chain reaction, restriction fragment length polymorphism and sequencing.

P64k protein from Neisseria meningitidis is well recognised in sera from individuals convalescent from meningococcal disease or vaccinated with the Cuban antimeningococcal vaccine VA-MENGOC-BC. The presence of the protein in more than 80 meningococcal strains has also been verified. It is immunogenic in animal models and the antibodies elicited show bactericidal activity against meningococci. To further investigate at the molecular level whether lpdA, the gene coding for P64k protein, is conserved among different N. meningitidis strains, a total of 20 strains isolated from different geographic areas were differentiated on the basis of restriction fragment length polymorphism (RFLP) patterns after polymerase chain reaction (PCR) amplification of the lpdA gene and restriction endonuclease digestion with HpaII. Although a total of five different PCR-RFLP patterns were present, nucleotide sequence determination showed that identity levels were as high as 93-99% among the N. meningitidis strains analysed.

Investigation of an outbreak of endemic coccidioidomycosis in Brazil's northeastern state of Piauí with a review of the occurrence and distribution of Coccidioides immitis in three other Brazilian states.

An outbreak of coccidioidomycosis is described that involved three individuals and eight of their dogs, who had engaged in a successful hunt for nine-banded armadillos (Dasypus novemcinctus) in the environs of Oeiras, a community in Brazil's north eastern state of Piauí. Diagnosis was based on clinical, serological and cultural findings. Four of 24 soil samples collected in and around the burrow of an armadillo yielded cultures of Coccidioides immitis, thus establishing the endemicity of that mould in the state of Piauí. A literature review revealed that C. immitis, aside from that state, is endemic in three other Brazilian states--Bahia, Ceará and Maranhão. These four contiguous states have semi-arid regions where climatic conditions and their flora are similar to those that exist in C. immitis's endemic regions in North, Central and South America.

[Free me from this nail! Please!]. / Livrem-me desta unha! Por favor!

Ingrowing toenails are a very frequent pathology in children and adolescents. There is an anatomic component, but also other factors, such as inadequate shoes and incorrect nail-trimming. We treated 47 patients with 69 ingrowing toenails, between one and 15 years of age. The evolution time was one month to 10 years and 11 patients had precedent surgeries. Lateral electrosurgical matricectomy was the choice technique. With a follow up of at least eight months, there is only one case of recurrence.

Cancrum oris (noma) in children.

Cancrum oris, noma or gangrenous stomatitis is a disease which affects primarily undernourished and immunosuppressed young children. Frequent in underdeveloped countries, it also is seen in rare cases of patients with AIDS and leukemia in America and in Europe. Once fatal, the disease is now better understood and today the repair of its terrible sequels is looked upon as a great surgical challenge. This paper reports a case of noma in a 3-year-old black African female admitted to this Service. In an already advanced stage of this illness with severe sequelae, she presented with partial amputation of the lips (upper and lower), right cheek, right side of the nose and maxilla. The choice of treatment of the infected area and eventual reconstruction is discussed.

[Medical transfers of children from Portuguese speaking African countries]. / Transferência sanitária de crianças dos países Africanos de língua oficial Portuguesa.

We reviewed the files of children coming from Portuguese speaking African Countries, admitted to the Surgery Department of Dona Estefânia Hospital between January 1991 and January 1997. There were 108 Medical Transfers: 17 from Angola, 47 from Cape Verde, 26 from Guinea-Bissau, 16 from S. Tomé and Príncipe and none from Mozambique. The assessment of the results and the medical course of these children leads the authors to propose changes, especially in the choice of patients and in hospital assistance, in order to achieve the best ratio between costs and results.

[Accidents with fireworks. Hand lesions in children]. / Acidentes com fogo de artifício. Lesões da mão na criança.

We report our experience in the treatment and rehabilitation of traumatic hand lesions due to firework explosions. From January 1990 to January 1997, eight patients were evaluated according to the same protocol. All patients are from rural areas, males were predominant (87%) and ten years-old were the prevalent age group. The lesions were unilateral in 87.5% of all cases, with a special incidence in the left hand (55%) and the finger was the most affected, index (25.5%). Amputation was the most frequent residual lesion (75%), followed by debridement (62.5%) and changes intactil sensitivity (50%). Early surgery and rehabilitation are the fundamental aspects for the successful treatment and functional prognosis of these patients, but prevention is still the best way to stop the occurrence of these cases.

[Electrical burns in children. 3 years of case histories]. / Queimaduras eléctricas na criança. Casuística de 3 anos.

The Burn Unit of Dona Estefânia Hospital admitted a total of 454 patients from January 1992 to January 1995, 24 of these patients suffered from electric shock. Of these 24 patients 3 suffered burns in the mouth, 15 in one or both hands and 6 multiple burns. In 19 patients the burns were up to 1%. A description is made of 5 cases, male children between the ages of 9 and 13 years, which were deemed severe. The incidents occurred outdoors with different voltages and in activities considered of ludic or experimental nature: two on the roof of a house, two with railway cables and one with an electrical cable in a port zone. The burnt areas vary between 4% and 70%, all of them 2nd and 3rd degree, with hospitalization lasting from 36 to 116 days. In addition to early and coordinated medical and rehabilitative treatment, according to individual needs, a description is also made of the cutaneous sequelae (deforming cicatrices, bridles), neurologic and psychologic sequelae, with emphasis on a patient who underwent amputation of the lower left leg and 4th and 5th ranges of the right foot. It was concluded that measures should be taken in education and legislation to prevent these accidents. Relevance is given to the need for a multidisciplinary team and specialized center for the treatment of these patients.

[Hand and foot infections in children]. / Infecções da mão e do pé na criança.

Hand and Foot anatomic and physiologic characteristics make the infections, located there, acquire specific aspects. Seventy seven in-patients admitted and/or with follow-up at the out-patient clinic of Dona Estefãnia Hospital with Hand (25) and Foot (52) infections, were reviewed during the period between January 1991 and January 1994. We treated, out-patients with paronychia (7 of the hand and 42 of the foot), one patient with hand pulpitis, and one with dorsum hand cellulitis. The remaining 16 with hand infection (64%) and 15 with foot infection (29%) were being treated with splint in the position of rest, elevation of the affected limb and endovenous antibiotic therapy. In all abscess cases, surgical drainage was conducted, 16 the of hand and 22 of the foot. There were no sequels in hand infection. In foot infection there was one osteitis of the first metatarsus and a cutaneous fistula.

[Colorectal prolapse in a child with a severe form of juvenile polyposis]. / Abaixamento colo-rectal numa criança com forma grave de polipose juvenil.

Colon polyps are very common in infancy, most cases are unique, seldom exceeding ten; as a rule, the treatment is endoscopic resection. The AA present a case of a severe diffuse colorectal juvenile polyposis in an 8-year-old black child, with a 4-year evolution of serious digestive bleeding, abdominal pains, anemia and hypoproteinemia. The disease scattered throughout the colon with a great density at the rectum and sigmoid level, coating fully the mucous membrane, making the classic treatment by endoscope unworkable. A resection of the rectum and descendent colon with transrectal pullthrough by the Soave technique with anal demucosization was performed. The post operative without incidents and the follow-up period was considered satisfactory. Complementary endoscopic resection of the remaining and scattered polyps followed. The result of the histopathological examination of all elements studied was juvenile polyps. This case demonstrates the necessity of surgical treatment with resection in cases of severe diffuse juvenile polyposis, in which endoscopic resection alone is not deemed to be sufficient.

[Fecal incontinence. What to do?]. / Incontinência fecal. O que fazer?

There are various functional or organic pathologies that can interfere with the defecation mechanism. The authors present 4 clinical cases with fecal incontinence: 1 false enconprese--2 myelomeningoceles--1 ileo-anal anastomose (total colectomy in Behçet disease). All cases were evaluated manometrically and operated with myorrhaphy of the rectum levators, plasty of gluteus muscles with approximation and median suture, (without rectum circumferential dissection), associating contiguous muscles of independent enervation. In incontinence due to ileo-anal anastomose, a prior ileostomy was made and an S ileal anal-pouch reconstructed. In other cases any intestinal derivation was made. In 3 cases, post operation treatment went well without incidents and there was a clear improvement in the continence. In the other case (myelomeningocele) a complication developed-an abscess with suture dehiscence-which most likely contributed to a less satisfactory result. After the incontinence cases being entirely studied the technique followed is easy to use, adopting neighboring muscular groups capable of improving the continence mechanism.

[Ritual circumcision and the plastic repair of phimosis]. / A circuncisão ritual e correcção plástica da fimose.

The AA. describe two variations of their personal technique of foreskin plasty for phimosis treatment. They utilize a variation of Duhamel procedure, with incision of foreskin dorsal face in italic S in cases where the striction ring is moderate and allows a slipping with glandular exposure. They resected ad minima the foreskin in the cases of very serious phimosis and make a YV plasty on the dorsal face, and if necessary a small excision à la demande of the remaining ventral skin. They achieve a good aesthetic result in both techniques and most of operated cases are hard to distinguish from a normal foreskin. The plasties with foreskin maintenance tend to be used in the modern European culture, where the rites disappeared and hygienic habits gained roots. With the exception of religious reasons or strict medical indications (diabetes, skin lesions, etc.) the phimosis repair by mutilation procedures tends to disappear.

[Acute appendicitis in children]. / Apendicite aguda na criança.

From January 1st, 1987 to December 31st, 1989, 267 patients were operated upon for acute appendicitis representing 97% of emergency laparotomies at the Pediatric Surgery Department of Santa Maria Hospital (HSM); of these, 207 records were analysed using a retrospective protocol and the results were as follows: most frequent symptoms were abdominal pain (99% of cases) and anorexia (86%). Referral for surgical evaluation was made in 35.8% of cases 48 hours after the onset of symptoms; surgery was performed in 129 patients (62.4%) in advanced stages of disease, with histopathological examinations of necrotic, perforated and gangrenous appendices. 15 patients (7.2%) had no appendicitis-11 were found to have follicular hyperplasia and 4 normal histology; of these, luminal distention by parasitic eggs was found in 4. Antibiotic therapy was used in 89 patients preoperatively and in 200 patients postoperatively; cefoxitin was the most commonly used in 89.9% and 83.0% respectively. There were 19 complications (9.2%): 8 parietal, 5 pelvic and 1 subphrenic abscesses, 4 total or partial obstructions and 1 lost drain; 4 patients (1.9%) were reoperated and there was no mortality.