Structural modification of titanium surface by octacalcium phosphate via Pulsed Laser Deposition and chemical treatment.

In the present study, the Pulsed Laser Deposition (PLD) technique was applied to coat titanium for orthopaedic and dental implant applications. Calcium carbonate (CC) was used as starting coating material. The deposited CC films were transformed into octacalcium phosphate (OCP) by chemical treatments. The results of X-ray diffraction (XRD), Raman, Fourier Transform Infrared Spectroscopy (FTIR) and scanning electron microscopy (SEM) studies revealed that the final OCP thin films are formed on the titanium surface. Human myofibroblasts from peripheral vessels and the primary bone marrow mesenchymal stromal cells (BMMSs) were cultured on the investigated materials. It was shown that all the investigated samples had no short-term toxic effects on cells. The rate of division of myofibroblast cells growing on the surface and saturated BMMSs concentration for the OCP coating were about two times faster than of cells growing on the CC films.

Glass-ceramic coated Mg-Ca alloys for biomedical implant applications.

Biodegradable metals and alloys are promising candidates for biomedical bone implant applications. However, due to the high rate of their biodegradation in human body environment, they should be coated with less reactive materials, such, for example, as bioactive glasses or glass-ceramics. Fort this scope, RKKP composition glass-ceramic coatings have been deposited on Mg-Ca(1.4wt%) alloy substrates by Pulsed Laser Deposition method, and their properties have been characterized by a number of techniques. The prepared coatings consist of hydroxyapatite and wollastonite phases, having composition close to that of the bulk target material used for depositions. The 100µm thick films are characterized by dense, compact and rough morphology. They are composed of a glassy matrix with various size (from micro- to nano-) granular inclusions. The average surface roughness is about 295±30nm due to the contribution of micrometric aggregates, while the roughness of the fine-texture particulates is approximately 47±4nm. The results of the electrochemical corrosion evaluation tests evidence that the RKKP coating improves the corrosion resistance of the Mg-Ca (1.4wt%) alloy in Simulated Body Fluid.

Prevalence of psychosis in epilepsy as a function of the laterality of the epileptogenic lesion.

Retrospective analysis of the psychiatric diagnoses in a group of patients surgically relieved of medically intractable epilepsy tested the hypothesis that patients with left-sided temporal lobe epileptogenic lesions are at greater risk for the development of a so-called schizophrenic-like psychosis than are those with right-sided temporal lobe epileptogenic lesions. The data confirmed the hypothesis and also demonstrated an increased prevalence of sinistrals in the psychotic group. Thus, epilepsy involving the dominant hemisphere at the inception of the seizure disorder is the significant risk factors. The data also indicated that a psychosis is unlikely to develop in patients with other (nontemporal) forms of focal epilepsy. On the basis of these data and data from other studies, the prevalence of psychosis in patients with poorly controlled temporal lobe epilepsy was estimated to be approximately 10% to 15%.

The seizures of frontal lobe epilepsy. A study of clinical manifestations.

We describe ictal clinical manifestations of frontal lobe epileptic seizures in 22 patients. After examination of all ictal clinical data, 14 catergories of signs and symptoms were established. The validity of the ictal clinical data used was confirmed on the basis of 99 frontal lobe seizures recorded by tele-electroencephalogram or tele-stereo-electroencephalogram. The main conclusion is that the frontal lobe appears to be partially connected with motor acitivity.

Surgical therapy for frontal epilepsies.

We have described our 25 years experience concerning 100 patients operated on for frontal epilepsy. Results show that 55% of patients are practically cured of their seizures and that 76% benefited from cortectomy (reduction of more than 75% of seizures). These results are the worst in the total series of St. Anne. Reasons for success and especially failure were analyzed in detail: 1. SEEG methods gave good indications along three dimensions of the limits and borders of the cortical excision. 2. When clinical semiology and organization of ictal discharges give evidence for rapid bilateral discharge, with involvement of axial musculature and generalized tonic-clonic manifestations, experience shows that it is necessary to combine cortectomy with a section of the adjacent cortico-subcortical fibers of the corona radiata, as if propagation of ictal discharges were impeded if not interrupted by sectioning such fibers and the primary site were incapable of expressing itself clinically. 3. If the characteristics of seizures suggest the quasisimultaneous involvement of the two frontal lobes and the existence of bilateral multifocal epilepsy, we suggest that a systematized anterior callosotomy might lead to useful results. 4. Finally, we propose general criteria for indications and contraindications for surgery.

[Neurophysiopathological hypothesis on startle epilepsy in man]. / Hypothèses neuro-physiopathologiques sur l'épilepsie-sursaut chez l'homme

Clinical observation and S.E.E.G. recordings performed with a surgical purpose in a typical case of startle-epilepsy has led to a reassessment of the relationship of this form of epilepsy and "Startle reaction". It is confirmed that the critical discharges take origin in the primary motor cortex. The authors discuss, in the light of experimental data already published, the physiopathological hypotheses likely to lead to a better understanding of startle epilepsy. On the one hand it is suggested that the startle reaction may be responsible through a feed-back mechanism for triggering the epileptogenic focus. On the other hand it is assumed that afferent pathways, central organization and efferent systems involved in startle reaction and actual fits are different.

[Continuous partial epilepsy: syndrome and disease]. / L'épilepsie partielle continue: syndrome et maladie.

Twenty three patients are described with a Kojewnikow syndrome in order to identify possible etiological factors. According to their history, clinical and E.E.G. features, patients could be classified into two groups; 1) Eleven patients corresponded to the classical description of the Kojewnikow syndrome: variable age at onset of the disease, rare somatomotor seizures, delay of onset of myoclonic jerks often of long duration, myoclonus limited to a small region, normal neurological examination, stable hemiplegia, normal results of psychometric tests, localised E.E.G. alterations. In most of these patients the etiology of the disorder was known, and the symptoms could be related to a localised lesion of the central cortex; 2) the second group (11 patients) presented with completely different characteristics: early onset of fits (age: 2 to 10 years), presence of other seizure types, short delay of onset of myoclonic jerks, high frequency of seizures, localization of myoclonus over large parts of the body, progressive evolution of a motor syndrome, associated neurological signs and disorders of sleep and behavior, progressive mental deterioration, characteristic E.E.G. pattern with long subclinical paroxysms of slow spikes (sharp waves) with variable localization, diffuse cerebral lesions of unknown etiology were found. Only one patient could not be allocated to either group. Several circumstantial data suggest that patients of the second group may suffer from a slow virus infection. Should this hypothesis be confirmed, a reconsideration of the Kojewnikow syndrome from the etiological standpoint would be of great theoretical and practical interest.

[Behavioral manifestations induced by electric stimulation of the anterior cingulate gyrus in man]. / Manifestations comportementales induites par la stimulation électrique du gyrus cingulaire antérieur chez l'homme

The electrical stimulation of a restricted part of area 24 in awake man elicits important behavioral changes. The present study is dealing with 83 epileptic patients whose brain activity was recorded in SEEG conditions, with a view to possible neurosurgery. In order to determine how seizures originate and propagate, 116 multileads electrodes (65 right, 51 left) were stereotaxically inserted in the anterior part of the cingular gyrus. 521 stimulations were performed. In 362 cases, this stimulation induced a particular behaviour which was characterized by an arousal, motor activities (involving fingers and hand, mouth, legs, eyes, associated movements of hand mouth, highly integrated movements), thymic modifications and hallucinatory manifestations. Topographical organization of the effective area in the cingular gyrus and the relation between the electrical responses and stimulation parameters are studied.

[Epilepsy and psychoses (from the viewpoint of a neurosurgical service)]. / Epilepsie et psychoses (point de vue d'un service de neurochirurgie).

The experience of a neurosurgical unit devoted to the surgical therapy of the epilepsies is only based on very peculiar patients. However, relationship between a given epilepsy and associated psychiatric disorders are more easily understood because of more extensive explorations. Bilateral temporal epilepsies involving the limbic system on the one hand, bilateral frontal epilepsies on the other one, and P.M. status which may be paralleled, make these patients more susceptible to acute mental confusions, to acute thymic disorders, to delirious attacks. Direct relations between chronic psychosis and severe epilepsies are much more uncertain.

Haemostatic treatment of a bleeding hepatocarcinoma by polypropylene mesh wrapping in a cirrhotic patient.

Spontaneous rupture of hepatocarcinoma (HCC) in a cirrhotic patient is a serious complication with a high incidence of mortality. The pathogenesis of this complication is unknown. Several hypotheses have been proposed in the literature worldwide. The diagnosis, in the absence of specific symptoms, is made by ultrasound, sometimes followed by a CT scan, and finally by exploratory paracentesis. An angiogram is performed to locate the site of the bleeding and possibly allow transcatheter arterial chemo-embolisation. Therapeutic options include one-stage or delayed resection, packing for sub-diaphragmatic bleeding HCC's, and hepatic artery ligation. Suture ligation of the bleeding source is usually impossible due to the friability of the tumor. No sizeable experience with the use of alcoholisation for haemostasis has been reported to date. We report a case of HCC bleeding from segment VI successfully treated by manual compression and placement of a polypropylene mesh (Biomesh P1, Cousin Biotech).

[Developmental centered care. Situation in Spanish neonatal units]. / Cuidados centrados en el desarrollo. Situación en las unidades de neonatología de España.

INTRODUCTION: Developmental centered care (DC) is focused on sensorineural and emotional development of the newborns. In Spain we have had information on the application of DC since 1999, but the extent of actual implementation is unknown. OBJETIVE: To determine the level of implementation of DC in Spanish neonatal units where more than 50 infants weighing under 1500g were cared for in 2012. A comparison was made with previous data published in 2006. MATERIAL AND METHODS: A descriptive observational cross-sectional study was performed using a survey with seven questions as in the 2006 questionnaire. RESULTS: The survey was sent to 27 units. The response rate was 81% in 2012 versus 96% in 2006. Noise control measures were introduced in 73% of units in 2012 versus 11% in 2006 (P<.01). The use of saccharose was 50% in 2012 versus 46% in 2006 (P=.6). Parents free entry was 82% in 2012 versus 11% in 2006 (P<.01). Kangaroo care was used without restriction by 82% in 2012 compared to 31% in 2006 (P<.01). CONCLUSIONS: The implementation of the DC in Spain has improved. There is still room for improvement in areas, such as the use of saccharose or noise control. However, it is important to highlight the positive change that has occurred in relation to unrestricted parental visits.

[Incidence of unplanned extubations in a neonatal intensive care unit. A before and after study]. / Frecuencia de extubaciones no programadas en una unidad de cuidados intensivos neonatales. Estudio antes y después.

INTRODUCTION: Unplanned extubations (UE) of mechanically ventilated newborns involves an undesirable increase in morbidity and mortality. OBJECTIVE: A 2-stage study compared the frequency of UE in a Neonatal Intensive Care Unit before and after the implementation of a program of preventive measures to decrease UE. PATIENTS AND METHODS: A before and after prospective study included all mechanically ventilated newborns participating in the 2 stage study from May-December 2011 and June-December 2012. In stage 1, the rate of UE per 100 intubated patient days was calculated and the characteristics of unplanned extubated newborns, circumstances of UE occurrence and need for re-intubation were studied. Consequently, a program of preventive measures for UE was designed and implemented, with the same variables being analysed in stage 2. RESULTS: No differences were found in patient characteristics during the two stages. Stage 1, incidence of UE was 5/100 intubated patient days; Stage 2, 4.5 UE/100 intubated patient days (P=.657). In both stages, most UE occurred during patient handling with re-intubation incidence at 77.4% and 67.7%, respectively. The combined rate of both stages during summer months of July, August and September was 6.2 UE/100 intubation days, in contrast with the remaining months of both stages: UE incidence rate, 3.4 UE/100 intubation days (p=.043). CONCLUSIONS: The implementation of a preventive measures program did not significantly reduce the incidence of UE. The summer period showed the highest incidence of UE.

[Ages of sitting up and walking in preterm newborns less than 1,500 G with bronchopulmonary dysplasia]. / Edades de sedestación y marcha en recién nacidos pretérmino menores de 1. 500 gr con displasia broncopulmonar.

INTRODUCTION: Adverse neurological events in very low birth weight (VLBW) children with bronchopulmonary dysplasia (BPD) are more frequent than in children without. An understanding of the ages when preterm infants acquire certain motor skills will give parents more appropriate information on motor development. The objective of the present study is to estimate the influence between BPD and the age of acquisition of sitting unsupported and independent walking in VLBW children with normal neurological examination at 2 years of corrected age. PATIENTS AND METHODS: A longitudinal study was conducted on a cohort of 885 children with VLBW, admitted to the Hospital "12 de Octubre" between January 1991 and December 2003. Age for both skills was established by interview with parents. Means were compared with t-test and Bonferroni adjustment where appropriate. RESULTS: Both motor skills were acquired later in the group with BPD (7.8±2m vs. 7.1±1.3m for sitting unsupported and 14.5±3.8m vs. 13.4±2.5m for walking) (P<.001). BPD was associated with delayed acquisition (above p90) of these skills, OR=2.6 (1.6-4.1) for sitting and OR=2.8 (1.6-4.8) for walking. Association was found after adjusting for gestational age (GA) and weight. CONCLUSION: BPD was associated with delayed acquisition of both skills in VLBW children with normal neurological examination at 2 years.