La adecuación del tratamiento antibiótico / Adequacy of antibiotic treatment

No disponible

Effects of feeding a high omega-3 fatty acids diet in dogs with naturally occurring osteoarthritis.

The aim of this randomized, placebo-controlled and double-blinded trial was to compare the effect of a veterinary therapeutic diet (VTD) rich in omega-3 fatty acids (omega-3) from fish origin to a regular diet used as control (CTR) over a period of 13 weeks in dogs afflicted by naturally occurring osteoarthritis (OA). Thirty privately owned dogs were selected. Dogs had lameness confirmed by an orthopaedic examination, had stifle/hip OA and had locomotor disability based on the peak of the vertically oriented ground reaction force (PVF) measured using a force platform. At Baseline, all owners were asked to determine 2-5 activities of daily living that were the most impaired. Activities were scores (0-4) in accordance with severity using case-specific outcome measures (CSOM). The PVF was also measured. Dogs (15/group) were then randomly assigned to receive either the CTR or the VTD. The CSOM was completed twice weekly. The recording of PVF was repeated at Week 7 and 13. The VTD-fed dogs showed a significantly higher PVF at Week 7 (p < 0.001) and at Week 13 (p < 0.001) when compared to Baseline. From Baseline to Week 13, VTD-fed dogs had a mean (± SD) change in PVF recording of 3.5 ± 6.8% of body weight (%BW) compared with 0.5 ± 6.1%BW (p = 0.211) in CTR-fed dogs. This change in primary outcome was consistent with an effect size of 0.5. Conversely, dogs fed the CTR did not show significant change in PVF measurements. At the end of the study, the CSOM was significantly decreased (p = 0.047) only in VTD fed dogs. In lame OA dogs, a VTD that contains high level of omega-3 from fish origin improved the locomotor disability and the performance in activities of daily living. Such nutritional approach appears interesting for the management of OA.

Estudio comparativo entre el hialuronato sódico al 0.15% y el alcohol polivinílico como tratamietno para el ojo seco / A comparative study of 0.15% sodium hyaluronate versus polyvinyl alcohol in the treatment of dry eyes

Objetivo: Evaluar la eficacia de dos lágrimas artificiales: el hialuronato sódico 0,15% y el alcohol polivinílico como tratamiento en pacientes con ojo seco.Material y métodos: Se ha seleccionado una muestra de 30 pacientes con ojo seco, en los que hemos considerado cada ojo por separado (60 ojos). A quince de ellos se les ha administrado como tratamiento alcohol polivinílico y a los otros quince hialuronato sódico 0,15%, en ambos casos 5 gotas al día durante un mes. Los parámetros que se han evaluado antes y después del tratamiento han sido: la agudeza visual, el test de Schirmer, el aclaramiento lagrimal, un cuestionario de sintomatología de ojo seco, la tinción corneal con fluoresceína, la tinción con rosa de bengala, la sensibilidad corneal así como la presencia de hiperemia bulbar, detritus en la lágrima, tapones en las glándulas de meibomio, eritema y edema en el borde libre palpebral.Resultados: Sólo hemos encontrado mejoría estadísticamente significativa tras el tratamiento en el valor del cuestionario, tinción con fluoresceína y tinción con rosa de bengala en el grupo de pacientes tratados con hialuronato sódico 0,15%. En el grupo de pacientes tratados con alcohol polivinílico no encontramos diferencia estadísticamente significativa en ninguno de los parámetros estudiados antes y después del tratamiento.Conclusiones: El hialuronato sódico 0,15% ha resultado ser más eficaz en el tratamiento de los pacientes con ojo seco que el alcohol polivinílico

Intraocular lidocaine in phacoemulsification: an endothelium and blood-aqueous barrier permeability study.

OBJECTIVE: To evaluate the effects of intraocular lidocaine hydrochloride (HCI) on the corneal endothelium and of blood-aqueous barrier (BAB) permeability in ultrasound phacoemulsification. DESIGN: Nonrandomized, comparative trial. PARTICIPANTS: Sixty patients who underwent uneventful, single-surgeon, clear cornea phacoemulsification were studied prospectively. METHODS: Sub-Tenon's anesthesia was administered to 30 patients (group 1), and intraocular lidocaine hydrochloride was administered to an additional 30 patients (group 2). An endothelial study of at least 120 cells per patient, using a noncontact specular microscope and a digital image analysis system, was performed before surgery and 1 month after surgery. Blood-aqueous barrier permeability was evaluated preoperatively and postoperatively (48 hours, 1 week and 1 month) using a laser flare meter. MAIN OUTCOME MEASURES: Endothelial parameters (cell density, hexagonality, and coefficient of variation in cell area) and BAB permeability. RESULTS: No significant differences were found between groups when comparing the postoperative changes produced in endothelial cell density (95% confidence interval [CI], 0.46, 4.7; P = 0.10), hexagonality (95% CI, -2.5, 3.5; P = 0.72), and coefficient of variation in cell area (95% CI, -8.3, 4.6; P = 0.57). A multivariate study detected no significant differences in mean flare values between groups during follow-up (P = 0.40). No clinically significant differences were found between mean preoperative and 1 month postoperative flare values in either group. CONCLUSIONS: The recovery of BAB permeability 1 month after surgery seems to suggest that no additional inflammation was induced by intraocular lidocaine HCI. The fact that no differences in postoperative changes in endothelial parameters were found between groups indicates that no further corneal endothelial damage (other than that caused by surgical manipulation) was incurred. According to our results, intracameral lidocaine HCI appears to be safe for the average phacoemulsification patient in the absence of ocular pathologic conditions.

Dolor central y dolor del lesionado medular / No disponible

Se trata de aglutinar los conocimientos actuales sobre el dolor que aparece tras una lesión del Sistema Nervioso Central, poniendo especial atención en su etiopatogenia y fisiopatología, ya que éstas constituyen la base tanto de los tratamientos plenamente establecidos, como de los actuales ensayos terapéuticos. Con este fin se ha llevado a cabo una amplia revisión las publicaciones de la última década, haciendo una cuidadosa selección de aquéllas con mayor repercusión en los aspectos anteriormente señalados (AU)

This paper tries to gather current knowledge regarding pain associated to an injury of the Central Nervous System, with special attention to its etiopathogenicity and physiopathology, since they provide the basis both for fully-established treatments and those used in current therapeutic trials. With this aim, an extended review have been carried out of the literature published in the past decade, performing a careful selection of those works with greatest impact in the aforementioned aspects (AU)

PEG-rHuMGDF promotes multilineage hematopoietic recovery in myelosuppressed mice.

PEG-rHuMGDF administered to normal mice is a lineage-specific growth factor for megakaryocytes and platelets as judged by morphologic examination of hematologic cells in marrow and peripheral blood smears. The purpose of this study was to document that PEG-rHuMGDF in myelosuppressed mice promotes multilineage hematopoietic recovery. High-dose 5-fluorouracil (5-FU) in mice results in profound myelosuppression and 0-30% survival. Mice receiving a single dose of PEG-rHuMGDF (1000 microg/kg) 1 day after 5-FU (225 mg/kg) demonstrate an increased survival (76% vs 27% in control mice at 14 days). Compared to surviving controls, PEG-rHuMGDF-treated mice not only show the expected higher platelet counts, but also increased marrow colony-forming unit granulocyte-macrophage, increased multilineage marrow cellularity, and increased neutrophil, monocyte, and lymphocyte counts in peripheral blood. PEG-rHuMGDF- and vehicle-treated mice both develop hepatic abscesses after 5-FU treatment, but the abscesses in the PEG-rHuMGDF-treated mice contain more neutrophils, suggesting that myeloid reconstitution contributes to their survival. Furthermore, survival in 5-FU-treated mice is significantly improved by granulocyte colony-stimulating factor and antibiotics, suggesting that infection rather than thrombocytopenia is the predominant cause of death. PEG-rHuMGDF after 5-FU promotes survival accompanied by accelerated lymphohematopoietic repopulation, suggesting that PEG-rHuMGDF, a lineage-specific thrombopoietic factor in normal mice, promotes multilineage hematopoietic recovery in myelosuppressed mice.

Effect of topical cyclosporin A on Thygeson's superficial punctate keratitis.

Thygeson's superficial punctate keratitis (Thygeson's SPK) is a distinct clinical entity, characterized by round conglomerates of discrete, granular, white-gray, fine intraepithelial dots without conjunctival involvement. The only effective treatment with regard to relieving symptoms and diminishing lesions has been topical corticosteroids, but their prolonged use can be associated with severe side-effects. The purpose of this study is to present the long-term results of the use of 2% topical cyclosporin A in olive oil in Thygeson's SPK. Eight patients diagnosed as having Thygeson's SPK were included. All the patients were treated with 2% cyclosporin dissolved in olive oil four times a day for three months, and two times a day for one month before withdrawing therapy. The follow-up period ranged from twelve to twenty-five months. The number of corneal lesions varied between 5 and 15 before treatment. After cyclosporin treatment, no corneal lesion was observed and the cornea remained clear after the follow-up period. In conclusion, 2% cyclosporin in olive oil is a safe alternative to corticosteroids in the treatment of Thygeson's SPK, and resulted in satisfactory control of the condition.

Variations in magnesium and zinc in hypertensive patients receiving different treatments.

We studied the influence of captopril, atenolol, and verapamil on serum and intraerythrocyte concentrations of magnesium and zinc in 30 normotensive control subjects (12 men and 18 women, aged 30 to 65 years, mean +/- SD 45.76 +/- 12.15 years) and 30 patients with untreated mild or moderate essential hypertension (14 men and 16 women, aged 30 to 65 years, mean +/- SD 49.50 +/- 13.58 years). Ten each of the hypertensive patients were treated with captopril, atenolol, or verapamil. Physical examination and biochemical analyses (serum Mg and Zn) were done in all participants at baseline, and in patients after 3 and 6 months of treatment. The results were compared according to a nested design with Neumann-Keuls test. We found no significant differences between controls and patients in serum and intraerythrocyte concentrations of Zn at the start of the study, although there was a significant decrease in serum Zn in patients after 3 (P < .01) and 6 months (P < .001) of treatment, regardless of the drug used. This decrease was thought to be attributable to the zincuric effect of captopril or to dietary measures, or both. Intraerythrocyte Zn was not significantly affected by antihypertensive treatment. Serum and intraerythrocyte concentrations of Mg were significantly lower (P < .001) in hypertensive than in normotensive subjects, and serum Mg in patients treated with verapamil was significantly lower (P < .05) than after treatment with captopril or atenolol. Serum Mg concentration was related directly with serum concentrations of high density lipoprotein cholesterol (r = 0.4043, P < .05). We conclude that supplementation with Mg may benefit patients with hypertension.

Influence of topically applied cyclosporine A in olive oil on corneal epithelium permeability.

The effect that topically administered cyclosporine A (CsA) dissolved in olive oil has on corneal epithelial permeability was determined by fluorophotometry. Twenty-six healthy volunteers, who had no ocular or general disease and were not receiving any topical or systemic treatments, were studied. A Fluorotron Master fluorophotometer was used. Measurements were taken before and 45 min after the instillation of 40 microliters of a 2% aqueous solution of sodium fluorescein without preservatives. Basal corneal epithelial permeability, as well as the permeability 24 h after the instillation of 2% CsA-olive oil and of the solvent alone, were calculated. Under sterile conditions, the Sandimmun oral solution (Sandoz, Basel, Switzerland) was used to prepare the topical 2% CsA. Immediately after the 2% CsA-olive oil or the solvent alone were instilled, the volunteers complained of itching for approximately 1 h and developed punctate keratopathy, which improved the next day. Epithelial permeability 24 h after instillation of 2% CsA-olive oil increased 7.03 times (p < 0.001), and that of the solvent alone increased 6.68 times (p < 0.001). No differences in corneal permeability were found between CsA-olive oil and the vehicle (p = 0.651). We concluded that the olive oil used to dissolve CsA is responsible for the increased corneal epithelial permeability.

[Four years of pediatric emergencies. Relationship between the increase in their number and personal initiatives in complementary examinations as well as hospital admissions]. / Cuatro años de urgencia pediátrica. Relación de su incremento y de la iniciativa propia en el número de exploraciones complementarias e ingresos hospitalarios.

In 16,848 paediatric emergencies taken care of from 1986 to 1989 in a regional hospital which had started work in 1985, we have confirmed an initial increase of over 20& per year in the number of paediatric emergencies that have become stable as we have reached full coverage of the total paediatric population in area. We have also stated that the volume of personal initiative emergencies has been increasing rather meaningluffly every year, going up from an initial 55% to a 75% in four years. On opposite the number of complementary checkups has decreased significantly from 38% to 35% and children hospital entries including those that required urgency observation have also gone down from a 21,69 in 1986 to a 15,8 in 1989. The growing tendency to overuse paediatric emergencies indiscriminately on the part of the population, leads us to make a serious proposal towards the adaptation and suitabilisation of emergency service in hospitals in order to be prepared to deal with non-urgent pathology.

[Dacryocystorhinostomy without bone perforation (author's transl)]. / Laco-rhinostomie sans perforation osseuse.

Present techniques of dacryocystorhinostomy require perforation of the frontal process of the maxillary bone in order to open a passageway between the conjunctival sac and the nasal fossa. This requires a relatively complex operation and leaves an almost horizontal conduit, flow rarely being perfect. A new technique for dacryocystorhinostomy which obviates the necessity for osseous perforation by passing a tube beneath the soft tissues of the face just superficial to the maxillary bone, between the lacus lacrimalis and the nasal atrium. The external diameter of the tube should not exceed 2 mm to that is produced no visible elevation on the surface of the face. The almost vertical position of the tube and the position of its inferior opening in the zone of maximal respiratory flow assures good drainage of tears. The operation can be performed in a few minutes, under local anesthesia, in the surgeon's office.

[Testicular teratoma in infancy]. / Teratoma testicular en la infancia.

The authors describe a case of testicle-based teratoma, in a 20-month old boy. Due to the characteristics of the palpation and its eventual transillumination, it may be confused with a hydrocele. They stress its rarity and on the basis of a review of the literature, they explain its histological peculiarities and refer to its prognosis, usually benign, when it is diagnosed at about 2 years of age, providing that a very careful examination of the histological sections rules out the presence of anaplastic cells. Finally there is a short discussion on the possibilities of complementary therapy when there are metastases.