Estudio clínico y micológico de otomicosis en diabéticos: una serie de 17 casos / Clinical and mycological study of otomycosis in diabetics: series of 17 cases

RESUMEN Introducción: La otomicosis en pacientes inmunosuprimidos esta caracterizada por ser bilateral y ser causada por candida. Pocos estudios comparan las características micológicas encontradas en la microscopía directa y el cultivo. Objetivo: Identificar las características clínicas y micológicas de la otomicosis en pacientes diabéticos. Material y método: Estudio transversal en centro hospitalario de segundo nivel. Criterios de inclusión: pacientes diabéticos con diagnóstico clínico de otomicosis. Intervención: la muestra se examinó directamente bajo el microscopio y se cultivó. Resultados: Se incluyeron 17 pacientes, 10 mujeres y 7 hombres con una edad media de 47,5 años. Los síntomas predominantes fueron hipoacusia en 91,4% (n =16), prurito en 82,4% (n =14), otorrea en 76,5% (n=13)y otalgia en 70,6% (n =12). Afección bilateral se encontró en 47,1% (n =8). Estudio directo al microscopio mostró levaduras en 94,1% (n =16) y 5,9% mostró aspergillus (n =1). Cándida fue el género más comúnmente encontrado en los cultivos y en el examen directo microscópico con 94,1% (n =16) y Candida albicans la especie más común con 88,2% (n =15). Conclusión: Candida albicans es el agente etiológico más común en pacientes diabéticos con otomicosis. Su presentación clínica más frecuente es hipoacusia, prurito y otorrea. El examen directo identificó adecuadamente a los géneros fúngicos.

ABSTRACT Introduction: Otomycosis in immunocompromised patients is characterize by its bilateral course and the predominant etiologic agent is Candida. Few studies compare the mycological features between microscopic direct exam and culture. Aim: To identify the clinical and mycological characteristics of otomycosis in diabetic patients. Material and method: Transversal study. Secondary care center. Inclusion criteria: diabetic patients with clinical diagnosis of otomycosis. Intervention: Direct examination under a microscope of the ear sample and culture. Results: We included 17 patients, 10 women, 7 men with a mean age of 47.5 years. Symptoms were hearing loss 94.1% (n = 16), pruritus 82.4% (n =14) otorrhoea 76.5% (n =13) and otalgia 70.6% (n =12). Bilateral involvement was found in 47.1% (n =8). Direct microscopic study found 94.1% of yeast (n =16) and 5.9% of Aspergillus (n =1). Candida was the most common fungal genus in culture and microscopic exam with 94.1% (n =16) of cases and Candida albicans was the most common species in 88.2% (n =15) cases. Conclusion: Candida albicans is the most common etiologic agent in diabetic patients with otomycosis. Main symptoms were hearing loss, itching and otorrhea. Direct exam correctly identified the fungal genus.

Uso de corticoides sistémicos en pacientes adultos hospitalizados por neumonía adquirida en la comunidad / Clinical efficacy of corticoids treatment in hospitalized adult patients with community-acquired pneumonia

Resumen La neumonía adquirida en la comunidad (NAC) es una enfermedad infecciosa común y potencialmente grave que ocasiona elevada morbilidad y mortalidad. La terapia con corticosteroides (CS) sistémicos se ha propuesto para el manejo de pacientes adultos hospitalizados por neumonía adquirida en la comunidad. Objetivos: Evaluar la eficacia y seguridad del tratamiento con corticosteroides sistémicos en pacientes con NAC grave. Métodos: Se buscó la información actualizada en cinco bases de datos: PubMed, Scielo, Epistemonikos, Lilacs y Cochrane Library. Se evaluaron los ensayos clínicos controlados aleatorizados que examinaron la eficacia y seguridad de los corticosteroides en adultos hospitalizados con NAC grave. Resultados: Se incluyeron diez revisiones sistemáticas y quince estudios primarios que reclutaron pacientes hospitalizados con NAC grave. La terapia con corticosteroides redujo significativamente la mortalidad por todas las causas (cociente de riesgo [RR]: 0,58; IC95%: 0,40 a 0,84), fracaso clínico precoz (RR: 0,32; IC95%: 0,15 a 0,7), riesgo de síndrome de dificultad respiratoria del adulto (RR: 0,23; IC95%: 0,07 a 0,80), necesidad de ventilación mecánica (RR: 0,40; IC95%: 0,20 a 0,77) y se acortó la estancia hospitalaria (diferencia media: −2.91 días; IC95%: − 4,92 a −0,89). La terapia esteroidal aumentó el riesgo de hiperglicemia (RR: 1,72; IC95%: 1,38 a 2,14) pero no la frecuencia de hemorragia gastrointestinal (RR: 0,91; IC95%: 0,40 a 2,05). Conclusión: La terapia con corticosteroides sistémicos disminuye significativamente la mortalidad, riesgo de complicaciones y acorta la estancia hospitalaria en pacientes con NAC grave. Estos resultados deben ser confirmados por estudios controlados aleatorizados de mayor potencia.

Community-acquired pneumonia (CAP) is a common and serious infectious disease accompanied with high morbidity and mortality. Corticosteroids (CS) therapy has been proposed for community-acquired pneumonia hospitalized adult patients. However, the effectiveness of adjunctive corticosteroids on relevant clinical outcomes of CAP remains inconsistent. Objectives: We assessed the efficacy and safety of adjunctive corticosteroids therapy in severe CAP patients. Methods: Five databases: PubMed, Scielo, Epistemonikos, Lilacs and Cochrane Library were searched for related studies published up to June, 2018. Randomized controlled trials (RCTs) of corticosteroids in hospitalized adults with severe CAP were included. Results: We assessed ten systematic reviews and fifteen primary studies enrolling severe CAP hospitalized patients. Corticosteroids therapy significantly reduced all-cause mortality (risk ratio (RR): 0.58; 95%CI: 0.40 to 0.84), early clinical failure (RR: 0.32; 95%CI: 0.15 to 0.7), risk of adult respiratory distress syndrome (ARDS) (RR: 0.23; 95%CI: 0.07 to 0.80), need for mechanical ventilation (RR: 0.40; 95%CI: 0.20 to 0.77) and decreased hospital length of stay (mean difference: −2.91 days; 95%CI: −4.92 to −0.89). Corticosteroids therapy increased hyperglycemia risk (RR: 1.72; 95%CI: 1.38 to 2.14) but not gastrointestinal hemorrhage frequency (RR: 0.91; 95%CI: 0.40 to 2.05). Conclusions: Adjuvant therapy with systemic corticosteroids decreases mortality, risk of hospital complications and shortens hospital length of stay in patients with severe CAP. These results should be confirmed by adequately powered studies in the future.

Caracterización de cafés torrefactados, provenientes del ecotopo E-220A / Characterization of roasted coffees from the ecotopo E-220A

Resumen Antecedente. Los ecotopos son entornos con condiciones edafológicas, acuíferas, y ambientales bien definidas, en las cuales se producen granos con características de calidad que cautivan mercados locales e internacionales. Objetivo. Correlacionar fisicoquímicamente café crudo y torrefactado proveniente de 2 zonas del Ecotopo_E-220A. Materiales y método. La investigación, se desarrolló en cuatro etapas con cafés variedad Colombia de tipo supremo y extra especial, provenientes del departamento de Nariño de los municipios de La Unión y de Buesaco, siguiendo un diseño experimental de bloques al azar con análisis multivariado, complementado con la técnica de componentes principales. Resultados. Se correlacionaron las zonas de estudio con las características intrínsecas del café crudo_ mayor altura, color verde intenso, granos grandes más uniformes y de mayor acidez titulable. Y a menor altura mayor contenido de lípidos. Los cafés de la zona 2_ mayor altura_ tienen menor acidez titulable, menor contenido de lípidos, presentan la mayor pérdida de estos durante la torrefacción y genera cafés torrefactados de color entre medio y medio ligero. La zona 1 por el mayor contenido de lípidos genera cafés más aromáticos. Igualmente, con la metodología de componentes principales se determinó que la de pérdida de peso en café tostado, los carbohidratos y la densidad aparente explican el primer componente en 0.846, 0.745, 0.845 respectivamente y el segundo componente agrupa al contenido de lípidos en 0.801 y el contenido de proteína cruda en 0.620.

Abstract Background. Ecotopos are environments with well-defined soil, aquifer and environmental conditions, in which grains with quality characteristics are produced that captivate local and international markets. Objective. Physically and chemically correlate raw and roasted coffee beans from 2 zones of Ecotopo E-220A. Materials and methods. The research was carried out in four stages with Colombian varieties of supreme and extra special type, from the department of Nariño of the municipalities of the Union and Buesaco, following an experimental design of random blocks with multivariate analysis, complemented with the technique of main components. Results. The study areas were correlated with the intrinsic characteristics of raw coffee - higher height, intense green color, larger, more uniform grain and higher titratable acidity. And at lower height, higher lipid content. The coffees of zone 2_ greater height_ have lower titratable acidity, lower lipid content, they present the greater loss of these during the roasting and generates roasted cafes of color between medium and light medium. Zone 1 due to its higher content of lipids produces more aromatic coffees. Likewise with the main components methodology it was determined that the loss of weight in roasted coffee, carbohydrates and apparent density explain the first component in 0.846, 0.745, 0.845 respectively and the second component groups the lipid content in 0.801 and The crude protein content at 0.620.

Red Maca (Lepidium meyenii) did not affect cell viability despite increased androgen receptor and prostate-specific antigen gene expression in the human prostate cancer cell line LNCaP.

We examined whether aqueous extract of Lepidium meyenii (red Maca) could inhibit growth, potentiate apoptotic activity of two anticancer drugs Taxol and 2-methoxyestradiol (2ME) or change mRNA expression for the androgen target genes, androgen receptor (Ar) and prostate-specific antigen (Psa) in the human prostate cancer cell line LNCaP. Red Maca aqueous extract at 0, 10, 20, 40 or 80 µg/ml was added to LNCaP cells, and viability was evaluated by the MTS assay at 24 or 48 hr after treatment. Furthermore, LNCaP cells were treated with 80 µg/ml of red Maca plus Taxol or 2ME 5 µM and viability was assessed 48 hr later. Finally, LNCaP cells were treated with red Maca 0, 20, 40 or 80 µg/ml, and 12 hr later, mRNA level for Ar or Psa was assessed by real-time PCR. Treatment with red Maca did not affect viability of LNCaP cells. Apoptotic activity induced by Taxol and 2ME in LNCaP cells was not altered with red Maca treatment. Relative expression of the mRNA for Ar and Psa increased with red Maca 20 and 40 µg/ml, but not at 80 µg/ml. We conclude that red Maca aqueous extract does not have toxic effects, but stimulates androgen signalling in LNCaP cells.

Efectos de la suplementación con testosterona sobre el rendimiento en resistencia / Efeitos da suplementação com testosterona sobre o desempenho da resistência / Effects of doping with testosterone on endurance performance

El dopaje en el deporte tiene su origen en la Grecia Clásica. Sin embargo, a lo largo del siglo pasado y hasta la actualidad, la utilización de este tipo de prácticas fraudulentas en el deporte ha ido en aumento. Entre las sustancias dopantes más utilizadas destacan la testosterona y sus derivados sintéticos, los anabolizantes sintéticos. A pesar de que estas sustancias prohibidas se han utilizado para la mejora del rendimiento en pruebas de fuerza y potencia, frecuentemente se detectan positivos en deportistas de resistencia. Los objetivos del presente estudio han sido informar acerca de los efectos ergogénicos de la suplementación con testosterona y anabolizantes sintéticos sobre el rendimiento en resistencia, a través de cambios sobre parámetros sanguíneos, así como los efectos secundarios que tienen sobre la salud. Para ello, se ha realizado una revisión en bases de datos como Elsevier, Medline, Pubmed y Web of Science incluyendo términos como testosterone, anemia, doping, endurance, erythropoietin, hepcidin e iron. La hepcidina se ha propuesto la principal reguladora de las reservas corporales de hierro y la suplementación con testosterona puede afectar a la síntesis de dicha hormona. Los efectos de la testosterona sobre la hepcidina podrían hacer mejorar tanto la capacidad de transporte como de difusión de oxígeno. De este modo, el dopaje con testosterona podría tener un potencial efecto ergogénico en modalidades de resistencia. Sin embargo, dichas mejoras pueden tener efectos negativos sobre el estado de salud del deportista, entre los que se encuentran trastornos metabólicos, orgánicos, psicológicos e inmunosupresión (AU)

Doping in sport has its origins in Ancient Greece. However, over the last century to the present, the use of such dishonest practices has increased. Among the most widely used performance enhancing drugs is the use of testosterone and its synthetics anabolics. Although these prohibited substances have been used to increase performance in test of strength and power, due to the ability to cause hypertrophy, very frequent it's detecting positive test doping by in endurance athletes by testosterone or synthetics anabolics. The aim of this study was to report the ergogenic effects of testosterone supplementation and synthetics anabolics on endurance performance, through changes on blood parameters. To this end, it has conducted a review in different databases such as Elsevier, Medline, Pubmed and Web of Science where terms such as testosterone, anemia, doping, endurance, erythropoietin, hepcidin and iron were included. Hepcidin has been proposed main regulator of body iron stores and testosterone supplementation may affect the synthesis of the hormone. The effects of testosterone on hepcidin could improve both transport capacity and oxygen diffusion. Thus, doping with testosterone could have a potential effect on ergogenic resistance patterns. However, such improvements can have negative effects on the health of the athlete like metabolic, organic, psychological disorders and immunosuppression (AU)

O doping no esporte tem suas origens na Grécia Antiga. No entanto, do último século para o presente, a utilização de tais práticas desonestas aumentou. Entre as drogas que melhoram o desempenho mais amplamente utilizadas são o uso de testosterona e seus anabolizantes sintéticos. Embora estas substâncias proibidas têm sido usados para aumentar o desempenho em testes de força e potência, devido à capacidade de causar hipertrofia, é muito frequentes detecção de doping por testosterona ou anabolizantes sintéticos no teste de atletas de endurance. O objetivo deste estudo foi relatar os efeitos ergogênicos da suplementação de testosterona e anabolizantes sintéticos sobre o desempenho de resistência, através de mudanças nos parâmetros sanguíneos. Para este efeito, procedeu a uma revisão em diferentes bancos de dados, tais como Elsevier, Medline, Pubmed e Web of Science, onde termos como a testosterona, anemia, doping, resistência, eritropoietina, hepcidina e ferro foram incluídos. Hepcidina foi proposto como principal regulador das reservas de ferro do corpo e a suplementação de testosterona pode afetar a síntese do hormonio. Os efeitos da testosterona sobre hepcidina poderia melhorar tanto a capacidade de transporte e difusão de oxigênio. Assim, a dopagem com testosterona pode ter um efeito potencial sobre padrões de resistência ergogênicos. No entanto, essas melhorias podem ter efeitos negativos sobre a saúde do atleta como metabolismo, distúrbios psicológicos orgânicos e imunossupressão (AU)

Influence of light presence and biomass concentration on nutrient kinetic removal from urban wastewater by Scenedesmus obliquus.

This work was aimed at studying the effect of light-darkness and high-low biomass concentrations in the feasibility of removing nitrogen and phosphorus from urban treated wastewater by the microalga Scenedesmus obliquus. Laboratory experiments were conducted in batch, where microalgae were cultured under different initial biomass concentrations (150 and 1500mgSSl(-1)) and light conditions (dark or illuminated). Nutrient uptake was more dependent on internal nutrient content of the biomass than on light presence or biomass concentration. When a maximum nitrogen or phosphorus content in the biomass was reached (around 8% and 2%, respectively), the removal of that nutrient was almost stopped. Biomass concentration affected more than light presence on the nutrient removal rate, increasing significantly with its increase. Light was only required to remove nutrients when the maximum nutrient storage capacity of the cells was reached and further growth was therefore needed. Residence times to maintain a stable biomass concentration, avoiding the washout of the reactor, were much higher than those needed to remove the nutrients from the wastewater. This ability to remove nutrients in the absence of light could lead to new configurations of reactors aimed to wastewater treatment.

Photobiotreatment model (PhBT): a kinetic model for microalgae biomass growth and nutrient removal in wastewater.

This article proposes a kinetic model for wastewater photobiotreatment with microalgae (the PhBT model). The PhBT model for nutrient uptake, coupled with the Verhulst growth model, is a simple and useful tool to describe batch experiments of nutrient removal by microalgae. The model has been validated with experiments of Chlorella vulgaris (C. vulgaris) grown in wastewater and different synthetic media. The model provided information about nitrogen and phosphorus limitation and their luxury uptake during the test. Productivity observed in synthetic medium (0.17 g SS L(-1) d(-1)) was similar to that obtained in nutrient enriched wastewater (0.15 g SS L(-1) d(-1)). Biomass productivity of this alga in wastewater and the efficient nutrient removal suggested that C. vulgaris could be cultured in wastewater for biomass production while nutrients are reduced from this stream.

Performance of a flat panel reactor in the continuous culture of microalgae in urban wastewater: prediction from a batch experiment.

A laboratory-scale flat panel photobioreactor was operated for the continuous growth of Scenedesmus obliquus and consequent removal of nutrients in wastewater. This study develops a simple model by which biomass values in continuous operation can be predicted from kinetic growth parameters obtained from a shorter batch experiment. Based on this study, biomass concentrations and productivities in continuous operation can be successfully predicted as a function of the specific hydraulic retention time (HRT) assumed. Considerable biomass production and nutrient uptake from wastewater were achieved in the experiment. Optimum operating conditions for the reactor depend on the particular objective: the maximization of biomass production and carbon dioxide biofixation involves a HRT of 2 µ(-1) (specific growth rate), whereas efficient nutrient removal involves a HRT as close as possible to µ(-1) (as long as discharges comply fully with the parameters set); alternatively biomass intended for biodiesel or biogas production would involve a HRT > 2 µ(-1).

Analisis estadístico de 134 casos consecutivos de ganglio centinela en el melanoma maligno cutáneo en las islas baleares. Utilidad terapeútica de la biopsia selectiva ganglionar e importancia d ela localización anatómica del tumor primario (2000-2006) / Statistic analyisis of 134 consecutive cases of sentinel lymph node in cutaneous malign melanoma in baleares islands. Therapeutic utility of selective sentinel limph node biopsy biopsy and relevance of anatomic localization of primary tumour (2000-2006)

La biopsia selectiva del ganglio centinela en el melanoma maligno cutáneo nos permite una apropiada estadificación, evitando innecesarias linfadenectomías y verificar que las ideas clásicas de las vías de drenaje linfático no se corresponden con la realidad, existiendo una gran variabilidad según su localización anatómica, y que el Breslow es el factor pronóstico más importante para predecir la supervivencia junto a otros en estos pacientes. La cirugía es pues necesaria para una adecuada clasificación de la enfermedad y planificar su tratamiento, extirpar el tumor primitivo y posibles metástasis de las áreas ganglionares y eliminar metástasis viscerales disminuyendo la masa tumoral para facilitar otros procedimientos. El motivo de este trabajo es observar si existe correlación entre ellos e intentar obtener los resultados que tras una apropiada detección gammagráfica (con un 100% de aciertos en la localización) y quirúrgica del ganglio centinela, determinando si existen diferencias respecto al número de drenajes y de ganglios centinelas extraídos que justifiquen las variaciones encontradas (AU)

The selective biopsy of the sentinel lymph node in the cutaneous malignant melanoma allows us to make an appropriate staging, avoiding unnecessary lymphadenectomies and verify that the classical ideas of lymphatic drainage ways do not correspond with reality, as there is great variability according to anatomic localisation, and the fact that Breslow thickness is the most important prognostic factor for predicting survival along with others in these patients. Thus, surgery is necessary for an adequate classification of the disease and to plan its treatment, remove the primitive tumour and possible metastasis of the ganglionic areas and eliminate visceral metastasis diminishing the tumour mass to facilitate other procedures. The reason for this work is to find out whether there is a correlation between them and try to obtain the results after an appropriate gammagraphic etection (with 100% correct choice in the localisation) and surgery of the sentinel lymph node and determine if there are differences with respect to the number of drainages and extracted sentinel lymph nodes that justify the variations found (AU)

[Fusion of SPECT with computed tomography or magnetic resonance for the interpretation of abnormal tracer uptake]. / Utilidad clínica de la fusión SPECT/CT con marcadores externos en patología oncológica.

BACKGROUND: Interpretation of abnormal foci with high tracer uptake may require morphological correlation. Fusion of functional images obtained by single photon emission computed tomography (SPECT) and anatomical images obtained by computed tomography (CT) or magnetic resonance (RM) allows an integrated comprehension of complementary information. AIM: To demonstrate that SPECT/CT fusion with external markers is useful in clinical practice to clarify the location and pathological meaning of questionable foci. MATERIAL AND METHODS: Thirty four pairs of images from separate equipments (31 SPECT/CT and 3 SPECT/RM) pertaining to 29 patients, were fused. Fifty one foci of abnormal tracer uptake of uncertain pathological meaning were analyzed. These were classified before and after the fusion as probably malignant or probably benign. RESULTS: Seventy percent of patients had a differentiated thyroid carcinoma. The fusion localized 100% of foci. Nine percent had a normal and 26% an abnormal anatomy. Before fusion 82% of foci were classified as potentially malignant. This figure changed to 59% after the fusion (p <0.01). Therefore the suspicion of malignancy was presumptively confirmed in 72% of foci and fusion results would have reached a 27% of incremental diagnostic value in 14 cases that changed of category (11 with differentiated thyroid carcinoma, one with colorectal cancer, one with a nasal Ewing sarcoma and one with a brain tumor). CONCLUSIONS: The fusion of SPECT and CT is useful in selected patients, specially those with differentiated thyroid carcinoma. The fusion of SPECT and RM is also feasible.

Utilidad clínica de la fusión SPECT/CT con marcadores externos en patología oncológica / Fusion of SPECT with computed tomography or magnetic resonance for the interpretation of abnormal tracer uptake

Background: Interpretation of abnormal foci with high tracer uptake may require morphological correlation. Fusion of functional images obtained by single photon emission computed tomography (SPECT) and anatomical images obtained by computed tomography (CT) or magnetic resonance (RM) allows an integrated comprehension of complementary information. Aim To demonstrate that SPECT/CT fusion with external markers is useful in clinical practice to clarify the location and pathological meaning of questionable foci. Material and methods: Thirty four pairs of images from separate equipments (31 SPECT/CT and 3 SPECT/RM) pertaining to 29 patients, were fused. Fifty one foci of abnormal tracer uptake of uncertain pathological meaning were analyzed. These were classified before and after the fusion as probably malignant or probably benign. Results: Seventy percent of patients had a differentiated thyroid carcinoma. The fusion localized 100 percent of foci. Nine percent had a normal and 26 percent an abnormal anatomy. Before fusion 82 percent of foci were classified as potentially malignant. This figure changed to 59 percent after the fusion (p <0.01). Therefore the suspicion of malignancy was presumptively confirmed in 72 percent of foci and fusion results would have reached a 27 percent of incremental diagnostic value in 14 cases that changed of category (11 with differentiated thyroid carcinoma, one with colorectal cancer, one with a nasalEwingsarcoma and one with a brain tumor). Conclusions: The fusion of SPECT and CT is useful in selected patients, specially those with differentiated thyroid carcinoma. The fusion of SPECT and RM is also feasible.

Brain metabolite concentration ratios in vivo: multisite reproducibility by single-voxel 1H MR spectroscopy.

Ten normal subjects were scanned identically at three separate sites (Little Rock, Houston, and New Orleans) to evaluate the reproducibility of brain metabolite ratios in single-voxel (1)H point-resolved spectroscopy sequence (PRESS) magnetic resonance (MR) spectroscopy in vivo. All scans were processed by a single individual at a single site. Coefficients of variation of the measured metabolite ratios generally were in the range found for previous single-voxel, single-site reproducibility studies. No differences were found among the sites for ratios of N-acetylaspartate to creatine (NAA/Cr) or choline to Cr (Cho/Cr) in left thalamus by multivariate ANOVA. Metabolite ratios of Cr or Cho relative to local brain H(2)O did not vary among the sites. However, by multivariate ANOVA, NAA/H(2)O differed between Little Rock and New Orleans, but not between those sites and Houston. Intraclass correlation coefficients suggested reasonable reproducibility between Little Rock and New Orleans, but not between those sites and Houston.

Drenaje linfático manual en el linfedema facial / Manual lymph drainage in facial lymphedema

Presentamos la evolución de una paciente de 19 años de edad con un adenoma pleomorfo de parótida que tras varios tratamientos, incluyendo vaciamiento ganglionar cervical y radioterapia, desarrolló linfedema facial. Debido a la repercusión de tipo emocional que originó en la paciente, se planificó tratamiento físico rehabilitador con drenaje linfático manual con el que mejoró tanto subjetiva como objetivamente (AU)

Dorsal root entry zone lesion versus spinal cord stimulation in the management of pain from brachial plexus avulsion.

In six patients with total or partial brachial plexus avulsion, spinal cord stimulation was tried as pain treatment. Two patients had had amputation of the arm and suffered from phantom limb and stump pain. After a mean follow-up of 14 months two patients were painfree, one had partial relief and required analgesics and in three patients there was no effect. In eleven patients, including the three patients in whom spinal cord stimulation had failed to produce a long-lasting pain relief, dorsal root entry zone (DREZ) lesions were performed. At early follow-ups all these patients reported substantial pain relief, but after a mean follow-up of 17 months the results were less favorable: Three patients were pain-free, three had a marked improvement and five had recurrence of the original pain. Neither of the two methods of treatment produced any serious side-effects or permanent sequelae.