Contrasting effects of cord injury on intravenous and oral pharmacokinetics of diclofenac: a drug with intermediate hepatic extraction.

STUDY DESIGN: Laboratory investigation in rats submitted to experimental spinal cord injury (SCI). OBJECTIVE: To determine the effect of acute SCI on the pharmacokinetics of diclofenac, a marker drug of intermediate hepatic extraction, administered by the intravenous and the oral routes. METHODS: Female Wistar rats were submitted to complete section of the spinal cord at the T8 level. SCI and sham-injured rats received 3.2 mg kg(-1) of diclofenac sodium either intravenously or orally, diclofenac concentration was measured in whole blood samples and pharmacokinetic parameters were estimated. Diclofenac was not selected as test drug because of its therapeutic properties, but because to its biopharmaceutical properties, that is, intermediate hepatic extraction. RESULTS: Diclofenac bioavailability after intravenous administration was increased in injured rats compared with controls due to a reduced clearance. In contrast, oral diclofenac bioavailability was diminished in SCI animals due to a reduction in drug absorption, which overrides the effect on clearance. CONCLUSION: Acute SCI induces significant pharmacokinetic changes for diclofenac, a marker drug with intermediate hepatic extraction. SCI-induced pharmacokinetic changes are not only determined by injury characteristics, but also by the route of administration and the biopharmaceutical properties of the studied drug.

[Complications in posterior ankle arthroscopy by classic and non-distraction portals]. / Complicaciones en la artroscopía posterior de tobillo por portales clásicos y sin distracción.

INTRODUCTION: Posterior ankle arthroscopy allows the diagnosis and treatment of multiple pathologies through minimal trauma. The use of posterior portals associated or not to mechanical distraction, allows a good vision of the posterior ankle, tendons of the region, and subtalar joint. OBJECTIVES: We evaluated intra- and postoperative complications of posterior ankle arthroscopy without joint distraction, and compared them with those described in international literature. MATERIAL AND METHODS: A retrospective study that evaluated 49 patients undergoing posterior ankle arthroscopy for several pathologies. All of them operated by a single surgeon, in two health institutions, for seven years. RESULTS: were analyzed using the visual analog scale and the AOFAS score. Intra- and postoperative complications were recorded. The average follow-up was 28 months. RESULTS: 33 men and 16 women. The average age was 38.6 years old. There were seven complications (14.3%): paresthesia and - or hypoesthesia of the sural nerve (four cases), residual pain in the portal (two cases), and portal scar dehiscence (one patient). The average improvement of VAS was 5.53 points, and the improved AOFAS score was an average of 35.78 points. CONCLUSIONS: Posterior ankle arthroscopy without distraction through the classic postero-lateral and posteromedial portals is a safe technique, with a low rate of complications.

INTRODUCCIÓN: La artroscopía posterior de tobillo permite el diagnóstico y tratamiento de múltiples patologías a través de un mínimo trauma. Los portales posteriores, asociados o no a distracción mecánica, permiten una buena visión de los tendones de la región y articulación substragalina. OBJETIVO: del presente estudio es evaluar las complicaciones intraoperatorias y postoperatorias de la artroscopía posterior del tobillo y retropié sin distracción articular y compararlas con las descritas en la bibliografía internacional. MATERIAL Y MÉTODOS: Estudio retrospectivo que evaluó 49 pacientes sometidos a artroscopía posterior de tobillo por diversas patologías. Todos operados por un único cirujano, en dos instituciones de salud, durante un período de siete años. Se analizaron los resultados mediante la escala visual analógica (EVA) y la escala de la American Orthopaedic Foot and Ankle Society (AOFAS, por sus siglas en inglés). Se consignaron las complicaciones intra- y postoperatorias. El seguimiento promedio fue de 28 meses. RESULTADOS: 33 varones y 16 mujeres (edad promedio 38.6 años). Hubo siete complicaciones (14.3%): cuatro parestesias y/o hipoestesia del nervio sural, dos casos de dolor residual en un portal y un caso de dehiscencia de cicatriz. Mejoría promedio de EVA de 5.53 puntos y mejoría promedio del AOFAS de 35.78 puntos. CONCLUSIONES: La artroscopía posterior de tobillo sin distracción por medio de los clásicos portales posterolateral y posteromedial es una técnica segura, con un bajo índice de complicaciones mayores y una baja morbilidad para el paciente.

Diabetic nephropathy produces alterations in the tissue expression profile of the orphan receptors GPR149, GPR153, GPR176, TAAR3, TAAR5 and TAAR9 in Wistar rats.

Diabetes mellitus is a debilitating health care problem affecting 382 million people around the world and one of the most common complications is diabetic nephropathy. For this reason, it is important to try to identify new mechanisms that could be involved in diabetes. A new class of receptors has been reported, called orphan receptors because the associated ligand and signaling cascades are unknown. These receptors could be an important source of targets for the treatment of many diseases such as diabetes and its associated complications like diabetic nephropathy. Therefore, the aim of this work was to study expression of the orphan receptors GPR149, GPR153, GPR176, TAAR3, TAAR5 and TAAR9 in the kidney of diabetic rats. We used male Wistar rats at 10-12 weeks of age. Diabetes was induced by a single dose of streptozotocin (60 mg/kg i.p.). After 4 weeks, tissues were obtained, and the expression of the mRNAs was measured by RT-PCR. Our results showed that the orphan receptors are expressed in a different way in the kidney. In conclusion, we suggest that orphan receptors could be involved in the development of diabetic nephropathy.

[Recurrent dislocation of peroneal tendons. Minimally invasive technique for the deepening of the groove]. / Luxación recidivante de tendones peroneos. Técnica mínimamente invasiva para la profundización del surco.

INTRODUCTION: Since William Clancy (1979) and Richard Ferkel (1997) publications, the technique of peroneal groove deepening in patients with chronic dislocation, has been used with very satisfactory results and few complications. The aim of the present study is to describe a new minimally invasive technique of peroneal groove deepening with burs and specific percutaneous surgery instrumentation and without fibula osteotomy; and to evaluate the clinical and imaging results, in 5 patients operated with this technique. MATERIAL AND METHODS: A retrospective study of 5 patients with clinical and imaging diagnosis of chronic dislocation of peroneal tendons. They were treated with minimally invasive technique. This technique was described in this paper. Results were evaluated by preoperative and postoperative AOFAS score and by images (dynamic ultrasound, TAC and RMN). RESULTS: None of the treated patients presented dislocation recurrence or pain at the time of evaluation. The AOFAS score improved an average of 25.5 points and was statistically significant (p value 0.001). In the images we observed a concavity of the groove in all the evaluated cases. CONCLUSIONS: This minimally invasive technique of deepening the groove of the peroneal tendons is reproducible, has reduced operating times compared to open surgery and has excellent results. This is a noninvasive treatment alternative for dislocation of peroneal tendons.

INTRODUCCIÓN: Desde las publicaciones de William Clancy en 1979 y las de Richard Ferkel en 1997, la técnica de profundización del surco en pacientes con luxación crónica de los peroneos ha sido ampliamente utilizada, obteniendo resultados muy satisfactorios y escasas complicaciones. El objetivo del presente trabajo es describir una nueva técnica de profundización del surco mínimamente invasiva con fresas y un motor específico de cirugía percutánea, sin osteotomía y sin dejar lecho cruento del peroné, además de evaluar los resultados clínicos e imagenológicos en cinco pacientes operados con esta técnica. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo de cinco pacientes con diagnóstico clínico y de imágenes de luxación crónica de tendones peroneos intervenidos con técnica mínimamente invasiva, la cual ya fue descrita. Los resultados fueron evaluados mediante el score AOFAS (por sus siglas en inglés American Orthopedic Foot and Ankle Score) de manera pre y postquirúrgica y a través de imágenes (ecografía dinámica, tomografía axial computada y resonancia magnética nuclear). RESULTADOS: Ninguno de los pacientes tratados presentó recidiva de luxación ni dolor al momento de la evaluación. El score AOFAS mejoró en promedio 25.5 puntos y fue estadísticamente significativo (p 0.001). En las imágenes observamos una concavidad del surco en todos los casos evaluados. CONCLUSIONES: Creemos que esta técnica mínimamente invasiva de profundización del surco de los peroneos es reproducible y presenta tiempos operatorios reducidos, comparada con la cirugía a cielo abierto; además tiene excelentes resultados. Por tales motivos, consideramos que se trata de una alternativa de tratamiento poco invasiva para la luxación de los tendones peroneos.

Wegener's granulomatosis appearing initially in the trachea.

We treated ten patients with Wegener's granulomatosis whose clinical picture differed only in stage of the disease at the time of the first visit. All patients were female with a mean age of 30 years and all presented with a picture of high tracheal obstruction. Three died and six have a permanent tracheostomy. Surgical treatment was unsuccessful; corticosteroids provided only transient improvement but cyclophosphamide induced remission. Removal of the stenosis either by open surgery or endoscopically by laser was not successful in accomplishing decannulation.

[Long-term course of liver rupture in preeclampsia. A case report]. / Evolución a largo plazo de la ruptura hepática en la preeclampsia. Informe de un caso.

A case report is presented of one preeclamptic patient with rupture of a big right subcapsular hematoma of the liver which was misdiagnosed with cholecystitis. A cesarean delivery was performed, which resulted is stillbirth, with abruptio placentae of 50%. The emergent treatment of the liver rupture was the right hepatic artery ligation, the postoperative development was favorable. Long term follow-up using ultrasound and liver function values were performed for 14 months and showed that the lesion has regressed with a normal hepatic imaging.

[Conservative management in severe pre-eclampsia]. / Manejo conservador en preeclampsia severa.

A total of 58 women with severe preeclampsia between 28-33 weeks of gestation were studied during the period from 1 October 1996 to 1 October 1997. Twenty-four women (42%) developed maternal or fetal indications necessitating early delivery within 48 hours, meanwhile the other 34 patients (58%) received expectant management. The average pregnancy prolongation period in the conservative management group was 6.4 days (range 3 to 18). The primary indications for delivery in this group were maternal indications 16 (47%), fetal compromise 13 (39%), 34 weeks of gestation 3 (8%), abruption placentae 1 (3%) and preterm labor 1 (3%). The mean birth weight and Apgar score at 5 minutes were 1520 +/- 310 g and 8, respectively. Expectant management was not associated with fetal death or maternal complications. The only neonatal death was related with sepsis and prematurity. The women in the early delivery group totaled two stillbirths and three neonatal deaths.

[Usefulness of stress-free test in preeclampsia]. / Utilidad de la prueba sin estrés en la preeclampsia.

INTRODUCTION: Poor perinatal outcome in patients with preeclampsia has been reported. This significant risk reinforces the importance of fetal evaluation. OBJECTIVE: The purpose of this study was to evaluate the utility of the nonstress test (NST) in preeclampsia. STUDY DESIGN: Criteria for inclusion in this report comprised pregnancies complicated by preeclampsia of longer than 28 weeks of gestation delivered 24 hours of final NST. The study population were divided into mild and severe preeclampsia. Each of the latter two groups was further subdivided into three subgroups by gestational age at 28-31, 32-34 and > 35 weeks. Measurements of adverse perinatal outcome included meconium staining, oligohydramnios, five-minute Apgar score less than 7 beyond 34 weeks of gestational age, intrauterine growth retardation, and perinatal death. RESULTS: A total of 250 patients with preeclampsia were analyzed, among these 147 with mild and 103 with severe disease. There were no stillbirths. Sensitivity of the NST was low ranged from 39% (mild preeclampsia) to 63% (severe disease). Its positive predictive value was equally low (66 and 45%) respectively. Specificity was quite high in both groups (89 and 64%). Its negative predictive value was 73% for mild disease and 78% for severe preeclampsia. CONCLUSION: The NST is an important test in antepartum care but based on its low sensitivity should not be considered as a stand alone test.

[Fibroepithelial polyp of the vagina. Report of a case]. / Polipo fibroepitelial de la vagina. Informe de un caso.

Fibro epithelial polyp of the vagina is a rare lesion. Although benign, it can be confused with Sarcoma botryoides, rhabdomyosarcoma and mixed mesodermal tumor because of its bizarre histology. A case is reported of a women 27 years old with a great pedunculated polyp of the vagina which measured 8 x 12 cm. The microscopy examination revealed fibro epithelial polyp of the vagina. Treatment is simple local excision. Recurrence is uncommon.

[Risk factors for preeclampsia. Multivariate analysis]. / Factores de riesgo para preeclampsia. Análisis multivariado.

OBJECTIVE: To determine in multivariate analysis the clinical, social, and demographic factors for preeclampsia. STUDY DESIGN: A case-control study was designed. Three hundred patients were included, divided in two groups. 150 cases with criteria diagnosis for preeclampsia. 150 patients with normal pregnancy and deliveries. The main variables analyzed were age, schooling, marital status, employment, socioeconomic status, smoking and alcohol consumption, body mass index, familiar history of preeclampsia, history of preeclampsia in previous pregnancy, parity and type of pregnancy (single or multiple). STATISTICAL ANALYSIS: For comparison of cases and controls on categorical variables, odds ratios and 95% confidence intervals were calculated, and multiple logistic regression analyses. RESULTS: Multiple logistic regression analysis showed that history of preeclampsia in previous pregnancy has OR 23.7, 95% p < 0.001, familiar history of preeclampsia OR 1.62, p < 0.08, high body mass has OR 1.60. CONCLUSIONS: The knowledge of the most important risk factors in our population could be useful for the clinical to pre-detect the patient who will develop preeclampsia.

[Maternal morbidity and mortality in HELLP Syndrome]. / Morbimortalidad materna en síndrome de HELLP.

OBJECTIVE: To describe the maternal morbidity and mortality in pregnancies complicated by HELLP Syndrome. STUDY DESIGN: This is a descriptive and prospective study of women with HELLP Syndrome managed at our center from January 1998 through March 2000. Patients are grouped into 3-class system of Mississippi classification. RESULTS: 170 cases were analysed, 156 (92%), ocurred ante partum and 14 (8%) postpartum; 15 cases (9%) developed at < 27 weeks, 112 (66%) between 28 to 36 weeks of gestational age and 43 (25%) at term. Maternal morbidity included acute renal failure (13.5%), abruptio placentae (6.6%), pneumonia (3%), subcapsular liver hematoma (2.3%), pulmonary edema (2.3%), diseminated intravascular coagulopathy (1.7%) and cerebral hemorrhage (1.2%). Maternal mortality was 4.7% (8 patients), 7 deaths ocurred in patients with class I disease and only one with class II HELLP Syndrome. 6 maternal deaths (75%) were associated to eclampsia. Up to 85% of the maternal morbidity and mortality developed with class I disease (platelet nadir < 50,000 mm3. CONCLUSIONS: There is a progressive rise in maternal morbidity and mortality as the pregnancy moves from class III to class I HELLP Syndrome. 75% of maternal mortality was associated with eclampsia. Early diagnosis of this syndrome could improve maternal prognosis and outcome.

Granulomatosis de Wegener con manifestaciones iniciales en la laringe. / Wegener's granulomatosis with initial manifestations in larynx

Diez pacientes de sexo femenino de 20 a 40 anos de edad, consultaron por procesos inflamatorios subgloticos que evolucionaron hacia la estenosis. El sintoma de comienzo fue disfonia o disnea de esfuerzo. Habia patologia concomitante: dos con pulmonar, dos con glomerulonefritis. Si bien no hubo biopsia positiva el diagnostico se obtuvo en dos casos por necropsia y en tres mas, por la respuesta al tratamiento con ciclofosfamida. Cuatro tuvieron deformacion nasal con destruccion del cartilago. En los pacientes muy obstruidos se intento la reseccion con anastomosis termino-terminal y la vaporizacion de la estenosis con laser, con exito poco duradero. Cinco tienen una traqueotomia que pueden ocluir en reposo

Granulomatosis de Wegener con manifestaciones iniciales en la laringe. / Wegeners granulomatosis with initial manifestations in larynx

Diez pacientes de sexo femenino de 20 a 40 anos de edad, consultaron por procesos inflamatorios subgloticos que evolucionaron hacia la estenosis. El sintoma de comienzo fue disfonia o disnea de esfuerzo. Habia patologia concomitante: dos con pulmonar, dos con glomerulonefritis. Si bien no hubo biopsia positiva el diagnostico se obtuvo en dos casos por necropsia y en tres mas, por la respuesta al tratamiento con ciclofosfamida. Cuatro tuvieron deformacion nasal con destruccion del cartilago. En los pacientes muy obstruidos se intento la reseccion con anastomosis termino-terminal y la vaporizacion de la estenosis con laser, con exito poco duradero. Cinco tienen una traqueotomia que pueden ocluir en reposo

Paracoccidioidomicosis: recopilación de 18 casos / Paracoccidioidomycosis: report of 18 cases

Se presentan 18 casos de paracoccidioidomicosis registrados entre 1970 y 1985. Todos los pacientes eran del sexo masculino, sus edades oscilaban entre los 35 y 59 años, provenían de áreas endémicas y en su mayoría presentaban la forma diseminada crónica de la enfermedad. El diagnóstico fue establecido por hallazgo del hongo en estudios micológicos e histopatológicos, excepto en 2 pacientes derivados para ser operados por secuelas de la afección. En el momento de comenzar el tratamiento, se comprobaron 6/7 pruebas de fijación de complemento positivas, 6/7 reacciones de contrainmunoelectroforesis positivas, 5/7 reacciones de inmunodifusión en gel positivas, y 3/7 enfermos presentaron intradermorreacciones positivas con el antígeno homólogo. El tratamiento con ketoconazol (400mg/día) brindó los resultados favorables más precoces, asegurando curación clínica y serológica y disminuyendo sensiblemente el riesgo de recaídas

Paracoccidioidomicosis: recopilación de 18 casos / Paracoccidioidomycosis: report of 18 cases

Se presentan 18 casos de paracoccidioidomicosis registrados entre 1970 y 1985. Todos los pacientes eran del sexo masculino, sus edades oscilaban entre los 35 y 59 años, provenían de áreas endémicas y en su mayoría presentaban la forma diseminada crónica de la enfermedad. El diagnóstico fue establecido por hallazgo del hongo en estudios micológicos e histopatológicos, excepto en 2 pacientes derivados para ser operados por secuelas de la afección. En el momento de comenzar el tratamiento, se comprobaron 6/7 pruebas de fijación de complemento positivas, 6/7 reacciones de contrainmunoelectroforesis positivas, 5/7 reacciones de inmunodifusión en gel positivas, y 3/7 enfermos presentaron intradermorreacciones positivas con el antígeno homólogo. El tratamiento con ketoconazol (400mg/día) brindó los resultados favorables más precoces, asegurando curación clínica y serológica y disminuyendo sensiblemente el riesgo de recaídas (AU)