Delayed spinal epidural hematoma following spinal anesthesia, far from needle puncture site.

STUDY DESIGN: Case report. OBJECTIVES: We report a case of spinal epidural hematoma (SEH) that appeared on the third postoperative day after lumbar spinal anesthesia, far from the needle puncture site. Possible mechanisms and etiological relation to patient's risk factors as well as diagnosis and management of SEH are briefly discussed. SETTING: Asklepieion General Hospital of Voula, Athens, Greece. METHODS AND RESULTS: A 64-year-old woman underwent an uneventful total knee arthroplasty operation under a spinal anesthetic. A lumbar puncture was performed in the L2-L3 interspace, that was atraumatic and successful on the first attempt. The operation was uneventful. On the third postoperative day, the patient developed a SEH that expanded from C2 to T3 levels. She was presented with bilateral shoulder pain, muscle weakness of the upper extremities with normal sensation, followed by paraparesis. The magnetic resonance imaging (MRI) revealed a large vascular malformation, partially ruptured forming a hematoma compressing the spinal cord toward the vertebral bodies The patient was treated conservatively and full recovery was achieved. CONCLUSION: The possibility of SEH must be considered whenever neurological symptoms occur in the postoperative period, especially after a neuraxial blockade. The causes are multiple, a not-known lesion predisposing to bleeding and hematoma formation may preexist and the anesthetic technique can be directly or indirectly connected to this complication. MRI is the preferred diagnostic method.

Endocuff-Assisted Colonoscopy—A Novel Accessory in Improving Adenoma Detection Rate: A Review of the Literature

Endocuff (Arc Medical Design) is a U.S. Food and Drug Administration-approved device that is attached like a cap to the distal tip of the colonoscope; it is used to improve adenoma detection rates during colonoscopy. The aim of this review was to summarize and evaluate the clinical and technical efficacy of Endocuff in improving adenoma detection rate. A comprehensive literature review was performed to identify studies describing this technique. In this review article, we have summarized case series and reports describing Endocuff use and results. The reported indications, results, limitations, and complications are discussed.

Neumonía por herpes virus simple tipo 1. Entidad infrecuente de difícil diagnóstico y mal pronóstico en trasplantados pulmonares / Pneumonia due to herpes simplex virus type 1: A diffi cult to diagnose condition with a poor prognosis in lung transplants

La neumonía herpética es una rara enfermedad que afecta casi con exclusividad apersonas con un déficit de inmunidad. Con frecuencia tiene un desenlace fatal. Su aparición está descrita en los primeros 2 meses luego del trasplante pulmonar, pero en nuestra experiencia se evidenció después de los 10 meses, 1 año y medio, 8 y 19 años. Describimos los hallazgos tomográficos detectados en 4 pacientes con trasplantes pulmonares que cursaron neumonía herpética. Presentaban fiebre, tos, expectoración y disnea, con empeoramiento progresivo de su clase funcional, y todos fallecieron tras la aparición de la enfermedad. El diagnóstico histológico se realiza mediante lavado bronquioalveolar o biopsia transbronquial,con posterior tinción con hematoxilina-eosina y/o marcación inmunohistoquímica. Los hallazgos tomográficos destacados fueron: opacidades en vidrio esmerilado de distribución parcheada, consolidación del espacio aéreo, derrame pleural y bronquiectasias. Debido a su baja frecuencia y mal pronóstico, es importante conocer y tener presente esta entidad en personas trasplantadas de pulmón para no demorar el diagnóstico y actuar lo más rápidamente posible...

Some comments on the process of counterurbanization in Europe.

PIP: The process of counter-urbanization in Western Europe is analyzed using the rank-size rule. Three major groups of countries are identified: those in which the decentralization of population began in the 1960s, those in which decentralization began in the 1970s, and those that still showed urban concentration in the 1970s. Comparisons are made among different types of counter-urbanization patterns.^ieng

HLA-DR typing "at the DNA level": RFLPs and subtypes detected with a DR beta cDNA probe.

The HLA-DR beta gene, used as a hybridization probe, detects RFLPs that correlate with HLA-DR specificities. Using genomic DNA from more than 200 individuals, we have carried out a population study with a cDNA probe for the DR beta chain, which, under appropriate conditions, does not cross-hybridize with genes from other HLA-D subregions (e.g., DP and DQ). We first assessed the correspondence between serologically defined HLA-DR types and DNA patterns obtained after digestion with TaqI and found that DNA patterns allowed us to identify most specificities. Only two pairs of antigens are not distinguishable: with the DR beta probe alone we cannot distinguish DR3 from DRw6 or DR7 from DRw9. However, the correct assignment can always be made for the first pair by hybridizing the same digests with a DQ alpha or DQ beta probe. Thus DR typing from the DNA patterns is practical and accurate. We also looked for serologically undetectable subtypes. RFLPs revealed high-frequency subtypes for the specificities DR 2, 3, 5, w6, 7, and w9. Some of these are more accurately viewed as variant haplotypes, since the relevant variation is probably not at the DR beta locus that determines the serological specificities but rather at other closely linked and highly homologous DR beta loci such as DR beta-III. Nevertheless, the existence of variant haplotypes for so many specificities indicates a wealth of polymorphic variation beyond that detected serologically and provides more specific markers for studies of various diseases associated with HLA-DR specificities.