[Bicortical reconstruction of a large calvarial bone defect with Hydroset® osteoconductive cement and titanium mesh. A preliminary study]. / Reconstitution bicorticale de grande taille de l'os calvarial par ciment ostéoconducteur Hydroset® associé à une grille en titane. Étude préliminaire.

INTRODUCTION: Bi-cortical calvarial bone loss is a very frequent issue for neurosurgery and craniofacial surgery. Several techniques can be used to reconstruct the skull, with variable difficulty and costs. The purpose of our study was to assess the use of Hydroset® osteoconductive cement for large size bicortical cranioplasties. MATERIALS AND METHODS: Three patients presented with extensive loss of calvarial bone bi-cortical substance (>25 cm(2)), between 2010 and 2012. The 3 patients underwent cranioplasty with Hydroset® osteoconductive cement and titanium mesh. RESULTS: The esthetic results were very satisfactory, especially for the skull dome, with a completely invisible and non-palpable cement/native skull junction. Scalp adherence to the cement was natural with maintenance of skin mobility. DISCUSSION: Bicortical calvarial bone reconstruction with Hydroset® cement is technically easy to perform, gives very good results, with an uneventful outcome, and induces lower costs.

Human endothelial lecitin-like oxLDL receptor-1 (LOX-1) expression is not associated with impairment of endothelium-dependent vasoreactivity in conduit vessels.

UNLABELLED: The cellular uptake of oxidized low density lipoprotein (LDL) is mediated through the oxidized LDL receptor-1, LOX-1. We investigated whether circulating factors link LOX-1 expression in endothelial cells and impaired endothelium-dependent vasoreactivity (EDVR) as functional indicator of atherogenesis. EDVR was measured as flow-mediated dilation (FMD) of the brachial artery in 27 patients with a known history of cardiovascular disease. Human umbilical vein endothelial cells (HUVEC) were incubated with bradykinin or prostacyclin in the presence of tumour necrosis factor-alpha (TNF-α) or with serum of each patient for four hours. Total mRNA and protein extracts were analysed for LOX-1 and eNOS expression relative to the expression in medium-treated cells and corrected for GAPDH expression. RESULTS: Prostacyclin and bradykinin did not modulate LOX-1 basal expression but were able to prevent significantly the up-regulation of LOX-1 expression by TNF-α, in HUVEC in vitro. Impaired EDVR was associated significantly with reduced endothelial nitric oxide synthase (eNOS) protein expression in HUVEC (r=0.788, P<0.001), diabetes (P=0.024), and smoking status (yes/no, P=0.047). In contrast, no such association was established with LOX-1 mRNA (r=0.292, P=0.138) or with LOX-1 protein expression in HUVEC (r=0.201, P=0.312). CONCLUSIONS: Using a combination of in vitro experiments with in vivo measurements, we found no evidence that endothelial LOX-1 expression and EDVR mediated through circulating factors were associated.

[Candida albicans cerebral granuloma in an immunocompetent patient. A case report]. / Granulome cérébral àCandida albicans chez un patient immunocompétent. Cas clinique.

We report a case of temporal lobe granuloma caused by Candida albicans in an immunocompetent patient. This 54-year-old patient had experienced headaches and some memory disorders for two to three months before his admission to the neurosurgical department. Cerebral-computer tomography and magnetic resonance imaging showed a single right-temporal lesion with a large peritumoral edema. We operated on the patient via a temporal approach using neuronavigation and resected the lesion. The anatomopathological result and the cultures of the granuloma showed C. albicans species. The patient received antifungal therapy for three months. No predisposing factors or immunosuppression was found. After seven months, he presented an ischemic cerebrovascular accident of the brain stem and then chronic meningitis complicated by hydrocephalus. The patient's condition progressively deteriorated and he died 18 months later in an other department. C. albicans can be found even in the immunocompetent patient, but is seldom observed. Surgery can provide an accurate diagnosis and therapeutic management in the initial phase, completed by antifungal therapy.

The impact of photodynamic therapy on the viability of Streptococcus mutans in a planktonic culture.

OBJECTIVE: This study investigated the effect of photodynamic therapy (PDT) with toluidine blue O (TBO) and a light-emitting diode (LED) on the viability of Streptococcus mutans cells in a planktonic culture. BACKGROUND DATA: Growth of Streptococcus mutans is the first step in the development of tooth decay. The use of light and dyes promotes cellular death in a noninvasive way, reducing treatment time. METHODS: The LED used in this study had output power of 116 mW, its energy was 21 J, and the fluency was 2.18 J/cm(2). Samples were prepared and divided into five groups: (1) control group (-); (2) control group (+); (3) TBO; (4) LED; and (5) LED + TBO. RESULTS: One hundred percent of the bacteria were killed following irradiation with LED and TBO. The biofilm that formed on the glass surfaces was analyzed by SEM and colony count. CONCLUSIONS: It was demonstrated that PDT was efficient at killing microorganisms and preventing the formation of biofilms.

[Surgical treatment of cortical and subcortical cavernomas. General principles and personal series of 20 cases treated between 2000 and 2006]. / Traitement chirurgical des cavernomes corticaux et sous-corticaux. Principes généraux et série personnelle de 20 cas opérés entre 2000 et 2006.

The surgical treatment of cortical or subcortical hemispheric cavernomas is founded on a series of questions: Is the cavernoma located in an eloquent or non-eloquent area? Is the cavernoma tangent to the cortex and visible immediately after the dura opening or deep seated in the hemisphere? Does the cavernoma lie in the depth of a sulcus and identifiable on the pretrans-sulcal approach MRI? Will perilesional tissue have to be removed to cure the epilepsy? What is the appropriate technology for each particular case: preoperative functional MRI, angiography, preoperative stereotactic guidance, peroperative ultrasonography, neuronavigation, peroperative neurophysiology and cortical stimulation, preoperative MRI? Based on a personal series of 20 cases operated on between 2000 and 2006, we describe our personal experience.

[Giant extradural epidermoid cyst of the posterior fossa]. / Kyste épidermoïde extra-dural géant de la fosse postérieure.

We report an unusual case of giant extradural epidermoid cyst of the posterior fossa in a 73-year-old man. The patient presented headache and gait disturbance for 3-4 months, cerebellar ataxia, left cerebellar dysmetria, and perturbed balance. The CT-scan showed a huge posterior fossa extradural lesion with a small area of peripheral contrast enhancement. Outcome was good after total resection of the lesion via a suboccipital approach. Pathology reported an epidermoid cyst. Extradural epidermoid cyst is a rare benign tumor of the skull which sometimes can reach considerable size. It is a slow growing lesion and may cause mild neurological deficits. The goal of surgical treatment is total resection of the tumor with its capsule. The long-term prognosis is excellent after successful resection.

Sarcoidosis: the value of exercise testing.

STUDY OBJECTIVES: To evaluate exercise testing for the assessment of the extent of pulmonary disease in patients with sarcoidosis. DESIGN: Retrospective analysis of consecutive patients with sarcoidosis referred to the Pulmonary Physiology Laboratory between 1992 and 1997, who completed at least 6 min of progressive bicycle exercise. Resting and exercise pulmonary function measurements were compared to radiographic stage of disease. SETTING: Pulmonary Physiology Laboratory at Washington, DC, Veterans Affairs Medical Center. PATIENTS: Forty-eight outpatient veterans with biopsy specimen-proven sarcoidosis. RESULTS: Across all radiographic stages of sarcoidosis, total lung capacity, resting diffusing capacity, and exercise gas exchange measurements had a significant variance with radiographic stage. Across the early radiographic stage disease (stages 0 to 2), the change in alveolar-arterial oxygen pressure gradient between rest and exercise, normalized for oxygen uptake, was the most significant measurement in its variation with radiographic stage. CONCLUSIONS: Changes in gas exchange with exercise may be the most sensitive physiologic measurements to assess the extent of disease in early radiographic stages of sarcoidosis.

Lactic acidosis secondary to nucleoside analogue antiretroviral therapy.

A 53-year-old woman with newly diagnosed HIV infection was treated with the nucleoside analogue antiretroviral agents lamivudine and stavudine and the protease inhibitor indinavir. An illness characterized by severe lethargy, persistent nausea and vomiting, lactic acidosis, hyperglycemia, and microvesicular hepatic steatosis developed. Her symptoms improved gradually after withdrawal of the antiretroviral agents. The illness can be explained by mitochondrial dysfunction caused by inhibition of mitochondrial DNA (mtDNA) polymerase by the nucleoside analogues. The patient was successfully treated with nonnucleoside reverse transcriptase inhibitors, which lack affinity for mtDNA polymerase.

Non-invasive grading of oligodendrogliomas: correlation between in vivo metabolic pattern and histopathology.

Several studies have shown that the prognosis of oligodendrogliomas is dependent on their histological grade. In order to identify a non-invasive method for the primary diagnosis and follow-up of these tumours, we investigated the relationship between their in vivo metabolism, assessed by positron emission tomography (PET), and their histological grade assessed at the same time. Forty-seven patients with histologically confirmed oligodendrogliomas were investigated. Conventional neuroradiological assessment by computed tomography and magnetic resonance imaging (MRI) was performed in all the patients. All the histology slices were reviewed by the same pathologist after referral from various pathology laboratories. The PET investigation included a carbon-1 methionine (11C-MET) uptake study and, in the majority of cases, a fluorine-18 fluorodeoxyglucose (18F-FDG) uptake study, in order to investigate at the same time both amino acid metabolism and glycolysis. The sampled tumour region of interest (ROI) was defined from the T1-weighted 3D MR scan matched with the PET scan. Tracer concentration in each voxel of the tumour ROI was divided by the mean concentration in an ROI of the same size located in the healthy brain tissue. For each tumour and each tracer, we characterized the metabolic pattern on the basis of the mean and the maximum tumour to healthy tissue concentration ratio, and also the standard deviation and range of the ratios, which indicate the degree of metabolic heterogeneity of the tumour. The histological criteria for differentiating between high- and low-grade tumours were those of the WHO and, partially, of the Sainte-Anne-Daumas-Duport classification. Highly significant differences between high- and low-grade oligodendrogliomas (Mann-Whitney test: P<0.0001) were observed for all the assessed parameters of 11C-MET uptake. On the other hand, the pattern of 18F-FDG uptake showed only moderate differences between the two tumour groups.

Antiangiogenic effects of the oral administration of liquid cartilage extract in humans.

BACKGROUND: The antiangiogenic properties of shark cartilage extracts have been demonstrated in animal models but there are no data in human subjects. MATERIALS AND METHODS: A placebo or one of two doses of a liquid shark cartilage extract was orally administered daily, from Day 1 to Day 23 of the study protocol, to 29 healthy male volunteers randomized into three groups. On Day 12, a polyvinyl alcohol sponge threaded in a perforated silicone tubing was inserted subcutaneously on the anterior side of the arm and removed on Day 23. Evaluation of endothelial cell density, with factor VIII immunostaining, an indirect measurement of angiogenesis, was performed on histological sections of the implant using a semiquantitative numerical scale ranging from 1 (low density) to 5 (high density). The hydroxyproline content of the sponges was measured by HPLC. RESULTS: The mean endothelial cell density was significantly lower in groups that had received the liquid cartilage extract: grades 2.24 +/- 0.10, 2.47 +/- 0.10, and 3.15 +/- 0.11 for 7 and 21 ml liquid cartilage extract and placebo, respectively (P < 0.01 for both comparisons). No grade 1 was observed in the placebo group, whereas 9 treated subjects received a grade 1. Hydroxyproline content of the sponges did not differ between groups and there was no significant correlation between hydroxyproline content and endothelial cell density in the sponges. CONCLUSIONS: These results demonstrate that the liquid cartilage extract contains an antiangiogenic component bioavailable in humans by oral administration. This is the first report of an inhibition of wound angiogenesis in healthy men.

Creatine kinase as a biochemical marker in diagnosis of placenta increta and percreta.

We describe 1 case of placenta increta and 1 of placenta percreta, both associated with elevated maternal serum creatine kinase concentration. In patients with placenta previa and ultrasonographic findings of an abnormally adherent placenta, an unexplained elevation in maternal serum creatine kinase level should alert the clinician to the possibility of placenta increta or placenta percreta, with an attendant increase in maternal morbidity.

The bendistal pliers: a solution for distal end bending of superelastic wires.

These new pliers were designed specifically to work with the currently and widely used superelastic arch wires and bondable molar tubes. They place an effective distal end bend without the need for wire annealing or overtwisting that frequently results in fracture of bondable molar tubes.

Evaluation of patterns of perfusion and metabolism in dobutamine-responsive myocardium.

OBJECTIVES: We investigated the patterns of perfusion and metabolism in dysfunctional myocardium whose contractility improved with dobutamine. BACKGROUND: Clinical studies have suggested that dobutamine echocardiography can identify hibernating myocardium, but laboratory studies suggest that reduced perfusion limits the response to dobutamine. METHODS: Twenty-five patients with coronary disease and ventricular dysfunction underwent low (5 and 10 micrograms/kg body weight per min) and high dose (maximum of 50 micrograms/kg per min) dobutamine echocardiography and positron emission tomography (PET) using nitrogen-13 (N-13) ammonia and fluorine-18 fluorodeoxyglucose (FDG) for imaging of perfusion and metabolism. Wall motion and tracer uptake were scored in 16 left ventricular segments. RESULTS: Perfusion and metabolism were normal in 56.4%, mildly reduced in 29.1% and mismatched (reduced perfusion, preserved FDG uptake) in 14.5% of dysfunctional segments viable on PET. Wall motion improved with dobutamine in 89 dysfunctional segments (62 at low dose, 27 only at peak dose), and 86 of these (97%) were viable on PET. Improvement in wall motion with dobutamine was more common in segments with normal perfusion and metabolism (56.5%) than in those with mildly reduced tracer uptake (28.5%, p < 0.001) and those with mismatch (32%, p = 0.03). All the segments with a biphasic response were supplied by vessels with > or = 70% stenosis, and 88% had normal perfusion and metabolism. CONCLUSIONS: The majority of viable segments with rest dysfunction had normal perfusion and metabolism, suggesting that myocardial stunning was common. Improvement of wall motion at low and high doses of dobutamine was highly correlated with myocardial viability on PET and was more common in myocardium with normal perfusion. A biphasic response to dobutamine identified segments with normal perfusion and metabolism supplied by severely diseased vessels.

Increased synthesis of high-molecular-weight cPLA2 mediates early UV-induced PGE2 in human skin.

Ultraviolet light (UV) B-induced inflammation is characterized by dramatic increases in prostaglandin E2 (PGE2) synthesis due to enhanced arachidonate deacylation from the membrane. Therefore, the effect of UV on sythesis, mass, and distribution of the high-molecular-weight phospholipase A2 (cPLA2) in cultured human keratinocytes and human skin was studied. The 105-kDa cPLA2 was demonstrated to be the critical enzyme in UV-induced PGE2 synthesis and erythema in the first 6 h postirradiation. Immunoprecipitation of 35S-labeled protein showed cPLA2 synthesis increased three- to fourfold 6 h after irradiation. Immunoprecipitated 32P-labeled cPLA2 demonstrated phosphorylation of cPLA2 was concurrently induced, suggesting that UV also activates cPLA2. This increase in cPLA2 synthesis and activation also closely correlated with increased PGE2 synthesis and [3H]arachidonic acid release and was effectively blocked by both an S-oligonucleotide antisense to cPLA2 and methyl arachidonate fluorophosphate, a specific inhibitor of cPLA2. Biopsy and histochemical examination of erythematous sites expressed increased amounts of cPLA2 whereas nonerythematous irradiated sites did not. In contrast, cyclooxygenase-1 and -2 in cultures and skin explants were unaffected 6 h post-UV, and no change in cyclooxygenase activity was observed at this time. These results suggest that increased cPLA2 synthesis occurs only when skin is exposed to UV doses that are sufficient to cause erythema and indicate expression of cPLA2 participates in acute UV inflammation.

Exner's Depression Index and the Harris-Lingoes MMPI-2 subscales for depression.

This study examined the relationship between scores on the Harris-Lingoes MMPI-2 subscales for Depression and the categories of Exner's Rorschach Depression Index (DEPI) for 53 clients of a counselling agency. Scores on the subscale Mental Dullness related to the Depression Index as a whole and to the category Blends < 4. The subscale Subjective Depression also related to the category Blends < 4.

[Ethanol and the gastrointestinal tract]. / Etanol e o trato gastrointestinal.

The effects of ethanol upon the gastrointestinal tract (mouth, pharynx, esophagus, stomach, duodenum, Oddi's sphincter, small bowel, colon and rectum) were reviewed. Several studies showed that the incidence of cancer in the mouth and pharynx is increased in alcoholics as a consequence of ethanol effects and probably those of other compounds found in liquors. The gastroesophageal reflux disease may be induced by alcohol since it reduces the pressure in the lower and the upper esophageal sphincter, as well as the extent of primary peristalsis. Several studies showed a strong correlation between esophageal cancer and alcohol abuse. The risk for developing this kind of tumour is significantly increased when alcohol abuse and smoking coexist. Alcoholism predisposes patients to Mallory-Weiss syndrome as well as to bleeding of esophageal varices Ethanol may affect gastric secretion, motility, and permeability. Some drugs acting upon the gastric alcohol-dehydrogenase are able to affect gastric absorption of ethanol. Eradication of Helicobacter pylori increases the activity of alcohol-dehydrogenase in the pyloric antrum. The effects of alcohol upon the gastric mucosa include caustic damage, retrograde diffusion of H+, and cytoprotection. This agent may cause an acute gastritis but it is probably not involved in chronic gastritis. Whether alcohol is a risk factor for ulcer or not is unknown. Some studies found an increased incidence of gastric cancer associated with consumption of beer, wine and vodka. Some authors reported a decreased pressure in Oddi's sphincter while others found it increased in association with the consumption of ethanol. The acute and the chronic consumption of alcohol may affect the structure of small bowel as well as the absorption of nutrients. Several studies reported a significant correlation between colorectal cancer and the chronic consumption of ethanol.

Colestase intra-hepática en situs inversus do fígado / Intrahepatic cholestasis with situs inversus of the liver

Em nossa pesquisa bibliográfica näo encontramos nenhum trabalho sobre colestase intra-hepática em situs inversus do fígado. OBJETIVO. Relatar um caso de seguimento por um de nós (MM) durante aproximadamente, 14 anos após o desaparecimento da mencionada colestase. MÉTODOS. Foram estudados aspectos clínicos, realizados diversos testes laboratoriais e efetuados três exames ultra-sonográficos e uma tomografia computadorizada. Tentou-se realizar colangiografias transparieto-hepática e endoscópica. RESULTADOS. Quatro dias após a paciente ter sido submetida à prótese aórtica (com circulaçäo extracorpórea) surgiu icterícia, urina escura e fezes claras. As bilirubinas, fosfatase alcalina, gamaglutamil transferase e colesterol séricos estavam muito elevados. Os exames ultra-sonográficos e a tomografia sem evidências de obstruçäo extra-hepática. Neste exame, em especial, ficou caracterizada a existência de situs inversus do estômago e fígado. Näo houve êxito na realizaçäo das colangiografias. Os dados clínicos e laboratoriais referentes à colestase normalizaron após quatro meses. Boa evoluçäo após 14 abos. CONCLUSAO. O diagnóstico diferencial entre colestase intra e extra-hepática em pacientes com situs inversus do fígado pode, realmente, ser dificil, exigindo associar dados clínicos e vários exames complementares, entre os quais a colangiopancreatografia endoscópica retrógrada. A realizaçäo desse exame pode, porém, ser difícil nos mencionados pacientes

[Intrahepatic cholestasis with situs inversus of the liver]. / Colestase intra-hepática em situs inversus do fígado.

Intrahepatic cholestasis with situs inversus of the liver has not been reported in the literature. PURPOSE--A follow-up case for approximately 14 years (by one of the authors, MM). METHODS--Clinical aspects were studied and several laboratory exams as well as three ultrasonography and one computerized tomography exams were performed. Percutaneous and endoscopic cholangiographies were attempted. RESULTS--Four days after the patient was submitted to a surgical replacement of the aortic valve (with extracorporeal circulation), she developed jaundice, severe pruritus, dark urine, and pale stools. Serum levels of bilirubin, alkaline phosphatase, gama-glutamil transferase, and cholesterol were very high. Ultrasonography and computerized tomography exams did not reveal any evidence of extrahepatic obstruction. The tomography exam confirmed the existence of situs inversus in the stomach and liver. We were not successful in performing the cholangiography exams. Clinical and laboratory data as to cholestasis returned to normal after 4 months with no recurrence or complication during the follow-up period (14 years). CONCLUSION--The differential diagnosis between intra and extra-hepatic cholestasis in patients with situs inversus of the liver may be difficult. Therefore it will be necessary to collect clinical data and various complementary exams such as endoscopic retrograde cholangiopancreatography which is very difficult to perform in these patients.