Eficacia terapéutica frente a la caspa grasa y la caspa seca de compuestos basados en terpineol, ácido salicílico y climbazol / Therapeutic effectiveness against oily or dry dandruff of compounds based on terpineol, salicylic acid and climbazole

Introducción: la caspa se define como una descamación excesiva del cuero cabelludo, en general acompañada de prurito. Su etiología es multifactorial y depende de la presencia de levaduras del género Malassezia, de la producción de sebo y de la susceptibilidad individual. Más allá de los tratamientos tradicionales para controlar la caspa, existen nuevas formulaciones que pueden incluir queratolíticos como el ácido salicílico, el climbazol, que además de agente antimicótico presenta potenciales propiedades antiproteolíticas o el terpineol, antimicótico de amplio espectro con acción antiinflamatoria. Objetivo: el objetivo principal de este estudio, consistió en evaluar el efecto sobre la caspa grasa de un champú con terpineol, extracto de sauce, ácido salicílico, climbazol y lipoaminoácido seborregulador y de una loción con terpineol, ácido salicílico, climbazol y glucósidos del extracto de roble y té verde. Se evaluó igualmente la eficacia sobre la caspa seca de un champú con terpineol, extracto de sauce, ácido salicílico y climbazol. Se realizaron una visita inicial (T0), otra al finalizar tratamiento (T28) y una final (T42), para evaluar la eventual reaparición de la caspa una vez suspendido el tratamiento. Material y Método: estudio unicéntrico abierto, no aleatorizado, a simple ciego, de 42 días de duración, llevado a cabo en 78 pacientes con caspa grasa o seca. Se clasificó la gravedad de la caspa en 4 grados. Según el tipo de caspa y su grado, se administraron un champú para caspa grasa (A), un champú para caspa seca (B), una loción para caspa grasa (C) o un champú neutro (D). Se establecieron 4 grupos de tratamiento en función del producto asignado (A, B, AC y CD). Resultados: un 59% de los participantes fueron mujeres y un 41% varones. La edad media fue de 47 años (rango 20-72). Del total de pacientes: 20 presentaron caspa grasa en grado medio-bajo (grupo A), 20 caspa seca en cualquier grado (grupo B), 17 caspa grasa en grado elevado (grupo AC) y 21 caspa grasa en grado medio-alto (grupo CD). Al cabo de cuatro semanas de tratamiento, el grado de caspa se redujo vs. basal en ≥70% de los casos en todos los grupos. Estas cifras ascendieron, en los pacientes con caspa grasa, a un 70% (grado bajo-medio), un 76,2% (grado medio-alto) y un 88,2% (grado elevado); el efecto fue más notable en aquellos con caspa seca, donde la cifra fue del 90%. La eliminación de la caspa fue completa en el 78,5%, 62,5%, 47% y 44,4% de ellos, respectivamente. Una vez transcurridas las dos semanas de lavado posterior al tratamiento, el nivel de caspa siguió descendiendo en un 55% de los pacientes tratados con el champú A, un 57,1% de los que emplearon la loción C, el 58,8% de los que usaron el champú A + la loción C, y el 35% de los que recibieron el champú B. Se declararon satisfechos o muy satisfechos con el producto un 70% de los pacientes del grupo A, un 80% del grupo B, un 66,7% del grupo CD y un 70,6% del grupo AD. Conclusiones: los resultados obtenidos en este estudio, orientan acerca de la eficacia frente a la caspa grasa y la caspa seca de dos champúes y una loción basados en terpineol, ácido salicílico y climbazol. Se requieren investigaciones adicionales que amplíen los resultados en este campo.

Introduction: dandruff is defined as excessive flaking of the scalp accompanied by itching. The etiology is multifactorial and depends on the presence of Malassezia yeasts, sebum production and individual susceptibility. Beyond traditional treatments to control dandruff, there are new formulations that may include keratolytics such as salicylic acid; climbazole, an antifungal agent which potential antiproteolytic properties, or terpineol, broad-spectrum antifungal with antiinflammatory action. Objective: the main objective of this study was to evaluate the effect on seborrheic dandruff of a shampoo with terpineol, willow extract, salicylic acid, climbazole and sebum-regulating lipoaminoacid, and a lotion with terpineol, salicylic acid, climbazole and glycosides from oak and green tea extract. Effectiveness on dry dandruff of a shampoo containing terpineol, willow extract, salicylic acid and climbazole was also evaluated. Three study visits were performed (T0, T28 and T42). Methods: single-center, open, non-randomized, single-blind, 42-day study conducted in 78 patients with seborrheic or dry dandruff. Dandruff severity was classified into 4 grades. A shampoo for oily dandruff (A), a shampoo for dry dandruff (B), a lotion for oily dandruff (C) and a neutral shampoo (D) were administered. Four treatment groups were established according to the assigned treatment (A, B, AC and CD). Results: 59% of participants were women and 41% men. The average age was 47 years (range 20-72). Of the total patients, 20 had medium-low oily dandruff (group A), 20 dry dandruff at any level (group B), 17 severe oily dandruff (AC) and 21 medium-high oily dandruff (group CD). After four weeks of treatment the severity of dandruff was reduced vs. baseline in ≥70% of cases in all groups; for oily dandruff results were 70% (low-medium grade), 76.2% (medium-high) and 88.2% (high level); the effect was most marked in patients with dry dandruff (90%). Dandruff removal was complete in 78.5%, 62.5%, 47% and 44.4% of them, respectively. Two weeks after having suspended the treatment, dandruff level continued to decline in 55% of patients treated with shampoo A, 57.1% of those who used the lotion C, 58.8% of patients who used shampoo A + lotion C, and 35% of those receiving shampoo B. Seventy per cent of patients in group A, 80% in group B, 66.7% of the CD group and 70.6% of the AD group were satisfied or very satisfied with the study treatments. Conclusions: the results obtained in this study suggest the effectiveness against oily and dry dandruff of two shampoos and a lotion based on terpineol, salicylic acid and climbazole. Further research to extend the results in this field is required.

Eficacia terapéutica frente a la caspa grasa y la caspa seca de compuestos basados en terpineol, ácido salicílico y climbazol / Therapeutic effectiveness against oily or dry dandruff of compounds based on terpineol, salicylic acid and climbazole

Introducción: la caspa se define como una descamación excesiva del cuero cabelludo, en general acompañada de prurito. Su etiología es multifactorial y depende de la presencia de levaduras del género Malassezia, de la producción de sebo y de la susceptibilidad individual. Más allá de los tratamientos tradicionales para controlar la caspa, existen nuevas formulaciones que pueden incluir queratolíticos como el ácido salicílico, el climbazol, que además de agente antimicótico presenta potenciales propiedades antiproteolíticas o el terpineol, antimicótico de amplio espectro con acción antiinflamatoria. Objetivo: el objetivo principal de este estudio, consistió en evaluar el efecto sobre la caspa grasa de un champú con terpineol, extracto de sauce, ácido salicílico, climbazol y lipoaminoácido seborregulador y de una loción con terpineol, ácido salicílico, climbazol y glucósidos del extracto de roble y té verde. Se evaluó igualmente la eficacia sobre la caspa seca de un champú con terpineol, extracto de sauce, ácido salicílico y climbazol. Se realizaron una visita inicial (T0), otra al finalizar tratamiento (T28) y una final (T42), para evaluar la eventual reaparición de la caspa una vez suspendido el tratamiento. Material y Método: estudio unicéntrico abierto, no aleatorizado, a simple ciego, de 42 días de duración, llevado a cabo en 78 pacientes con caspa grasa o seca. Se clasificó la gravedad de la caspa en 4 grados. Según el tipo de caspa y su grado, se administraron un champú para caspa grasa (A), un champú para caspa seca (B), una loción para caspa grasa (C) o un champú neutro (D). Se establecieron 4 grupos de tratamiento en función del producto asignado (A, B, AC y CD). Resultados: un 59% de los participantes fueron mujeres y un 41% varones. La edad media fue de 47 años (rango 20-72). Del total de pacientes: 20 presentaron caspa grasa en grado medio-bajo (grupo A), 20 caspa seca en cualquier grado (grupo B), 17 caspa grasa en grado elevado (grupo AC) y 21 caspa grasa en grado medio-alto (grupo CD). Al cabo de cuatro semanas de tratamiento, el grado de caspa se redujo vs. basal en ≥70% de los casos en todos los grupos. Estas cifras ascendieron, en los pacientes con caspa grasa, a un 70% (grado bajo-medio), un 76,2% (grado medio-alto) y un 88,2% (grado elevado); el efecto fue más notable en aquellos con caspa seca, donde la cifra fue del 90%. La eliminación de la caspa fue completa en el 78,5%, 62,5%, 47% y 44,4% de ellos, respectivamente. Una vez transcurridas las dos semanas de lavado posterior al tratamiento, el nivel de caspa siguió descendiendo en un 55% de los pacientes tratados con el champú A, un 57,1% de los que emplearon la loción C, el 58,8% de los que usaron el champú A + la loción C, y el 35% de los que recibieron el champú B. Se declararon satisfechos o muy satisfechos con el producto un 70% de los pacientes del grupo A, un 80% del grupo B, un 66,7% del grupo CD y un 70,6% del grupo AD. Conclusiones: los resultados obtenidos en este estudio, orientan acerca de la eficacia frente a la caspa grasa y la caspa seca de dos champúes y una loción basados en terpineol, ácido salicílico y climbazol. Se requieren investigaciones adicionales que amplíen los resultados en este campo.(AU)

Introduction: dandruff is defined as excessive flaking of the scalp accompanied by itching. The etiology is multifactorial and depends on the presence of Malassezia yeasts, sebum production and individual susceptibility. Beyond traditional treatments to control dandruff, there are new formulations that may include keratolytics such as salicylic acid; climbazole, an antifungal agent which potential antiproteolytic properties, or terpineol, broad-spectrum antifungal with antiinflammatory action. Objective: the main objective of this study was to evaluate the effect on seborrheic dandruff of a shampoo with terpineol, willow extract, salicylic acid, climbazole and sebum-regulating lipoaminoacid, and a lotion with terpineol, salicylic acid, climbazole and glycosides from oak and green tea extract. Effectiveness on dry dandruff of a shampoo containing terpineol, willow extract, salicylic acid and climbazole was also evaluated. Three study visits were performed (T0, T28 and T42). Methods: single-center, open, non-randomized, single-blind, 42-day study conducted in 78 patients with seborrheic or dry dandruff. Dandruff severity was classified into 4 grades. A shampoo for oily dandruff (A), a shampoo for dry dandruff (B), a lotion for oily dandruff (C) and a neutral shampoo (D) were administered. Four treatment groups were established according to the assigned treatment (A, B, AC and CD). Results: 59% of participants were women and 41% men. The average age was 47 years (range 20-72). Of the total patients, 20 had medium-low oily dandruff (group A), 20 dry dandruff at any level (group B), 17 severe oily dandruff (AC) and 21 medium-high oily dandruff (group CD). After four weeks of treatment the severity of dandruff was reduced vs. baseline in ≥70% of cases in all groups; for oily dandruff results were 70% (low-medium grade), 76.2% (medium-high) and 88.2% (high level); the effect was most marked in patients with dry dandruff (90%). Dandruff removal was complete in 78.5%, 62.5%, 47% and 44.4% of them, respectively. Two weeks after having suspended the treatment, dandruff level continued to decline in 55% of patients treated with shampoo A, 57.1% of those who used the lotion C, 58.8% of patients who used shampoo A + lotion C, and 35% of those receiving shampoo B. Seventy per cent of patients in group A, 80% in group B, 66.7% of the CD group and 70.6% of the AD group were satisfied or very satisfied with the study treatments. Conclusions: the results obtained in this study suggest the effectiveness against oily and dry dandruff of two shampoos and a lotion based on terpineol, salicylic acid and climbazole. Further research to extend the results in this field is required.(AU)

Eficacia de un complemento alimenticio con serenoa serrulata y tocotrienol-tocoferol frente a la alopecia androgenética y el efluvio telógeno femeninos: A propósito de un estudio piloto / Effectiveness of a dietary supplement with serenoa serrulata and tocotrienol-tocopherol against female androgenetic alopecia and telogen effluvium: Report of a pilot study

Introducción: la alopecia androgenética femenina (FAGA) y el efluvio telógeno (ET), son causas comunes de pérdida de cabello en las mujeres. Un hecho conocido en estos tipos de alopecia es la mayor actividad de la 5α-reductasa, que reduce la testosterona a dihidro-testosterona, andrógeno que acelera el ciclo capilar y acorta su duración. La Serenoa serrulata es una especie vegetal, cuyos componentes presentan un efecto inhibidor de la 5α-reductasa. Objetivo: el objetivo principal de este estudio, consistió en valorar la eficacia y la tolerancia, frente a la alopecia femenina de la administración diaria oral, de un complemento alimenticio con extracto de Serenoa serrulata, L-cistina, complejo tocotrienol-tocoferol, hierro, zinc y vitaminas H, B1, B2, B3, B5, B6 y B12 durante seis meses. Material y Método: estudio piloto unicéntrico, abierto, no aleatorizado, a simple ciego, de 180 días de duración, llevado a cabo en voluntarias con FAGA o ET. Se valoró el aspecto macroscópico del cabello, la densidad capilar mediante microfotografía, la relación anágena / telógena (A/T) mediante tricograma, el número de cabellos desprendidos mediante ensayos de peinado ("combing test") y de lavado ("wash test"). Se realizó una encuesta de autovaloración de los resultados. Resultados: la edad media de las participantes (n=10) fue de 40±15,5 años. El tiempo de evolución fue de 4,5±2 años y de tres meses para la FAGA y el ET, respectivamente. Al final del tratamiento las participantes presentaron un incremento medio del 6,9%, en la proporción de cabellos en fase anágena y la relación A/T media aumentó a 3,3. El 80% mostraron una mayor densidad capilar al finalizar el estudio. Al cabo de tres meses, todas las participantes presentaron una reducción media de la pérdida de cabellos del 56%, respecto de la visita basal. El 90% percibieron una mayor o igual cantidad de cabello al final del estudio y el 80% lo notaron más fuerte. No se registró ninguna molestia inducida por el tratamiento. Conclusiones: la buena evolución de las variables analizadas apunta a un beneficio terapéutico, frente a la FAGA y el ET. Estudios con mayor número de pacientes, son necesarios a futuro.(AU)

Introduction: female androgenetic alopecia (FAGA) and telogen effluvium (TE) are common causes of hair loss in women. A known fact in these types of alopecia is the increased activity of 5a-reductase which reduces testosterone to dihydrotestosterone, accelerating hair cycle and shortening its duration. Serenoa serrulata is a plant species whose components have an inhibitory effect on 5a reductase. Objective: the main objective of this study was to evaluate the efficacy and tolerance against female alopecia of a food supplement with Serenoa serrulata extract, L-cystine, tocotrienol-tocopherol complex, iron, zinc, and vitamins H, B1, B2, B3, B5, B6 and B12 administered daily for six months. Material and Methods: single-center, open-label, non-randomized, single-blind, 180-days pilot study conducted in women with FAGA or TE. The study assessed the macroscopic appearance of the hair, hair density by microphotograph, the anagen / telogen ratio (A/T) by trichogram, and the number of detached hair by combing and wash tests. Self-assessment survey of the results was performed. Results: the mean age of participants (n = 10) was 40 ± 15.5 years. FAGA and ET had an evolution of 4.5 ± two years and three months, respectively. After treatment the participants had an average increase of 6.9% in the proportion of hairs in anagen phase, and the mean A/T ratio increased to 3.3. Eighty percent or patients showed an increased capillary density at study end. After three months, all participants had a mean reduction of hair loss of 56% vs baseline. Ninety percent perceived a greater or equal amount of hair at the end of the study and 80% noticed it stronger. No adverse effects induced by treatment were observed. Conclusions: the good results of the analyzed variables suggest a therapeutic benefit against FAGA and ET. Additional research is warranted to confirm the observed data.(AU)

Eficacia de un complemento alimenticio con serenoa serrulata y tocotrienol-tocoferol frente a la alopecia androgenética y el efluvio telógeno femeninos: A propósito de un estudio piloto / Effectiveness of a dietary supplement with serenoa serrulata and tocotrienol-tocopherol against female androgenetic alopecia and telogen effluvium: Report of a pilot study

Introducción: la alopecia androgenética femenina (FAGA) y el efluvio telógeno (ET), son causas comunes de pérdida de cabello en las mujeres. Un hecho conocido en estos tipos de alopecia es la mayor actividad de la 5α-reductasa, que reduce la testosterona a dihidro-testosterona, andrógeno que acelera el ciclo capilar y acorta su duración. La Serenoa serrulata es una especie vegetal, cuyos componentes presentan un efecto inhibidor de la 5α-reductasa. Objetivo: el objetivo principal de este estudio, consistió en valorar la eficacia y la tolerancia, frente a la alopecia femenina de la administración diaria oral, de un complemento alimenticio con extracto de Serenoa serrulata, L-cistina, complejo tocotrienol-tocoferol, hierro, zinc y vitaminas H, B1, B2, B3, B5, B6 y B12 durante seis meses. Material y Método: estudio piloto unicéntrico, abierto, no aleatorizado, a simple ciego, de 180 días de duración, llevado a cabo en voluntarias con FAGA o ET. Se valoró el aspecto macroscópico del cabello, la densidad capilar mediante microfotografía, la relación anágena / telógena (A/T) mediante tricograma, el número de cabellos desprendidos mediante ensayos de peinado ("combing test") y de lavado ("wash test"). Se realizó una encuesta de autovaloración de los resultados. Resultados: la edad media de las participantes (n=10) fue de 40±15,5 años. El tiempo de evolución fue de 4,5±2 años y de tres meses para la FAGA y el ET, respectivamente. Al final del tratamiento las participantes presentaron un incremento medio del 6,9%, en la proporción de cabellos en fase anágena y la relación A/T media aumentó a 3,3. El 80% mostraron una mayor densidad capilar al finalizar el estudio. Al cabo de tres meses, todas las participantes presentaron una reducción media de la pérdida de cabellos del 56%, respecto de la visita basal. El 90% percibieron una mayor o igual cantidad de cabello al final del estudio y el 80% lo notaron más fuerte. No se registró ninguna molestia inducida por el tratamiento. Conclusiones: la buena evolución de las variables analizadas apunta a un beneficio terapéutico, frente a la FAGA y el ET. Estudios con mayor número de pacientes, son necesarios a futuro.

Introduction: female androgenetic alopecia (FAGA) and telogen effluvium (TE) are common causes of hair loss in women. A known fact in these types of alopecia is the increased activity of 5a-reductase which reduces testosterone to dihydrotestosterone, accelerating hair cycle and shortening its duration. Serenoa serrulata is a plant species whose components have an inhibitory effect on 5a reductase. Objective: the main objective of this study was to evaluate the efficacy and tolerance against female alopecia of a food supplement with Serenoa serrulata extract, L-cystine, tocotrienol-tocopherol complex, iron, zinc, and vitamins H, B1, B2, B3, B5, B6 and B12 administered daily for six months. Material and Methods: single-center, open-label, non-randomized, single-blind, 180-days pilot study conducted in women with FAGA or TE. The study assessed the macroscopic appearance of the hair, hair density by microphotograph, the anagen / telogen ratio (A/T) by trichogram, and the number of detached hair by combing and wash tests. Self-assessment survey of the results was performed. Results: the mean age of participants (n = 10) was 40 ± 15.5 years. FAGA and ET had an evolution of 4.5 ± two years and three months, respectively. After treatment the participants had an average increase of 6.9% in the proportion of hairs in anagen phase, and the mean A/T ratio increased to 3.3. Eighty percent or patients showed an increased capillary density at study end. After three months, all participants had a mean reduction of hair loss of 56% vs baseline. Ninety percent perceived a greater or equal amount of hair at the end of the study and 80% noticed it stronger. No adverse effects induced by treatment were observed. Conclusions: the good results of the analyzed variables suggest a therapeutic benefit against FAGA and ET. Additional research is warranted to confirm the observed data.

Variation in nerve autograft length increases fibre misdirection and decreases pruning effectiveness: an experimental study in the rat median nerve.

OBJECTIVES: In the clinical set, autologus nerve grafts are the current option for reconstruction of nerve tissue losses. The length of the nerve graft has been suggested to affect outcomes. Experiments were performed in the rat in order to test this assumption and to detect a possible mechanism to explain differences in recovery. METHODS: The rat median nerve was repaired by ulnar nerve grafts of different lengths. Rats were evaluated for 12 months by behavioural assessment and histological studies, including ATPase myofibrillary histochemistry and retrograde neuronal labelling. RESULTS: It was demonstrated that graft length interferes in behavioural functional recovery that here correlates to muscle weight recovery. Short nerve grafts recovered faster and better. Reinnervation was not specific either at the trunk level or in the muscle itself. The normal mosaic pattern of Type I muscle fibres was never restored and their number remained largely augmented. An increment in the number of motor fibres was observed after the nerve grafting in a predominantly sensory branch in all groups. This increment was more pronounced in the long graft group. In the postoperative period, about a 20% reduction in the number of misdirected motor fibres occurred in the short nerve graft group only. CONCLUSION: Variation in the length of nerve grafts interferes in behavioural recovery and increases motor fibres misdirection. Early recovery onset was related to a better outcome, which occurs in the short graft group.

Paracoccidioides brasiliensis in a postpartum Pap smear. A case report.

BACKGROUND: There are several reported cases that describe female genital tract infections with opportunistic fungi, such as Blastomyces dermatitidis, Coccidioides immitis, Aspergillus flavus, Cryptococcus neoformans and Mucor. We describe a case of paracoccidiodomycosis limited to the uterine cervix. To the best of our knowledge, no such case has been described before in the English-language literature. CASE: A 27-year-old, healthy female, gravida 3, para 2, abortion 1, presented for a routine gynecologic examination at six weeks' postpartum. Her past medical history was unremarkable. A routine cervical/endocervical smear revealed the presence of multiple fungal forms at different stages of development with a characteristic "pilot's wheel" appearance consistent with Paracoccidioides brasiliensis. Detailed medical examination of the patient did not reveal the presence of the primary infection in any other system. Cultures of the endometrium revealed no growth of the fungal organisms. The patient was asymptomatic, and therefore no therapy was initiated. Repeat Papanicolaou smears were negative for organisms. CONCLUSION: Paracoccidioidomycosis can present as a limited form, involving the cervix only. Identification and recognition of the infection are important in cytopathology.

Experimental median nerve repair by fresh or frozen nerve autografts and xenografts.

The authors described the reconstruction of a terminal branch of the brachial plexus (the median nerve) by different kinds of peripheral nerve grafts, in rats. Fresh or frozen autografts from Sprague-Dawley rats and fresh or frozen xenografts from Beagle dogs were used. Three, six, nine and twelve months after grafting, rats underwent histological assessment (muscle, nerve and spinal cord) and simple functional assessment by the grasping test. The immune reaction was prevented by the freezing and thawing method that had rendered xenografts acellular. This process allowed a satisfactory reinnervation of the flexor carpi radialis muscle (FCR) and a function recovery about 75% of control value. Nevertheless, the force recovery in rats that received frozen grafts was slower than those received fresh autografts. Probably, the destruction of cellular elements by freezing produced a deficient environment for nerve regeneration. However, this gap was partially compensated at twelve months after surgery by the maturation and the secondary adaptation of regenerated nerve fibers. Theses results showed that the force recovery is directly correlated to the capability of the nerve fibers to reproduce, histologically, a next to normal nerve pattern.

Selective restoration of sensation by peripheral nerve grafts directly implanted into the contralateral C7 dorsal root ganglion: an experimental study in rat brachial plexus.

OBJECTIVE: In brachial plexus injuries, when the dorsal root ganglion (DRG) is avulsed from the spinal cord there is no possibility of direct repair. Therefore, in the present report the median nerve was connected directly to the contralateral C7 DRG, to restore forepaw sensation. METHODS: The ulnar nerve was sectioned, and a 15-mm segment of nerve was removed. The median nerve was sectioned, transposed dorsally, and repaired using a sural nerve graft directly implanted into the C7 contralateral DRG. Rats were then assessed 6 and 12 months later by behavioral, histological, and plasma extravasion techniques. RESULTS: All animals recovered sensation in the forepaw. Retrogradely labeled sensory neurons were demonstrated in the C7 DRG, and the whole forepaw was labeled after plasma extravasion induction by median nerve antidromic stimulation. Several myelinated and positively neurofilament-stained fibers were demonstrated in the grafted median nerve. CONCLUSION: The surgical strategy proposed might be a useful alternative to selective sensory repair in the emerging field of brachial plexus reconstruction by direct spinal cord surgery.

[IgA deficiency] / Deficiência de IgA.

OBJECTIVE: The studies about immunoglobulin A (IgA) deficiencyin the clinical, laboratorial and terapeutic aspects. METHODS: Bibliografic review of the last ten years about thesubject by Medline system and direct research. RESULTS AND CONCLUSIONS: IgA deficiency is the most frequent primary immunodeficiency, with the average prevalence of 1:700and must be studied in its clinical, laboratorial and terapeutic aspectsby pediatrician and other specialists. The clinical characteristics ofthe total and partial immunodeficiency must be known, so as thecomplications and laboratory techniques for determine accurate diagnosis and prognostic.

Selective motor hyperreinnervation using motor rootlet transfer: an experimental study in rat brachial plexus.

Misdirection of sensory fibers into motor pathways is, in part, responsible for the poor results obtained after peripheral nerve repair. After avulsion of the C-5 root in rats, the authors connected a C-4 ventral rootlet to the musculocutaneous nerve by means of a sural nerve graft. In this way, they were able to increase the number of regenerating motor fibers and avoid growth of sensory fibers into the nerve grafts. Functional recovery was evaluated electrophysiologically and histologically. The origin of the axons that reinnervated the nerve graft was analyzed by means of morphological studies including retrograde labeling procedures. Motor neurons survived and regenerated after the rootlet transfer and there was no functional impairment. Many neurons were retrograde labeled in the ventral horn and widespread biceps muscle reinnervation was demonstrated with recovery of nearly normal electrophysiological properties. Motor hyperreinnervation of the musculocutaneous nerve was observed. This high degree of reinnervation in a long (40-mm) graft was attributed to the good chance that a muscle fiber can be reinnervated by a motor fiber when the number of regenerating motor neurons is increased and when competitive sensory fibers are excluded from reinnervation.

Muscle fiber type reorganization and behavioral functional recovery of rat median nerve repair with vascularized or conventional nerve grafts.

In 1921, Ney introduced the concept of nerve grafts with preservation of the vascular blood supply. Today, over 70 years later, the use of vascularized nerve grafts in clinical practice is still controversial. Although the results of experiments with vascularized and conventional nerve grafts have been compared on the basis of electrophysiological and histological observations, the literature includes no vaJid comparison of the clinical and behavioral significance of these results. Therefore, in the experiments reported here, the rat median nerve was repaired using either a vascularized or a conventional ulnar nerve graft. The rates behavior between 0 and 360 days after surgery was assessed by the grasping test. Nienty-five, 120, 150, 210 and 360 days after surgery rats were submitted to retrograde labeling studies and muscle samples were removed and studied using routine hematoxilin-eosin and ATPase histochemistry. The present study provides evidence that autografting is a reliable procedure for nerve repair. Motor axons were able to reinnervate and largely respecify muscle properties. Reinnervation was not selective either at the nerve trunk level or at the muscle fiber. A mechanism of collateral pruning might have been present in the early phases of reinnervation. This mechanism was, however, self limiting and unable to correct all wrong projections. A mechanism of terminal sprouting was in part responsible for time-related improvement in muscle force recovery. While the present study does provide evidence that recovery was 20% faster in rats with vascularized grafts than in those with conventional grafts (P < 0.0001), it does not, however, provide evidence for better functional recovery in long-term assessment.

[Emphysematous cholecystitis (author's transl)]. / Colecistitis enfisematosa.

A case of emphysematous cholecystitis is reported. The gallblader size in this case was 25 x 12 cms. The patient underwent successful cholecystectomy and responded adequately to cloramphenicol, peniciline and metronidazol. The late antibiotics are usually recommended due to the prevalence of Clostridia and Escherinchia bacterial infections in the gallbladder of patients with this illness.