ABSTRACT
Abstract Genetic and phylogenetic relationships among seven piranha species of the genera Serrasalmus and Pygocentrus from the Paraná-Paraguay, São Francisco and Tocantins River basins were evaluated in the present study by partial sequences of two mitochondrial genes, Cytochrome b and Cytochrome c Oxidase I. Phylogenetic analysis of Maximum-Likelihood and Bayesian inference were performed. Results indicated, in general, greater genetic similarity between the two species of Pygocentrus (P. nattereri and P. piraya), between Serrasalmus rhombeus and S. marginatus and between S. maculatus, S. brandtii and S. eigenmanni. Pygocentrus nattereri, S. rhombeus and S. maculatus showed high intraspecific genetic variability. These species have each one, at least two different mitochondrial lineages that, currently, occur in sympatry (S. rhombeus) or in allopatry (P. nattereri and S. maculatus). Species delimitation analysis and the high values of genetic distances observed between populations of S. rhombeus and of S. maculatus indicated that each species may corresponds to a complex of cryptic species. The non-monophyletic condition of S. rhombeus and S. maculatus reinforces the hypothesis. The geographic distribution and the genetic differentiation pattern observed for the piranha species analyzed herein are discussed regarding the geological and hydrological events that occurred in the hydrographic basins.
Resumo Relações genéticas e filogenéticas de sete espécies de piranhas dos gêneros Serrasalmus e Pygocentrus das bacias hidrográficas Paraná-Paraguai, São Francisco e Tocantins foram avaliadas com base em sequências parciais dos genes mitocondriais Citocromo b e Citocromo c Oxidase I. Foram realizadas análises filogenéticas de Máxima Verossimilhança e de inferência Bayesiana. Os resultados indicaram, em geral, maior similaridade genética entre as duas espécies de Pygocentrus (P. nattereri e P. piraya), entre Serrasalmus rhombeus e S. marginatus e entre S. maculatus, S. brandtii e S. eigenmanni. Pygocentrus nattereri, S. rhombeus e S. maculatus revelaram ter alta variabilidade genética intraespecífica. Essas espécies têm, cada uma, pelo menos duas linhagens mitocondriais que, atualmente, ocorrem em simpatria (S. rhombeus) ou alopatria (P. nattereri e S. maculatus). Análises de delimitação de espécies e os altos valores de distância genética observados entre as populações de S. rhombeus e de S. maculatus indicam que cada espécie pode, na verdade, corresponder a um complexo de espécies crípticas. A condição não-monofilética de S. rhombeus e S. maculatus reforça essa hipótese. A distribuição geográfica e o padrão de diferenciação genética observados para as espécies de piranhas analisadas são discutidos com relação aos eventos geológicos e hidrológicos que ocorreram nas bacias hidrográficas.
Subject(s)
Animals , Characiformes , Paraguay , Phylogeny , Brazil , Bayes Theorem , RiversABSTRACT
Genetic and phylogenetic relationships among seven piranha species of the genera Serrasalmus and Pygocentrus from the Paraná-Paraguay, São Francisco and Tocantins River basins were evaluated in the present study by partial sequences of two mitochondrial genes, Cytochrome b and Cytochrome c Oxidase I. Phylogenetic analysis of Maximum-Likelihood and Bayesian inference were performed. Results indicated, in general, greater genetic similarity between the two species of Pygocentrus (P. nattereri and P. piraya), between Serrasalmus rhombeus and S. marginatus and between S. maculatus, S. brandtii and S. eigenmanni. Pygocentrus nattereri, S. rhombeus and S. maculatus showed high intraspecific genetic variability. These species have each one, at least two different mitochondrial lineages that, currently, occur in sympatry (S. rhombeus) or in allopatry (P. nattereri and S. maculatus). Species delimitation analysis and the high values of genetic distances observed between populations of S. rhombeus and of S. maculatus indicated that each species may corresponds to a complex of cryptic species. The non-monophyletic condition of S. rhombeus and S. maculatus reinforces the hypothesis. The geographic distribution and the genetic differentiation pattern observed for the piranha species analyzed herein are discussed regarding the geological and hydrological events that occurred in the hydrographic basins.
Subject(s)
Characiformes , Animals , Bayes Theorem , Brazil , Paraguay , Phylogeny , RiversABSTRACT
Abstract Genetic and phylogenetic relationships among seven piranha species of the genera Serrasalmus and Pygocentrus from the Paraná-Paraguay, São Francisco and Tocantins River basins were evaluated in the present study by partial sequences of two mitochondrial genes, Cytochrome b and Cytochrome c Oxidase I. Phylogenetic analysis of Maximum-Likelihood and Bayesian inference were performed. Results indicated, in general, greater genetic similarity between the two species of Pygocentrus (P. nattereri and P. piraya), between Serrasalmus rhombeus and S. marginatus and between S. maculatus, S. brandtii and S. eigenmanni. Pygocentrus nattereri, S. rhombeus and S. maculatus showed high intraspecific genetic variability. These species have each one, at least two different mitochondrial lineages that, currently, occur in sympatry (S. rhombeus) or in allopatry (P. nattereri and S. maculatus). Species delimitation analysis and the high values of genetic distances observed between populations of S. rhombeus and of S. maculatus indicated that each species may corresponds to a complex of cryptic species. The non-monophyletic condition of S. rhombeus and S. maculatus reinforces the hypothesis. The geographic distribution and the genetic differentiation pattern observed for the piranha species analyzed herein are discussed regarding the geological and hydrological events that occurred in the hydrographic basins.
Resumo Relações genéticas e filogenéticas de sete espécies de piranhas dos gêneros Serrasalmus e Pygocentrus das bacias hidrográficas Paraná-Paraguai, São Francisco e Tocantins foram avaliadas com base em sequências parciais dos genes mitocondriais Citocromo b e Citocromo c Oxidase I. Foram realizadas análises filogenéticas de Máxima Verossimilhança e de inferência Bayesiana. Os resultados indicaram, em geral, maior similaridade genética entre as duas espécies de Pygocentrus (P. nattereri e P. piraya), entre Serrasalmus rhombeus e S. marginatus e entre S. maculatus, S. brandtii e S. eigenmanni. Pygocentrus nattereri, S. rhombeus e S. maculatus revelaram ter alta variabilidade genética intraespecífica. Essas espécies têm, cada uma, pelo menos duas linhagens mitocondriais que, atualmente, ocorrem em simpatria (S. rhombeus) ou alopatria (P. nattereri e S. maculatus). Análises de delimitação de espécies e os altos valores de distância genética observados entre as populações de S. rhombeus e de S. maculatus indicam que cada espécie pode, na verdade, corresponder a um complexo de espécies crípticas. A condição não-monofilética de S. rhombeus e S. maculatus reforça essa hipótese. A distribuição geográfica e o padrão de diferenciação genética observados para as espécies de piranhas analisadas são discutidos com relação aos eventos geológicos e hidrológicos que ocorreram nas bacias hidrográficas.
ABSTRACT
BACKGROUND: The Cobb angle measurement is well established for the measurement of coronal deformity aspect of scoliotic curves. The effect of positional differences in relation to the apex side of the scoliosis is not yet fully quantified. While theoretically plausible that positioning error with rotation toward the apex of the scoliosis would decrease the Cobb angle, the relations are not investigated yet and were object of this study. MATERIALS AND METHODS: Multiple measurements of the Cobb angle were performed, while turning a spine-pelvic cadaveric specimen with a right-sided thoracic scoliosis of 47° (in neutral position) from 45° to -45° in steps of 5° using biplanar radiography. Statistical methods were applied to find the critical position, in which measurement errors potentially become clinically relevant (Cobb angle deviation >5°). RESULTS: Turning the specimen to the right (toward the apex of the scoliosis) produced during the first -15° of rotation, a Cobb angle ranging from 47° to 45°. At -20°, the Cobb angle was 42°, at -25° rotation 37° and at -30° rotation 36°. Above -30° rotation, the measured Cobb angle decreased to 36° (77 % of the original Cobb angle). No relevant differences were found by rotating the specimen to the left (away from the apex) (47° at neutral rotation and 44° at maximal error rotation of +45°). CONCLUSION: The influence of rotational misplacement of the patient at the time of image acquisition on Cobb angle measurements is negligible for a rotational misplacement of ±20° of rotation for a idiopathic right-sided thoracic scoliosis of 47°. Over 20° of rotational misplacement of the patient toward the apex of the scoliosis falsely decreases the Cobb angle.
Subject(s)
Patient Positioning , Scoliosis/diagnostic imaging , Thoracic Vertebrae/diagnostic imaging , Humans , Image Processing, Computer-Assisted , Radiography , RotationABSTRACT
Today, lumbar disc disease is a very common disease, which will be often seen in both the family practice as well as in the consultations of orthopedics, neurology, rheumatology or neurosurgery. Furthermore, lumbar disc surgery is one of the most common spinal surgical procedures worldwide. But, for many centuries, physician had no clear understanding of the anatomical condition and the pathomechanism of this disease. Therefore, no rational treatment was available. The Hippocratic physicians knew the signs and symptoms of lumbar disc disease, which they then called "sciatica". But, they subsumed different disorders, like hip diseases under this term. In the mid-18th century, it was the Italian physician Domenico Felice Antonio Cotugno (1736-1822), who first brought clarity in the concept of radicular syndromes; he recognized, that the so-called "sciatica" could be of neurogenic origin. In 1742, a contemporary of Cotugno, the German Josias Weitbrecht (1702-1747) has to be credited for the first precise description of the intervertebral disc. Nearby a hundred years later, the German Hubert von Luschka (1820-1875) described for the first time a herniated disc in a pathologic specimen. With the landmark report of the New England Journal of Medicine in 1934, the two American surgeons, William Jason Mixter (1880-1958) and Joseph Seaton Barr (1901-1963), finally cleared the pathomechanism of lumbar disc disease.
Subject(s)
Intervertebral Disc Degeneration/history , Intervertebral Disc Displacement/history , Low Back Pain/history , Orthopedics/history , Radiculopathy/history , Sciatica/history , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , History, Ancient , History, Medieval , HumansABSTRACT
In ancient times as well as in the Middle Ages treatment options for discogenic nerve compression syndrome were limited and usually not very specific because of low anatomical and pathophysiological knowledge. The stretch rack (scamnum Hippocratis) was particularly prominent but was widely used as a therapeutic device for very different spinal disorders. Since the beginning of the nineteenth century anatomical knowledge increased and the advances in the fields of asepsis, anesthesia and surgery resulted in an increase in surgical interventions on the spine. In 1908 the first successful lumbar discectomy was initiated and performed by the German neurologist Heinrich O. Oppenheim (1858-1919) and the surgeon Fedor Krause (1857-1937); however, neither recognized the true pathological condition of discogenic nerve compression syndrome. With the landmark report in the New England Journal of Medicine in 1934, the two American surgeons William Jason Mixter (1880-1958) and Joseph Seaton Barr (1901-1963) finally clarified the pathomechanism of lumbar disc herniation and furthermore, propagated discectomy as the standard therapy. Since then interventions on intervertebral discs rapidly increased and the treatment options for lumbar disc surgery quickly evolved. The surgical procedures changed over time and were continuously being refined. In the late 1960s the surgical microscope was introduced for spinal surgery by the work of the famous neurosurgeon Mahmut Gazi Yasargil and his colleague Wolfhard Caspar and so-called microdiscectomy was introduced. Besides open discectomy other interventional techniques were developed to overcome the side effects of surgical procedures. In 1964 the American orthopedic surgeon Lyman Smith (1912-1991) introduced chemonucleolysis, a minimally invasive technique consisting only of a cannula and the proteolytic enzyme chymopapain, which is injected into the disc compartment to dissolve the displaced disc material. In 1975 the Japanese orthopedic surgeon Sadahisa Hijikata described percutaneous discectomy for the first time, which was a further minimally invasive surgical technique. Further variants of minimally invasive surgical procedures, such as percutaneous laser discectomy in 1986 and percutaneous endoscopic microdiscectomy in 1997, were also introduced; however, open discectomy, especially microdiscectomy remains the therapeutic gold standard for lumbar disc herniation.
Subject(s)
Diskectomy/history , Intervertebral Disc Degeneration/history , Intervertebral Disc Displacement/history , Low Back Pain/history , Radiculopathy/history , Sciatica/history , Traction/history , Germany , History, 15th Century , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , History, Ancient , History, Medieval , Humans , Low Back Pain/prevention & control , Nerve Compression Syndromes/history , Nerve Compression Syndromes/therapy , Orthopedics/history , Radiculopathy/prevention & control , Sciatica/surgeryABSTRACT
The genetic divergence among invasive and native populations of Plagioscion squamosissimus from four Neotropical hydrographic basins was assessed using the hypervariable domain of the mitochondrial DNA (mtDNA) control region. Plagioscion squamosissimus is native to the neighbouring hydrographic basins of the Parnaíba and Amazon Rivers, and the latter includes the Araguaia-Tocantins drainage, but it is invasive in other basins due to introductions. The mtDNA nucleotide polymorphism supported the hypothesis that the Amazon and Parnaíba populations constitute the same species and are separated into two independent evolutionary lineages. Absence of nucleotide polymorphism was observed within and among P. squamosissimus populations invasive to the uppper and middle Paraná River basins. Nucleotide divergence was null or low comparing the Paraná invasive populations with the populations native to the Parnaíba River basin, whereas it was significantly high compared to Tocantins populations. These results ascertain that P. squamosissimus populations invasive to the upper Paraná River basin and to the middle Paraná River basin downstream of the Itaipu dam are derived from the Parnaíba River basin. The genetic data presented are potentially useful to assist further studies on P. squamosissimus taxonomic and geographic distribution, development of ecological guidelines for managing populations invasive to the upper Paraná River basin and for preservation of native fish diversity.
Subject(s)
Genetic Variation , Introduced Species , Perciformes/genetics , Animals , DNA, Mitochondrial/genetics , Genetic Drift , Haplotypes , Perciformes/classification , Phylogeny , Rivers , South America , Tropical ClimateABSTRACT
BACKGROUND: Recent studies suggest that patients on mammalian target of rapamycin (mTOR) inhibitors experience a reduction in cutaneous carcinogenesis by an estimated 50% or more compared with calcineurin inhibitors. While randomized trials are running, organ transplant recipients are frequently switched from calcineurin inhibitors to mTOR inhibitors when cutaneous carcinogenesis increases. OBJECTIVES: To slow carcinogenesis in our patient, a heart transplant recipient with a neuropathic diabetic foot syndrome who had developed cutaneous carcinogenesis at a rate of more than 20 squamous cell carcinomas (SCC) annually. METHODS: The patient's immunosuppression was switched from the calcineurin inhibitor ciclosporin to the mTOR inhibitor everolimus. RESULTS: Carcinogenesis slowed to six SCC annually; however, he developed recalcitrant diabetic foot ulcers which were purely neuropathic and nonangiopathic, and a limb-threatening fistulating necrotic erysipelas of the right leg. Both sites responded poorly to antibiotic therapy, offloading and debridement. This skin fistula became chronic and some toes were at risk for minor amputation. In view of the propensity for mTOR inhibitors to impair would healing, immunosuppression was switched back to ciclosporin. All wounds healed rapidly, but skin carcinogenesis rose to former levels. CONCLUSIONS: This case impressively illustrates the clinical dilemma for mTOR inhibitor use where benefit in carcinogenesis is counterbalanced by impairment in wound healing. Changes in immunosuppressive regimens should thus be made on an individual basis with careful consideration of the relative risks.
Subject(s)
Diabetic Foot/physiopathology , Immunosuppressive Agents/adverse effects , Skin Neoplasms/prevention & control , TOR Serine-Threonine Kinases/antagonists & inhibitors , Wound Healing/drug effects , Aged , Calcineurin Inhibitors , Cardiomyopathy, Dilated/surgery , Cell Transformation, Neoplastic/drug effects , Drug Substitution , Everolimus , Heart Transplantation , Humans , Male , Sirolimus/adverse effects , Sirolimus/analogs & derivatives , Sirolimus/antagonists & inhibitors , ToesABSTRACT
Fish species of the Zungaro genus (Siluriformes, Pimelodidae) are amongst the largest migratory fish in Latin America and have considerable economic importance for commercial fishing in Brazil. However, natural populations of this large catfish are experiencing a severe decline. There are significant taxonomical inconsistencies for this fish. Two geographically separated species of the fish were initially described, one endemic in the Amazon and another in the Paraná-Paraguay River basins. A taxonomic review had recently proposed that there is only one Zungaro species in Brazil, based on morphological data. We made a molecular study of Zungaro populations in an attempt to solve taxonomical inconsistencies and to analyze genetic diversity in natural populations of this genus. We analyzed two regions of the mitochondrial DNA (the control region and the ATPase 6 gene region) of individuals sampled from the Paraná-Paraguay River and Amazon River basins. Analyses based on p-distances and maximum likelihood phylogenetic models showed a genetic difference between populations corresponding to different species. Genetic differentiation between Zungaro populations was at the same level as that observed between other Siluriformes species, using the same DNA sequences. We conclude that Zungaro species of the Paraná-Paraguay River basin do not belong to the same species found in the Amazon basin. This finding has a significant implication for conservation of this fish, given that populations are disappearing at a high rate in the Paraná-Paraguay River basin, mainly due to impoundments.
Subject(s)
Catfishes/classification , Catfishes/genetics , DNA, Mitochondrial/genetics , Genetic Variation/physiology , Phylogeny , Animals , Brazil , Rivers , Species SpecificityABSTRACT
Leporinus friderici, native to the Amazon Basin and popularly known as "piau-três-pintas", has great ecological and economic importance; it is widely fished and consumed throughout much of tropical South America. Knowledge of the genetic diversity of this native species is important to support management and conservation programs. We evaluated microsatellite loci amplification, using heterologous primers, in 31 individuals of L. friderici. These samples were collected from natural populations of the Araguaia River basin, in central Brazil, and the DNA was extracted from samples of muscle tissue. Eight loci were successfully analyzed. Six of them were polymorphic, and the number of alleles ranged from three to 10. Values of expected heterozygosities for these polymorphic loci ranged from 0.488 to 0.795. Exclusion probability (0.983), the identity probability (0.000073), and the mean genetic diversity values were high, showing that these microsatellite markers are suitable for assessing the genetic variability of L. friderici populations. There is a growing interest in studies that evaluate the genetic variability of natural populations for various purposes, such as conservation. Here, we showed that a viable alternative to the costly development of specific primers for fish populations is simply testing for heterologous amplification of microsatellite markers available from research on other species.
Subject(s)
Fishes/genetics , Microsatellite Repeats/genetics , Animals , Fishes/classification , Gene Frequency/genetics , Genetic Variation/geneticsABSTRACT
Pseudoplatystoma corruscans (Spix and Agassiz, 1829) and Pseudoplatystoma reticulatum (Eingenmann and Eigenmann, 1889) are large migratory catfishes of high biological importance and great commercial value in South America. Because fertile crossbreeds can be artificially produced in hatcheries, a high genetic proximity between these two Pimelodidae species is conceivable. Possible escape of crossbred specimens from pisciculture stations is a serious environmental concern. Despite their importance, knowledge of P. corruscans and P. reticulatum biology, ecology, population diversity and genetics is limited. In the present work, the genetic divergence between P. corruscans and P. reticulatum populations from the Paraná River Basin was analyzed on the basis of polymorphisms in ISSR fragments and in the hypervariable sequence of the mitochondrial DNA (mtDNA) control region. Estimates of intraspecific haplotype (h > 0.5) and nucleotide diversities (pi < 0.01) indicate that P. corruscans and P. reticulatum have survived a historical population decline, followed by a demographic expansion. The interspecific polymorphisms within the mtDNA control region and ISSR fragments were suitable as diagnostic molecular markers and could be used to discriminate the two species. A unique Pseudoplatystoma specimen, captured in the Upper Paraná River Floodplain, was identified by these DNA diagnostic markers as a hybrid P. reticulatum x P. corruscans, which possibly escaped from pisciculture. The integrity of the natural population of P. corruscans in the Upper Paraná River is at risk of genetic introgression or homogenization due to the presence of hybrids and the transposition of P. reticulatum upstream through the Canal da Piracema at Itaipu Dam. Data presented herein improve the understanding of the genetic relatedness between P. corruscans and P. reticulatum and represent potential tools for future programs of conservation and surveillance of genetic introgression events and the genetic integrity of these populations.
Subject(s)
Catfishes/genetics , DNA, Mitochondrial/genetics , Animals , Genetics, Population , Polymerase Chain Reaction , Polymorphism, Genetic/genetics , RiversABSTRACT
Pseudoplatystoma corruscans (Spix and Agassiz, 1829) and Pseudoplatystoma reticulatum (Eingenmann and Eigenmann, 1889) are large migratory catfishes of high biological importance and great commercial value in South America. Because fertile crossbreeds can be artificially produced in hatcheries, a high genetic proximity between these two Pimelodidae species is conceivable. Possible escape of crossbred specimens from pisciculture stations is a serious environmental concern. Despite their importance, knowledge of P. corruscans and P. reticulatum biology, ecology, population diversity and genetics is limited. In the present work, the genetic divergence between P. corruscans and P. reticulatum populations from the Paraná River Basin was analyzed on the basis of polymorphisms in ISSR fragments and in the hypervariable sequence of the mitochondrial DNA (mtDNA) control region. Estimates of intraspecific haplotype (h > 0.5) and nucleotide diversities (π < 0.01) indicate that P. corruscans and P. reticulatum have survived a historical population decline, followed by a demographic expansion. The interspecific polymorphisms within the mtDNA control region and ISSR fragments were suitable as diagnostic molecular markers and could be used to discriminate the two species. A unique Pseudoplatystoma specimen, captured in the Upper Paraná River Floodplain, was identified by these DNA diagnostic markers as a hybrid P. reticulatum x P. corruscans, which possibly escaped from pisciculture. The integrity of the natural population of P. corruscans in the Upper Paraná River is at risk of genetic introgression or homogenization due to the presence of hybrids and the transposition of P. reticulatum upstream through the Canal da Piracema at Itaipu Dam. Data presented herein improve the understanding of the genetic relatedness between P. corruscans and P. reticulatum and represent potential tools for future programs of conservation and surveillance of genetic ...
Pseudoplatystoma corruscans Spix e Agassiz, 1829 e Pseudoplatystoma reticulatum Eigenmann e Eigenmann, 1889 são peixes migratórios de grande porte, com alta importância biológica e elevado valor comercial na América do Sul. Híbridos férteis são obtidos em cativeiro e, portanto, é esperada alta proximidade genética entre essas duas espécies de Pimelodidae. Escapes de espécimes híbridos a partir de estações de piscicultura representam um sério problema ambiental. Apesar da sua importância, conhecimentos sobre a biologia, ecologia, diversidade de populações e genética de P. corruscans e P. reticulatum são escassos. No presente trabalho, foi avaliada a divergência genética entre P. corruscans e P. reticulatum da Bacia do Rio Paraná, com base em fragmentos ISSR e na seqüência D-loop do DNA mitocondrial (mtDNA). As estimativas das diversidades intra-específicas haplotípica (h > 0,5) e nucleotídica (π < 0,01) evidenciaram que P. corruscans e P. reticulatum sobreviveram a um declínio populacional histórico, seguido de expansão demográfica. Os polimorfismos interespecíficos no mtDNA e nos fragmentos ISSR foram eficientes para diagnósticos e discriminaram as duas espécies. Um espécime de Pseudoplatystoma capturado na planície de inundação do Alto Rio Paraná foi identificado com esses marcadores moleculares como híbrido P. reticulatum x P. corruscans, que possivelmente escapou de psicicultura. A integridade da população de P. corruscans no Alto Rio Paraná está ameaçada, por introgressão ou homogeneização genética, pela presença de híbridos e pela transposição para montante de P. reticulatum através do Canal da Piracema em Itaipu. Os dados apresentados constituem um avanço na compreensão do parentesco entre P. corruscans e P. reticulatum e representam ferramentas em potencial para programas de conservação biológica, incluindo o monitoramento de introgressão e de integridade genética das populações.
Subject(s)
Animals , Catfishes/genetics , DNA, Mitochondrial/genetics , Genetics, Population , Polymerase Chain Reaction , Polymorphism, Genetic/genetics , RiversABSTRACT
Postoperative adhesions represent a common consequence in patients who underwent abdominal or pelvic surgery. Such adhesions can be asymptomatic, but they can cause complications such as chronic abdomino-pelvic pain, secondary infertility, an increase in bowel obstruction risk and more complexity for future surgery, including longer surgery times and an increase in morbidity. Normally, adhesions appear after offences against the peritoneum, causing flogosys, and develop both in new sites, previously not involved, and in sites already interested in adhesiolysis. Previous laparotomy is an important risk factor, as after laparatomy a minimum of 93% of patients present adhesions during a following surgery. Furthermore, the rate of recurrence after adhesiolysis is 85%. Among several strategies employed, valid prevention methods are: using minimally invasive surgery techniques, reducing the incision area, containing tissue dehydration during surgery and an accurate hemostasis. Also, for preventing and reducing adhesions, the usage of NSAIDs, fibrinolytics and anticoagulants, as well as the application of substances acting as a physical barrier, have been proposed. Recently, crystalloid solutions have been introduced, using the hydro-flotation principle for intraperitoneal organs. This research aims to analyze causes and epidemiology for postoperative adhesions, with particular regard to gynecological operations and to describe and compare the means available to prevent them.
Subject(s)
Gynecologic Surgical Procedures/adverse effects , Tissue Adhesions/prevention & control , Abdominal Pain/etiology , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Anticoagulants/therapeutic use , Digestive System Surgical Procedures/adverse effects , Drug Therapy, Combination , Female , Fibrinolytic Agents/therapeutic use , Humans , Italy , Laparoscopy/adverse effects , Laparoscopy/methods , Liquid Crystals , Pelvic Pain/etiology , Risk Factors , Secondary Prevention , Tissue Adhesions/epidemiology , Treatment OutcomeABSTRACT
AIM: Prevalence, optimal diagnostic approach and consequences of clinically unsuspected osteomyelitis in diabetic foot ulcers are unclear. Early diagnosis of this infection may be crucial to ensure correct management. METHODS: We conducted a prospective study in 20 diabetic patients with a chronic foot ulcer (>8 weeks) without antibiotic pretreatment and without clinical signs for osteomyelitis to assess the prevalence of clinically unsuspected osteomyelitis and to compare the value of magnetic resonance imaging (MRI), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) and 99mTc-labelled monoclonal antigranulocyte antibody scintigraphy (99mTc-MOAB). Those with suggestive scans underwent bone biopsy for histology (n = 7). RESULTS: Osteomyelitis was confirmed by biopsy in seven of the 20 clinically unsuspected foot ulcers. Presence of osteomyelitis was not related to age, ulcer size, ulcer duration, duration of diabetes or HbA1c. C-reactive protein was slightly elevated in patients with osteomyelitis (35.1 +/- 16.0 mg L(-1) vs. 12.2 +/- 2.6 mg L(-1) in patients with and without osteomyelitis respectively; P = 0.07). MRI was positive in six of the seven patients with proven osteomyelitis, whereas 18F-FDG PET and 99mTc-MOAB were positive only in (the same) two patients. Of the seven patients with osteomyelitis, five had lower limb amputation and in one patient the ulcer was persisting after 24 months of follow-up. In contrast, of the 13 patients without detectable signs of osteomyelitis on imaging modalities only two had lower limb amputation and two persisting ulcers. CONCLUSIONS: Clinically unsuspected osteomyelitis is frequent in persisting foot ulcers and is a high risk factor for adverse outcome. MRI appears superior to 18F-FDG PET and 99mTc-MOAB in detecting foot ulcer-associated osteomyelitis and might be the preferred imaging modality in patients with nonhealing diabetic foot ulcers.
Subject(s)
Diabetic Foot/diagnostic imaging , Fluorodeoxyglucose F18 , Magnetic Resonance Imaging , Osteomyelitis/diagnosis , Radiopharmaceuticals , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Diabetic Foot/complications , Diabetic Foot/pathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Osteomyelitis/drug therapy , Osteomyelitis/microbiology , Positron-Emission Tomography , Radiography , Staphylococcus aureus/isolation & purificationABSTRACT
Hyperostosis frontalis interna is a restricted bilateral thickening of the frontal endocranial surface, which is frequently found in postmenopausal females today. Surprisingly, this condition had a higher male prevalence in its rare archaeological records. This is again highlighted by the oldest known male European hyperostosis frontalis interna case in an adult Celtic from 100 BC presented here. This unique specimen supports earlier suggestions of the possible microevolution of human endocrine regulation, e.g. by sex steroids, and its pathoanatomical impact.
Subject(s)
Gonadal Steroid Hormones/pharmacology , Hyperostosis Frontalis Interna/etiology , Anthropology, Physical , Archaeology , Biological Evolution , Female , Fossils , Humans , Male , Sex FactorsABSTRACT
Prevention and the correct treatment of the diabetic foot have important social and economic consequences. Risk stratification is essential for choosing the appropriate treatment strategy. History and careful clinical examination identify the risk in each individual patient with diabetes. Peripheral neuropathy (PNP), foot deformation, peripheral arterial disease (PAD) and a history of previous ulcer or amputation are the most important risk factors. PAD must be diagnosed and treated by percutan transluminal angioplasty or bypass surgery where necessary. Primary foot deformation or secondary due to PNP require shoe modifications. Good metabolic control of diabetes and treatment of other cardiovascular risk factors (dyslipidemia, hypertension) delay or prevent the development of PNP and PAD. Therefore an early multidisciplinary approach is essential for each patient with diabetes and foot problems. In the presence of a foot ulcer, it's important to diagnose osteomyelitis by clinical or radiological examination. The choice and duration of antibiotic treatment and surgical intervention depends on the localisation and extension of infection around the ulcer and the presence of osteomyelitis. In case of limb threatening infection, the patient should be referred to a specialized treatment facility immediately.
Subject(s)
Diabetes Mellitus, Type 2/therapy , Diabetic Foot/therapy , Arthropathy, Neurogenic/etiology , Arthropathy, Neurogenic/therapy , Diabetes Mellitus, Type 2/etiology , Diabetic Angiopathies/etiology , Diabetic Angiopathies/therapy , Diabetic Foot/etiology , Diabetic Neuropathies/etiology , Diabetic Neuropathies/therapy , Humans , Patient Care Team , Risk FactorsABSTRACT
Although in practice since antiquity the nonoperative treatment of spinal deformities is still controversial. Giving preference to orthotic treatment and physiotherapy the historical development of nonoperative treatment will be demonstrated by the examples of idiopathic scoliosis and Scheuermann's kyphosis. It is surprising how early essential and still valuable principles of nonoperative treatment had been acquired and how many of the present-day concepts have remarkable forerunners in the 19th century. In the light of previous knowledge and personal experience the indication, practice and realistic capabilities of modern nonoperative treatment of idiopathic scoliosis and Scheuermann's kyphosis are pointed out.
Subject(s)
Exercise Therapy , Kyphosis/therapy , Orthopedics/history , Orthotic Devices , Physical Therapy Modalities , Scheuermann Disease/therapy , Scoliosis/therapy , Adolescent , Braces , Child , Europe , Female , History, 16th Century , History, 18th Century , History, 19th Century , History, 20th Century , Humans , Kyphosis/history , Male , Orthotic Devices/history , Physical Therapy Modalities/history , Radiography , Scheuermann Disease/history , Scoliosis/diagnostic imaging , Scoliosis/historyABSTRACT
BACKGROUND: The aim of this study was to evaluate the efficacy of bed-rest in the treatment of threatened abortion. This is based on the extensive use made today of this practice, although there are no studies that suggest or prove its therapeutic success, and on the contrary many of them demonstrate its possible risks. METHODS: The efficacy of bed-rest is evaluated by comparing the abortion rate in patients treated with bed-rest those who received no treatment. A retrospective study was made on data obtained from interviews with 226 patients with previous threatened abortion hospitalised for pregnancy-related reasons at the Obstetrics and Gynecology Clinic of Policlinico Umberto I in Rome between October 1998 and June 1999. RESULTS: The following results were obtained: 84% of the 146 patients treated with bedrest continued pregnancy beyond week 20, whereas 16% aborted before week 20. Of the 80 patients who were not treated, 80% continued pregnancy beyond week 20 and 20% aborted before week 20. These results do not show statistically significant differences between the two groups (c2=0.4 p=NS). CONCLUSIONS: These results suggest that bed-rest does not improve the prognosis of threatened abortion.
Subject(s)
Abortion, Threatened/prevention & control , Bed Rest , Adolescent , Adult , Female , Humans , Pregnancy , Retrospective StudiesABSTRACT
In 1850, about three centuries after the conquest of Peru by Pizzaro, the Austrian von Scherzer brought a sufficient quantum of coca leaves to Europe to permit the isolation of cocaine. As suggested by his friend Sigmund Freud, descriptions of the properties of the coca prompted the Austrian Koller to perform in 1884 the first clinical operation under local anesthesia, by administration of cocaine on the eye. The use of cocaine for local and regional anesthesia rapidly spread throughout Europe and America. The toxic effects of cocaine were soon identified resulting in many deaths among both patients and addicted medical staff. Local anesthesia was in a profound crisis until the development of modern organic chemistry which led to the synthesis of pure cocaine in 1891. New amino ester local anesthetics were synthesized between 1891 and 1930, such as tropocaine, eucaine, holocaine, orthoform, benzocaine, and tetracaine. In addition, amino amide local anesthetics were prepared between 1898 and 1972 including nirvaquine, procaine, chloroprocaine, cinchocaine, lidocaine, mepivacaine, prilocaine, efocaine, bupivacaine, etidocaine, and articaine. All of these drugs were ostensibly less toxic than cocaine, but they had differing amounts of central nervous system (CNS) and cardiovascular (CV) toxicity. Bupivacaine is of special interest because of its long duration of action and history of clinical application. Synthesized in 1957, the introduction of bupivacaine on the market in 1965 paralleled the progressive and cumulative reports of CNS and CV toxicity, leading to the restriction of its use and the identification of a special therapy-resistant CV toxicity. Numerous experimental studies were conducted to identify the fine cellular mechanism of this toxicity, which refines our understanding of the action of local anesthetics. The identification of optically active isomers of the mepivacaine family led to the selection of ropivacaine, a pure S-(-) enantiomer, whose toxicology was selectively and extensively studied before its introduction on the market in 1996. During the rapid and extensive use of ropivacaine in the clinic, unwanted side-effects have been found to be very limited.
Subject(s)
Amides , Anesthetics, Local , Cocaine , Amides/chemistry , Amides/pharmacology , Amides/toxicity , Anesthetics, Local/chemistry , Anesthetics, Local/history , Anesthetics, Local/toxicity , Animals , Bupivacaine/chemistry , Bupivacaine/pharmacology , Bupivacaine/toxicity , Cocaine/chemistry , Cocaine/pharmacology , Cocaine/toxicity , Europe , History, 19th Century , History, 20th Century , Humans , North America , RopivacaineABSTRACT
In the past rickets, poliomyelitis, and tuberculosis of the knee joint were the main causes for deformities and shortening of the children's legs. Orthotics played a major role in treatment and rehabilitation, and they were often used for life. In the nineteenth century orthopaedic surgeons developed procedures such as tenotomy, osteoclasis, osteotomy, excision of joints and arthrodesis, combined with conservative therapy or instead of it. In an incessant attempt to control wound suppuration--before Lister's antiseptic principle and aseptic practices were available--the "subcutaneous" approach was inaugurated for tendon and bone surgery.
