Comparación de ortesis para el tratamiento de la artrosis de la base del pulgar / Compare splint for patients with thumb osteoarthritis (OA)

INTRODUCCIÓN: El tratamiento de la osteoartritis (OA) tiene como primer objetivo reducir el dolor y mejorar la función de la articulación afectada. La primera indicación para el tratamiento conservador de la rizartrosis es la inmovilización. La intención de inmovilizar es proveer soporte a la articulación carpometacarpiana (CMC) del pulgar mientras se permiten movimientos funcionales de la mano. Hay una variedad de ortesis para el pulgar disponibles, tanto prefabricadas como hechas a medida, y en diferentes tipos de material. Lamentablemente no hay lineamientos específicos del tipo de ortesis adecuada para la OA de la articulación CMC. El abordaje del Terapista Ocupacional incluye la consideración de la utilización de ortesis. Además el Terapista Ocupacional confecciona ortesis termoconformadas hechas a medida. OBJETIVO: Evaluar la efectividad de las ortesis termoconformadas inmovilizadoras de las articulaciones CMC y Metacarpofalangica (MCF) del pulgar vs. las ortesis termoconformadas inmovilizadoras de la articulación CMC. PACIENTES Y MÉTODO: Ensayo clínico no farmacológico de tecnología médica de riesgo no significativo, usando un diseño cruzado de nueve semanas de duración con dos períodos de tratamiento de cuatro semanas cada uno y una semana intermedia de washout (sin ortesis). En el primer período de tratamiento al paciente se le asignó aleatoriamente una ortesis corta o la larga que utilizó durante cuatro semanas y luego de una semana de washout cambió a la otra durante otras cuatro semanas. El estudio se realizó con pacientes derivados consecutivamente asignados al azar a fin de un tratamiento diferente. El dolor se evaluó con la Escala Visual Analógica. (EVA). La capacidad funcional manual se evaluó con la Sub Escala Funcional del Australian Canadian Osteoarthritis Hand Index versión (AUSCAN; Queensland, Australia), validada al español. RESULTADOS: Se incluyeron 18 pacientes, 13 (72%) eran de sexo femenino y tenían una mediana (p25-75) edad de 59.00 (55.00-66.50) años. En cuanto al estadio radiológico 1 (5.6%) paciente tenía estadío radiológico Eaton I, 10 (55.6 %) Eaton II, y 7 (38.9%) Eaton III. Siete pacientes (38.9%) comenzaron la intervención con la ortesis corta y 11 (61.1%) con la ortesis larga. El dolor disminuyó significativamente en el primer período: al día 0 la mediana de dolor fue 7.5 (5.00-9.00), en comparación con el día 28 donde la mediana fue de 3.00 (2-6.25) (p=000.1). La función mejoró significativamente en el primer período; la mediana de función manual al día 0 fue 0.54 (00.47-00.68), en comparación con el día 28 que fue de 0.76 (0.51-0.86) (p=0.028). No se observaron cambios significativos en dolor y función en el segundo período. No hubo diferencia en el tipo de ortesis asignada de acuerdo a mano dominante, mano tratada, uso de analgésicos y estadio de Eaton, pero hubo una mayor tendencia de utilizar la ortesis corta en ocupaciones de carga media, de 12.00 pacientes (66%), 7.00 (58,3%) ortesis cortas, versus 5.00 (41,7%) ortesis larga (p=0.017). Para pacientes con ocupaciones de carga liviana de 6.00 pacientes (33,3%), 6.00 (100%) tuvieron una tendencia de utilizar ortesis largas (p=0.017). CONCLUSIONES: Independiente del modelo de ortesis que se utilice, en este estudio se observó una mejoría clínica de los pacientes tanto en intensidad de dolor como en la función al primer mes de tratamiento. Estos hallazgos indicarían que este tipo de intervención terapéutica es positiva en rizartrosis. (AU)

INTRODUCTION: The treatment of osteoarthritis (OA) has as its primary objective to reduce pain and improve function of the affected joint. The first indication for conservative treatment is immobilization. The intention is to provide support to immobilize the carpometacarpal (CMC) of the thumb while functional hand movements are allowed. There are a variety of thumb splints available, both prefabricated and custommade, and different types of material. Unfortunately there are no specific guidelines on the type of correct splint for OA of the CMC joint. The Occupational Therapist approach includes consideration of the use of orthotics. OBJECTIVE: Analyze the effect of two different splints: thermoformed orthotics immobilizing the CMC and metacarpophalangeal (MCP) joints of the thumb vs. the thermoformed orthotics immobilizing the CMC joint, on hand function and pain in individuals with CMC OA. PATIENTS AND METHODS: Non-pharmacological medical technology clinical trial no significant risk, using a two period crossover design, the two four-week treatment periods were separated by oneweek washout period (without splint). A table of random symbols was used to determine treatment order assignments. Pain was evaluated by the Visual Analogue Scale (VAS); and hand functional by the Functional Sub Scale of Canadian Osteoarthritis Hand Index Australian version (AUSCAN, Queensland, Australia), validated in Spanish. RESULTS: Eighteen patients were included, 13 (72%) were female and they were middle-aged (p 25-75) of 59.00 (55.00-66.50) years. As for the radiological stage 1 (5.6%) patient had Radiological stage Eaton I, 10 (55.6 %) Eaton II, y 7 (38.9%) Eaton III. Seven patients (38.9%) started the intervention with the short orthosis and 11 (61.1%) with the long orthosis. The pain decreased significantly in the first period: at day 0 the median pain was 7.5 (5.00-9.00), compared to day 28 where the median was 3.00 (2- 6.25) (p = 000.1). The function improved significantly in the first period; the median manual function at day 0 was 0.54 (00.47- 00.68), compared to day 28 which was 0.76 (0.51-0.86) (p = 0.028). There were no significant changes in pain and function in the second period. There was no difference in the type of splint assigned according to dominant hand, hand treated, analgesic use and Eaton stage, but there was a greater tendency to use short orthotics in medium load occupations of 12.00 patients (66%), 7.00 (58.3%) short orthoses, versus 5.00 (41.7%) long orthoses (p = 0.017). For patients with light load occupations of 6.00 patients (33.3%), 6.00 (100%) had a tendency to use long orthoses (p = 0.017). CONCLUSIONS: Regardless of the orthotic model used, in this study clinical improvement was observed in both pain intensity and function at the first month of treatment. These findings would indicate that this type of therapeutic intervention is positive in thumb osteoarthritis. (AU)

Catheterization via Caudal Puncture of the Epidural Space with a 5F Angiography Catheter and a Coaxial Steerable 0.038" Guidewire for Delivery of Drugs and Adhesiolysis.

UNLABELLED: We describe a technique for epidural medication delivery with angiographic catheters and guidewires inserted via caudal puncture and advanced cephalad under fluoroscopic guidance in the treatment of painful spinal diseases. METHODS: From November 2005 to September 2006 a total of 18 consecutive patients underwent adhesiolysis by an angiographic 5 French hockey-stick tip catheter and a coaxial 0.038" steerable guidewire inserted at the sacral hiatus and advanced cephalad under fluoroscopic guidance up to the site of adhesion. We obtained pain relief for more than three months in 61% of patients. There were no periprocedural/postprocedural complications. Our system of accessing the epidural space provides a safe means of delivering epidural medication, performing mechanical adhesiolysis and may be useful in the treatment of selected patients with painful spinal diseases.

Protected carotid stenting: the usefulness of filter protection devices.

We report our experience in carotid artery stenting using a filter protection device. From July 2003 to September 2006 we treated 62 patients by internal carotid stenting using a filter protection device. Procedural success was achieved in 100% of cases. There were five periprocedural complications: one dissection of the internal carotid artery, two TIAs and two groin haematomas at the site of needle access. Neurological examination performed after the procedure and during the 30 days of follow-up did not reveal major neurological complications. Cerebral protection with a filter during carotid artery stenting seemed feasible and safe.

Short, medium and long term efficacy of epidurally injected anaesthetic-corticosteroid mixture in lumbocruralgia and lumbosciatalgia.

We assessed the efficacy of an epidural sited anaesthetic-corticosteroid mixture with transforaminal or interlaminar/interspinous access, in subjects with chronic lumbocruralgia or lumbosciatalgia caused by discal pathology or degenerative foraminal stenosis. From September 2003 to June 2005, 84 patients were treated in the transforaminal region and 32 in epidural space through back access (interlaminar or interspinous) with 2 ml cortisone (megacort) and 2ml anaesthetic (naropine 7.5mg/ml). All 116 patients underwent a minimum of two and a maximum of three treatment sessions. The results were evaluated for a follow-up period of ten months by comparing the answers given by the patients with the Visual Analogic Score. This was done prior to and after every single injection and during the follow-up period. Out of 142 spaces treated, improvement of symptoms for a period varying from one to three months was recorded in 74 cases (52%), for a period of more than three months in 53 (37%) cases, while in the remaining 15 (11%) cases no sufficient regression of pain was reported. In many cases of chronic lumbago/lumbosciatalgia, the percutaneous injection of an anaesthetic-cortisone mixture can be useful in relieving or even killing pain for a period of more than three months. No major complication was reported.

Group A streptococcal meningitis: report of a case and review of literature since 1976.

Group A streptococcal (GAS) invasive disease has become increasingly common in recent years. However, acute bacterial meningitis caused by this pathogen is unusual. We report a case of GAS meningitis in a previously healthy 21/2-year-old child associated with a dramatically rapid course and fatal outcome. A literature review of previously reported cases is presented. This case serves as a reminder that GAS can cause severe meningitis in otherwise healthy hosts.

Outcome while awaiting heart transplantation in children: a comparison of congenital heart disease and cardiomyopathy.

BACKGROUND: Outcomes for children who undergo heart transplantation differ for children with congenital heart disease as compared to those with structurally normal hearts. Similar data have not been reported for these groups of patients for the morbidity and mortality associated with waiting for a donor. We report these data. METHODS: A retrospective review was performed for all pediatric patients who were listed for heart transplantation at Stanford from 1977 to 1996, comparing mortality and major morbidity for patients with congenital heart disease and those with cardiomyopathy and structurally normal hearts. RESULTS: There were 96 patients who met study criteria, of whom 67 were successfully transplanted. The median waiting time was 23 days. Survival at 30 days was 93% and at 90 days was 81%, with no difference between groups. Major complications were identified in 38% of patients with structurally normal hearts, vs 9% of patients with congenital heart disease (p < 0.001). CONCLUSIONS: Overall mortality is similar for patients with congenital heart disease and those with structurally normal hearts while listed for heart transplantation, but patients with congenital heart disease have fewer episodes of major morbidity during this time.

DNA fragment assembly using neural prediction techniques.

The paper describes an alternative approach to the fragment assembly problem. The key idea is to train a recurrent neural network to tracking the sequence of bases constituting a given fragment and to assign to a same cluster all the sequences which are well tracked by this network. We make use of a 3-layer Recurrent Perceptron and examine both edited sequences from a ftp site and artificial fragments from a common simulation software: the clusters we obtain exhibit interesting properties in terms of error filtering, stability and self consistency; we define as well, with a certain degree of approximation, a metric on the fragment set. The proposed assembly algorithm is susceptible to becoming an alternative method with the following properties: (i) high quality of the rebuilt genomic sequences, (ii) high parallelizability of the computing process with consequent drastic reduction of the running time.

Vulvo-vaginitis and reproduction.

The main micro-organisms able to interfere with the reproductive function have been considered. In particular, the problems concerning the vaginal environment and its interactions with spermatozoa, immunological aspects and contraception. Lastly, reference has been made to methods of prevention and study in the field of diagnostics and of clinical management.

Cyto-histological aspects of chorionepithelioma in fluorescence.

The Author illustrates cytochemical and histochemical pictures of the chorion-epithelioma, which the fluorochromization with orange acridine, according to the Bertanlanffy's method, gives with extreme clearness. The intense colouring of both nucleic acids, DNA and RNA indicates a lively functional activity and elevated trophism of the trophoblastic cells.

Intragraft cytokine profile during human liver allograft rejection.

Forty-three human liver allograft biopsies and normal liver were directly analyzed for inflammatory and immunoregulatory cytokine gene expression by polymerase chain reaction (PCR). IL-5 gene expression was predominantly present in biopsies from liver allografts with histopathological evidence of acute rejection. IL-2 gene expression was rarely observed in rejecting allografts or allografts without evidence of rejection. In contrast, IL-4 message was readily detectable in the majority of liver allografts regardless of clinical status. The inflammatory mediators IL-1 beta, TNF-alpha, and IL-6 were detected with similar frequency in rejecting allografts and allografts without evidence of rejection. These findings suggest that inflammatory and immunoregulatory cytokines are produced within the allograft. Moreover, IL-5 may play a role in the local mechanisms of liver allograft rejection.

Cytokine and T cell receptor gene expression at the site of allograft rejection.

Intragraft cytokine and T cell receptor gene expression was analyzed in rejecting renal allografts by polymerase chain reaction (PCR). Message for IL-1 beta, IL-6, and TNF-alpha was detected in nephrectomy tissue with pathological evidence of acute or chronic rejection. Similarly, mRNA for both IL-6 and TNF-alpha was present in renal biopsies from acute rejecting kidneys. IL-2R, IL-4, and IL-5 mRNA was present in both rejecting and rejected kidney allografts, indicating that these cytokines may play a role in ongoing renal allograft rejection. Conversely, IL-2, IL-7, and IFN-gamma message was detected infrequently. In order to address the diversity of T cells in rejecting kidneys, we have analyzed the clonality of the TcR present within the allograft tissue. Rearranged TcR genes were identified in all allografts examined (n = 16) indicating the presence of T cells bearing the alpha/beta TcR. We have determined that there is a heterogeneous infiltration of T cells in the rejected allograft with TcR representing x = 7.47 +/- 2.4 families rearranged in samples obtained from nephrectomies, whereas x = 5.33 +/- 0.58 families were detected in samples obtained from biopsy tissue. These data indicate that (1) cytokines are produced locally which may contribute to graft cell destruction, (2) the heterogeneity of intragraft T cells during kidney allograft rejection may exist because nonspecific lymphocytes have been recruited to the site by locally produced cytokines or because T cells are responding to multiple epitopes or multiple donor antigens. Detection of intragraft cytokines and TcR may prove useful in elucidating the mechanism of rejection and therefore lead to improved immunosuppression.

An improved method for the detection of soluble interleukin 2 receptors in liver transplant recipients by flow cytometry.

A new flow cytometric method (FCM) for detection of soluble interleukin 2 receptor (sIL-2R) in serum was established. Using this method, results from one to forty samples can be obtained in less than 2 hr as compared with 5 hr in an ELISA. Comparing over 300 sera samples tested by both methods, we found the FCM to be as specific and sensitive as the ELISA, but even more reproducible. Regression analysis of ELISAt on FCMt showed there is a strong relationship between the two assays and they mimic each other over time. We studied the daily serum levels of sIL-2R by FCM in 18 liver allograft recipients: 7 were in the stable group, 6 in the rejection group, and 5 had both rejection and infection. Low or decreasing sIL-2R levels correlated with absence of rejection. In patients with rejection episodes, a typical elevation of sIL-2R was followed by a rapid decrease of sIL-2R after successful response to rejection therapy. Patients with multiple complications displayed elevated sIL-2R levels. In conclusion, because of its rapid turnover time and accuracy, the FCM has the potential to determine the appropriate timing of post-transplant liver biopsies.

Asymmetric Boltzmann machines.

We study asymmetric stochastic networks from two points of view: combinatorial optimization and learning algorithms based on relative entropy minimization. We show that there are non trivial classes of asymmetric networks which admit a Lyapunov function L under deterministic parallel evolution and prove that the stochastic augmentation of such networks amounts to a stochastic search for global minima of L. The problem of minimizing L for a totally antisymmetric parallel network is shown to be associated to an NP-complete decision problem. The study of entropic learning for general asymmetric networks, performed in the non equilibrium, time dependent formalism, leads to a Hebbian rule based on time averages over the past history of the system. The general algorithm for asymmetric networks is tested on a feed-forward architecture.

[A case of thrombosis of the superior longitudinal sinus]. / Su un caso di trombosi del seno longitudinale superiore.

A case of cerebral venous sinus thrombosis is described in a forty-two years old patient. The literature is reviewed about clinical presentation and neuroradiological findings. We consider the use of NMR in diagnosis.

[Diagnostic and prognostic value of the echo-Doppler and transcranial Doppler methods in the acute phase of ischemic ictus]. / Valore diagnostico e prognostico della metodica eco-Doppler e Doppler transcranico negli ictus ischemici in fase acuta.

The ischaemic ictuses are a frequent pathology. For their annulling potentiality a quick etiopathogenetic diagnosis is necessary to institute a suitable therapy that limiting the extension of the cerebral damage. In this respect, it is fundamental the use of the duplex methods in real time together with doppler valuation of the neck vessels (carotid and vertebral) and of the intracranial big arteries. The direct observation of the endoluminal surface in the extracranial vessels and the valuation of the circulatory condition in the individual arterial districts explored give as important of haemodynamic information which, added to that obtained through a computerized axial tomography and the clinic, allows a correct diagnostic valuation with important effects on the therapy as well as a reliable prognostic formulation. Description of two clinical cases.

Antibiotic prophylaxis in neurosurgery. Study comparing two groups of patients with and without treatment.

We present the results of a study comparing two groups of patients who underwent neurosurgical operations, one pretreated with Ampicillin (184) and the other not (193), in comparable time-spans. The results of this study argue for a beneficial action of Ampicillin prophylaxis on neurosurgical infections. A brief discussion of the appropriate literature is given.