The supporting role of the teres major muscle, an additional component in glenohumeral stability? An anatomical and radiological study.

Muscle coordination plays an important role in glenohumeral stability. The rotator cuff and the long head of the biceps are considered the primary dynamic stabilizers muscles. However, the fact that a subgroup of patients with a massive tear in the rotator cuff were able to keep a normal function, should make us question this traditional view. We hypothesize that the teres major which is also a monoarticular scapulohumeral muscle, although it is not part of the conjoined tendon of the rotator cuff, can play a role in glenohumeral stability by a direct support of the humeral head generated by the particular posteroanterior location of this muscle under the humeral head and which, as far as we know, has not been written up previously. This particular effect could appear while the arm is being lifted and the humeral head could be leaning on against the teres major muscle belly underneath it. An anatomical a radiological study was carried out to substantiate our hypothesis. Two cadaver specimens were used for the anatomical study. Frist body was studied through conventional dissection. The second body was analysed through sectional anatomy. Then a radiological study was carried out using magnetic resonance imaging in a healthy male volunteer. Both anatomically and radiologically, the anteroinferior surface of the humeral head was showed firmly resting against the muscle belly of the teres major, to the point of misshaping it from 110 degrees of arm elevation with external rotation. The specific contribution of this effect to the glenohumeral stability needs to be confirmed by further studies and can help us to prevent the high incidence of glenohumeral dislocations.

[Euthanasia, assisted suicide and palliative care: a review by the Ethics Committee of the French Society of Anaesthesia and Intensive Care]. / Fin de vie, euthanasie et suicide assisté : une mise au point de la Société française d'anesthésie et de réanimation (Sfar).

CONTEXT: Management of the end of life is a major social issue which was addressed in France by law, on April 22nd 2005. Nevertheless, a debate has emerged within French society about the legalization of euthanasia and/or assisted suicide (E/AS). This issue raises questions for doctors and most especially for anesthetists and intensive care physicians. OBJECTIVE: To highlight, dispassionately and without dogmatism, key points taken from the published literature and the experience of countries which have legislated for E/AS. RESULTS: The current French law addresses most of the end of life issues an intensive care physician might encounter. It is credited for imposing palliative care when therapies have become senseless and are withdrawn. However, this requirement for palliative care is generally applied too late in the course of a fatal illness. There is a great need for more education and stronger incentives for early action in this area. On the rare occasions when E/AS is requested, either by the patient or their loved-ones, it often results from a failure to consider that treatments have become senseless and conflict with patient's best interest. The implementation of E/AS cannot be reduced to a simple affirmation of the Principle of autonomy. Such procedures present genuine difficulties and the risk of drift. CONCLUSION: We deliver a message of prudence and caution. Should we address painful end of life and moral suffering issues, by suppressing the subject, i.e. ending the patient's life, when comprehensive palliative care has not first been fully granted to all patients in need of it ?

Hacia un enfoque clínico-científico en el diagnóstico con test neurodinámicos (tensión neural) / Toward a clinicoscientific approach to diagnosis with neurodynamic (neural tension) tests

Durante cierto tiempo han existido múltiples ideas erróneas en cuanto al diagnóstico clínico con test neurodinámicos (tensión neural). Este artículo intenta resolver estos problemas y propone varias formas de unir las ciencias básicas y clínicas a la aplicación e interpretación de los test neurodinámicos en la práctica clínica. El objetivo es que el enfoque pueda ser más sistemático y con mayor base científica. Los nervios normalmente son mecanosensibles si se les aplica la suficiente fuerza. Esta afirmación enlaza con el hecho de que los test neurodinámicos normalmente producen respuestas neurodinámicas. Los test neurodinámicos (TND) estándar1-3 probablemente producen la suficiente fuerza en el sistema nervioso como para evocar actividad neuronal y síntomas. Puesto que los TND son positivos, se hace necesario determinar qué es un test positivo anormal y de qué tipo puede ser (manifiesto o encubierto) en el paciente. El siguiente paso es establecer una posible causa que el test anormal no nos indica. Esto se realiza con un examen habilidoso y detallado. El paso final para proporcionar soluciones neurodinámicas a los problemas anteriores es determinar si el test anormal es relevante para el problema del paciente. El artículo termina con la afirmación de que algunos tipos de neuropatodinámica es mejor tratarlos y otros, no

Several misconceptions in clinical diagnosis with neurodynamic (neural tension) tests have existed for some time. This paper attempts to resolve these problems and proposes various ways of linking the basic and clinical sciences to application and interpretation of neurodynamic tests in clinical practice. This is so that the approach can be more scientifically based and systematic. Nerves are normally mechanosensitive, given enough force. This statement links to the fact that neurodynamic tests normally produce neurodynamic responses. The standard neurodynamic tests1-3 probably produce sufficient force in the nervous system to evoke neuronal activity and symptoms. Since normal NDTs are positive, it becomes necessary to determine what is an abnormal positive test and what kind this might be (overt or covert) in the patient. The next step is to establish a possible cause which is not indicated by the abnormal test. This is performed with skilled and detailed examination. The final step in providing neurodynamic solutions for the above problems is to determine whether the abnormal test is relevant to the patient problem. This article is finalised by the statement that some types of neuropathodynamics are best treated and others left alone

Integración de técnicas de OMT en la evaluación y tratamiento de un paciente con lesión del sistema neuromotor / Integration of OMT techniques in the evaluation and treatment of a patient with a neuromotor impairment

Introducción. La terapia manual ortopédica (OMT) es una especialidad de la fisioterapia que debería ser tenida en cuenta en otras especialidades como la fisioterapia pediátrica o neurológica. Material y métodos. Se muestra la adaptación del protocolo de Kaltenborn-Evjenth (K-E) para la valoración de este caso, y se integra el tratamiento de OMT en un programa global de reeducación neuromotriz donde intervienen otros profesionales además del fisioterapeuta. Se describen las técnicas específicas para la región de la muñeca y se explica la utilización de técnicas de masaje funcional tanto de forma aislada como integradas en diferentes actividades. Resultados. Se produce un aumento de la movilidad pasiva y desaparición del dolor, que permite al paciente utilizar más su mano y progresar en el tratamiento, mejorando su capacidad para ejecutar tareas que requieren presas finas. Discusión. Aunque las principales causas de la dificultad para ejecutar presas finas son de origen neurológico, el factor biomecánico puede estar condicionando el tratamiento y la evolución del paciente

Introduction. Orthopedic manual therapy (OMT) is a physical therapy specialization that should be considered in other physical therapy specialties, such as neurological and pediatric physiotherapy. Material and methods. This case report describes the adaptation of the Kaltenborn-Evjenth evaluation protocol, and the integration of OMT treatment in a global neuromotor rehabilitation program where other professionals act. This case report also describes the use of specific techniques for the wrist region and it is also explained the use of functional massage techniques, in an isolated way and combined with other activities. Results. The increase of PROM in wrist extension and radial deviation, along with absence of pain, enabled the patient to use his right hand more efficiently. These factors may also contribute to improve the subject's ability to successfully execute a pincer grasp. Discussion. Although the main cause of impaired fine motor function in CVA is of neural origin, restrictions of joint motion may also warrant biomechanical assessment and treatment

Tratamiento manual de dolor lumbar y ciática con neurodinámica clínica / Manual treatment of low back pain and sciatica with clinical neurodynamics

Este artículo describe la aplicación del concepto de neurodinámica clínica junto a terapia manual sobre una paciente con dolor lumbar y síntomas radiculares. Se analizan con detalle los mecanismos causales, haciendo hincapié en el diagnóstico y en la reevaluación constante que genera la progresión en las diferentes técnicas de tratamiento. La disfunción consistía en un espacio de cierre reducido de la interfaz y una disfunción de la tensión neural. Se trató con maniobras de apertura de la interfaz para evitar la presión sobre la raíz nerviosa y con las movilizaciones neurales. Las técnicas fueron suaves y progresaron despacio desde niveles bajos a más altos según iba mejorando. Se concluye que el enfoque puede ser efectivo y, con progresiones específicas, razonamiento clínico y selección de técnicas, se pueden tratar los mecanismos causales, con énfasis en las categorías diagnósticas y en las progresiones sistemáticas. Se pueden tratar diferentes componentes de las disfunciones diferenciadamente y las técnicas de tratamiento pueden adaptarse con eficacia a las necesidades personales del paciente sin riesgo de provocación de síntomas

This article describes the application of the concept of clinical neurodynamics with manual therapy to a patient with low back pain and radicular symptoms. The causal mechanisms have been carefully analyzed with emphasis on diagnostic categories and in the continue reevaluation that creates the progressions in the different treatment techniques. The dysfunctions consisted of reduced closing interface dysfunction and the neural tension dysfunction. It has been treated with opening interface in order to avoid the pressure on the nerve root and with neural mobilizations. The techniques were gentle and progressed slowly from lower to higher levels as the improvement occurred. It has been concluded that the approach can be effective and, with specific progressions, clinical reasoning and technique selection, the causal mechanisms can be treated with emphasis on diagnostic categories and systematic progressions. Different component dysfunctions can be treated distinctly and the treatment techniques can be adapted effectively to the patient's intimate needs without the risk of provocation of symptoms

Intravenous liposomal benznidazole as trypanocidal agent: increasing drug delivery to liver is not enough.

With the aim of investigating if delivery of benznidazole (BNZ) to liver could be increased by incorporating the drug in multilamellar liposomes, single bolus of free BNZ or liposomal BNZ formulations (MLV-BNZ) composed of HSPC:DSPG:Chol 2:1:2 (mol/mol/mol) at 0.7% (w/w) drug/total lipid ratio, were injected by intramuscular (i.m.), subcutaneous (s.c.) and intravenous (i.v.) routes, at 0.2 mg BNZ/kg, in rats. The resulting blood concentrations were followed along 9 h post-injection (p.i.) and drug accumulation in liver was determined after 4 and 9 h p.i. Only upon i.v. injection of MLV-BNZ, a threefold higher BNZ accumulation in liver was obtained, together with blood BNZ concentrations of 1.1 microg/ml (30% lower than the blood BNZ concentration achieved upon i.v. administration of free drug) occurred 4 h p.i. However, such increased liver uptake of BNZ, raised twice a week had no effect on parasitaemia levels of mice infected with the RA strain of Trypanosoma cruzi. Our results indicate that the relationship between increased selectivity for an infected tissue and therapeutic effect is not always straightforward, at least for the MLV-BNZ regimen used in the present study.

Liposomal benznidazole: a high-performance liquid chromatographic determination for biodistribution studies.

In this work, an isocratic high-performance liquid chromatographic method for quantitation of liposomal benznidazole (BNZ) in biological tissues is presented. The method comprises protein precipitation together with an efficient extraction of bulk or liposomal BNZ with acetonitrile-dimethylsulfoxide (1:1, v/v) at a 2:1 (extraction solvent-tissue matrix, v/v or /vw) ratio; the process is completed by a final precipitation with trichloroacetic acid. The resultant supernatants are assayed chromatographically using a Kromasil C18 (25- x 0.4-cm i.d., 100 A, 5- microm particle size), with an isocratic mobil phase consisting of acetonitrile-water (40:60, v/v), a flow rate of 0.9 mL/min, and detected at 324 nm. Bulk BNZ is used as a reference standard for the analysis of samples containing liposomal BNZ. The assay is linear over a concentration range of 0.75 (the lowest quantity of analyte determined with precision and accuracy of >or= 20%) to 25 microg/mL-g in all liquid and solid matrices. Within-day precision is better than 6.4% in plasma and 8.6% in liver, the same for the two assayed concentrations. Between-day precision is 5.4% and 12.3% in plasma and 9% and 6.9% in liver for the two assayed concentrations, respectively. The absolute recoveries range between 70% and 97%. Therefore, the method is accurate and precise to be employed for detection of minor quantities of liposomal BNZ in biological tissues.

Development and in vitro characterisation of a benznidazole liposomal formulation.

The purpose of this study was to find a multilamellar liposomal formulation for the antichagasic drug Benznidazole (BNZ). Different lipid matrices and organic solvents for BNZ were tested in order to obtain the liposomes with the highest g BNZ/100 g total lipid (D/TL) ratio. The best lipid matrices resulted from hydrogenated phosphatidylcholine from soybean (HSPC): Cholesterol (Chol): distearoyl-phosphatidylglycerol (DSPG) (molar ratio 2:2:1) prepared with BNZ dissolved in DMSO. Drug loading of 2 g BNZ/100 g total lipids at a total lipid concentration of 20-30 mM was obtained. Two in vitro assays on the HSPC:Chol:DSPG formulation to predict its in vivo behaviour were performed. In the first experiments, after 60 min at 1-450-fold dilution in buffer at 37 degrees C, the amount of drug associated to liposomes was reduced from 2 to 0.25 g BNZ/100 g total lipids at a rate of 65% (drug lost) min(-1) at the first minute followed by 0.4% (drug lost) min(-1) during the next hour. When incubated in plasma at 37 degrees C, the HSPC:Chol:DSPG formulations bounded a high amount of plasma proteins: r=2400 microg plasma protein per micromol total lipid.

Valoración fisioterápica del paciente con dolor / Physiotherapy assessment of the patient with pain

La anamnesis es uno de los puntos imprescindibles para el correcto tratamiento del paciente con dolor. Por tanto, se considera fundamental una adecuada valoración por parte del fisioterapeuta. En el artículo se describen unas pautas de actuación base sobre las cuales cada profesional realizará el seguimiento de sus pacientes de manera detallada. La localización de su dolor, su intensidad, así como su calidad y cronología son algunos de los puntos tratados (AU)

Volatile compounds of dry hams from Iberian pigs.

A study on volatile compounds from three batches of dry hams from Iberian pigs ('montanera', fed on acorns and pasture; 'recebo', fed on acorns, pasture and a commercial diet; and 'pienso', fed on a commercial diet) has been made. Over 64 compounds were identified in the headspace volatiles from all three batches, including aldehydes, alcohols, short-chain fatty acids, furan derivatives, lactones and other miscellaneous compounds. Significant differences were found between batches at several levels (P<0·0005, P<0·005, P<0·05) for many volatile compounds, mainly between 'montanera' and 'pienso' batches. Overall quantitative differences, but not qualitative ones, were observed between batches.