Brown tumor of the cervical spine: a case report and review of the literature.

Brown tumors (BT) are benign focal bone lesions that may appear in the context of primary and secondary hyperparathyroidism (HPT). Involvement of the spine is exceedingly rare. We present a case of brown tumor involving the cervical spine, the third reported in the literature. In the literature review (until August 2010), we found nine cases of spinal BT in primary HPT and 14 cases in secondary HPT. Fifteen patients (65%) had evidence of spinal cord compression. A 34-year-old woman on long-term hemodialysis, with secondary HPT, presented with a 9-month history of persistent neck pain. Radiographs of the cervical spine revealed an expansive osteolytic lesion in the posterior arch of the second cervical vertebra. MR imaging revealed an expansive mass on C2 affecting the vertebral body, odontoid process, right pedicle, laminas, and spinous process; there were no signs of spinal edema. A CT-guided needle biopsy of the lesion showed destruction of trabecular bone, infiltration of the fibroblastic cells, and abundant osteoclast-like multinucleated giant cells with hemorrhage and hemosiderin pigment, and the diagnosis of brown tumor was made. Cervical pain disappeared within a few days of parathyroidectomy, and rapid remineralization of C2 was evident within a few months. BT must always be considered in the context of hyperparathyroidism and osteolytic lesions. Vertebral BT can be particularly devastating due to medullar compression symptoms. Regression or complete disappearance of these lesions after parathyroidectomy is common, but prompt surgical decompression is necessary in case of medullar compression symptoms.

Sexual behavior of castrated boars treated with prostaglandin F(2alpha).

The objectives were to test the hypothesis that exogenous prostaglandin F(2alpha) (PGF(2alpha)) temporarily restores sexual behavior of castrated boars, and to evaluate effects of PGF(2alpha) on serum hormone concentrations. At 35 d after castration, nine lean-type adult boars were randomly assigned to three treatments in a 3x3 latin square (with three replicates). Treatments were three doses of PGF(2alpha) doses (0, 10, and 20mg) and three periods of treatment, with 5 d between each period. Serum testosterone (T) concentrations were non-detectable at the start of the experiment. Serum concentrations of estradiol (E2), LH, prolactin (PRL), and cortisol were unaffected (P>0.05) by PGF(2alpha) treatment. The interval from treatment to ejaculation in boars treated with 10mg (758s) or 20mg (660s) PGF(2alpha) did not differ, but were different (P < 0.05) from control boars (>1 800s). Ejaculation duration and false mounts differed (P < 0.05) between control boars and boars treated with 10 or 20mg PGF(2alpha). In conclusion, PGF(2alpha) treatment did not change serum concentrations of T, E2, LH, PRL, or cortisol, but restored sexual behavior. This restoration may have been due to an effect of PGF(2alpha) directly in specific areas of the brain, or indirectly via release of other hormones that stimulated areas in the brain that affected sexual behavior.

Utilización de la estadística en cirugía ortopédica y traumatología / Statistic in orthopaedic surgery and traumatology

Los estudios de investigación epidemiológica se sustentan en los métodos de la estadística. Para poder alcanzar conocimiento sobre poblaciones frecuentemente se estudian muestras representativas de las mismas. Estos estudios se basan en la inferencia estadística. La inferencia se puede realizar mediante la estimación de parámetros por intervalos de confianza o bien mediante el cálculo de la significación estadística –valores p– mediante contrastes de hipótesis. En un intervalo de confianza se busca una solución que proporcione seguridad y precisión. Con los contrastes de hipótesis se cuantifica la probabilidad de que las observaciones muestrales puedan ser explicadas por el azar del muestreo, midiendo los errores tipo I y tipo II. En cada hipótesis de investigación existe un contraste apropiado en función de los tipos de variables estudiadas, su distribución, el número de sujetos estudiados y el número de grupos que se comparan. La utilización de valores p está sujeta a controversia, ante lo que se ofrecen alternativas como la utilización de métodos bayesianos o el enfoque a intervalos de confianza. Los estudios dirigidos a la medición de eventos a lo largo de periodos de observación se denominan estudios de supervivencia. Existen distintos métodos en función del tipo de periodos estudiados y de las variables a analizar. Los métodos estadísticos multivariantes permiten analizar dos o más variables a la vez. Existen métodos exploratorios que pueden simplificar el número de variables o de sujetos y métodos confirmatorios como la regresión logística que permite analizar el papel de variables confusoras y de interacciones (AU)

Objetive: Epidemiologic research is based on statistical methods and usually studies representative samples to attain knowledge about population. These studies are based on statistical inference. There are two ways to make inference. One is the parameter estimation with confidence intervals, another is the hypothesis test. A confidence interval allow us to control the precision (a range of the estimated variable) and the confidence (the probability of the population parameter to be included in that range) of the results. A hypothesis test quantifies the chance that a result could be explained by the random nature of the sample measuring type I and type II errors. Every research question has a matching hypothesis test according to the types of the variables, their distribution, the number of sampled units and the groups to be compared. The use of p-values is subject to controversy. Other methods like Bayesian statistics or confidence intervals offer alternatives. Survival studies measure events along time intervals. There are different methods regarding the type of intervals or the data to be analyzed. Multivariate statistics allow us to analyze two or more variables at a time. The exploratory methods can simplify the data, both the number of subjects and the variables. Confirmatory methods like logistic regression enable the analysis and importance of confounding and interacting variables (AU)

Ovarian follicular dynamics after cauterization of the dominant follicle in anestrous ewes.

An experiment was conducted to ascertain if follicles could reach ovulatory size after the largest follicle (dominant) has been removed at different times during a progestin treatment in anestrous ewes, and secondly to determine if these new follicles could respond to an hCG-induced ovulation and have similar function as corpora lutea. Mature crossbred sheep (n=44) in anestrous were treated with an intravaginal sponge containing 40 mg of FGA (day 0=sponge insertion) for 9 days. Treatments consisted of cauterization of the largest follicle on the experimental day 3 (T1), day 6 (T2) and day 9 (T3); day 12 to ascertain the size of the largest follicle in control ewes. During laparotomies, the diameters of the largest follicle (DF), and those of the second and third largest follicles (SF1 and SF2, respectively) were determined. On day 12, a second laparotomy was performed for those ewes which had their DF cauterized on days 3, 6 and 9, a fourth group was left intact and only laparotomized on day 12. At this time, the size of the new DF, SF1 and SF2 were determined. Immediately after the laparotomy on day 12, all the ewes were treated with 1000 i.u. of hCG to induce ovulation. Blood samples were collected daily from day 0 to 50 and samples were analyzed for progesterone concentrations. The size of the DF at the time of sponge removal was smaller that those observed on day 3 or 6 of sponge suggesting that follicles in ewes treated with this progestin regress and a new wave of follicular development ensues between day 6 and the time of sponge removal. The size of the DF on day 12 was also smaller in ewes that have the largest follicle removed at the time of sponge removal reflecting that these follicles had a shorter period of growth; however, the rate of growth was greater for these follicles than for follicles arising after cauterization on day 3 or 6 after sponge insertion. There were no differences among treatments, in the number of ewes that formed a corpus luteum (CL) in response to hCG. Life span of the corpora lutea did not differ among ewes having their DF removed on day 6 or 9 or those that served as controls, however, ewes that had their DF removed on day 3 developed longer lived CL in a larger proportion of animals. Average progesterone concentration during the life span of the induced corpora lutea was greater in control ewes than in any other experimental group. These observations allow us to conclude that, (a) the follicular dynamics observed in anestrous ewes treated with a progestin intravaginal sponge resembles that observed during the normal estrous cycle in the ewe; (b) the effects of progesterone on life span of the corpus luteum could not be only related to direct effects at the follicle but also involve changes in other components of the uterine-ovarian-hypothalamic axis; (c) the mechanisms controlling luteal life span seem to be different to those mechanisms controlling the function of the induced corpus luteum.

Resonancia magnética en el diagnóstico y el seguimiento de la fascitis eosinofílica / Role of the nuclear magnetic resonance in the diagnosis and follow up of eosinophilic fascitis

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"Lumps" and "bumps" that mimic acute aortic and brachiocephalic vessel injury.

Laceration of the thoracic aorta or brachiocephalic vessels due to blunt trauma is relatively common. In such cases, prompt and accurate diagnosis followed by timely surgery is essential. These injuries typically occur at the aortic isthmus and can usually be readily identified at aortography, which remains the standard of reference for diagnosis. However, numerous anatomic variants that manifest as "lumps" or "bumps" on aortograms can mimic true vascular injury, thereby leading to false-positive or false-negative diagnosis. These variants include aortic spindle, classic or atypical ductal diverticula, and infundibula of the brachiocephalic arteries and adjacent branches or of the right third intercostal artery. Ductus diverticula typically occur at the isthmus and have smooth, uninterrupted margins with gently sloping shoulders. Infundibula are also smoothly marginated but can occur in a variety of locations and generally taper into one or more vessels at their apex. Knowledge of the imaging appearances of these anatomic variants is necessary for correct interpretation of aortograms of the aorta and brachiocephalic vessels in blunt trauma patients.

Subtle or atypical injuries of the thoracic aorta and brachiocephalic vessels in blunt thoracic trauma.

Aortic or brachiocephalic vessel injuries secondary to blunt thoracic trauma are relatively common and can occur throughout the length of the thoracic aorta or in various locations in the brachiocephalic vessels. Aortography remains the standard of reference for the diagnosis of these injuries despite recent technologic advances in other imaging modalities. The classic aortographic finding in aortic or brachiocephalic vessel injury consists of a large false aneurysm, typically protruding from the medial aspect of the aortic isthmus. However, intrathoracic aortic or brachiocephalic vessel injury can and does occur at any intrathoracic location and may exhibit a wide variety of radiographic appearances, thereby presenting a diagnostic challenge even for experienced trauma angiographers. Large false aneurysms may appear oval or rounded, tubular, or asymmetrically globular and may manifest in unusual locations such as the ascending aorta. Although smaller, irregularly shaped false aneurysms at atypical locations may be obscure or mimic ductus diverticula, their irregular, sharp margins allow them to be distinguished as injuries. The subtlety of aortic or brachiocephalic vessel injuries necessitates a high degree of suspicion along with meticulous imaging technique in all cases and the use of additional projections in equivocal cases for definitive diagnosis.

[Treatment of irritable colon with lidamidine and support psychotherapy]. / Tratamiento del colon irritable con lidamidina y psicoterapia de apoyo.

To evaluate the usefulness of lidamidine treatment in patients with irritable colon syndrome, a controlled double blind study was carried out. Forty patients with Manning symptom criteria and negative screening to stool examination, rectosigmoidoscopy and barium enema were included. Four groups of treatment were randomly integrated: Lidamidine with and without group psychotherapy and placebo with and without group psychotherapy, for six weeks. After a washout period, treatment was switched. Thirty-eight patients with a total of 76 observations were evaluated. Favorable response was shown by 94.7% and 68.4% of those who received only lidamidine and placebo, respectively, and by 84.3% and 63.2% of those who additionally received psychotherapy. Difference with or without psychotherapy was not significant. Globally, response was better with lidamidine than with placebo (89.5% vs 65.8%, p = 0.02). Adverse reactions were minimum. Lidamidine can be a useful drug in the treatment of irritable colon syndrome.

[Toxoplasmosis and contact with animals: study of 390 cases]. / La toxoplasmosis y el contacto con animales: estudio de 390 casos.

Three hundred and ninety patients with suspected toxoplasmosis due to their contact with animales--they owned them, or work with them--are studied. The great significance of this way of acquiring the disease is stated. Every patient had a complement fixation test and an intradermal reaction test with toxoplasmine. An 85.2% positiveness to complement fixation, and a 64.1% to intradermal test were found among those patients who informed animal contact; a 70,6% positiveness to complement fixation, and a 56,2% to intradermal reaction was found in the patients who denied having any contact with animals. This showed both the importance of animal contact as well as other forms of transmission. The contacts were also studied, and the animals were classified according to J. Jira, the researcher: maximal, high, minimal and unreceptiveness to toxoplasma. The possibility of acquiring toxoplasmosis from other sources besides the close contact with animals must be taken into consideration.