Using Cognitive Reserve to Create Norms for the TMA-93 (Relational Binding of Images).

BACKGROUND: TMA-93 examines relational binding using images. Biomarker validation has demonstrated that it is discriminative for diagnosing early AD. The effect of cognitive reserve on TMA-93 performance remains unexplored and could improve the interpretative framework for using the test. OBJECTIVE: To study the effect of cognitive reserve on TMA-93 performance and to provide new norms for the test that include its measurement. METHODS: Cognitively unimpaired people aged 55 and over were systematically recruited for this cross-sectional normative study in southern Spain. Age, sex, and scores on the Cognitive Reserve Questionnaire (CRQ; maximum score: 25 points) were collected, and the TMA-93 was administered (maximum score: 30 points). Percentile-based reference data that captured combinations of socio-demographics variables with significant effect on TMA-93 performance were calculated. RESULTS: 902 participants (62.5% female; age: median = 68, IQR = 61-75, range = 55-90) were included. CRQ total scores were globally low (median = 8, IQR = 5-13, range = 0-24). Cognitive reserve, including modifiable items as reading activity and intellectual gaming activity, and age mainly supported the TMA-93 total score variance. Sex seemed to have some influence in the elderly. TMA-93 total scores medians began to drop from 70-75 years old. Higher total score on the CRQ and, possibly, female sex determined a gentler slope. New norms based on these variables showed wide variations in scores for the 5th and 10th percentiles. CONCLUSION: Visual relational binding ability depends on cognitive reserve, including modifiable items. The age-related binding deficit is buffered by higher cognitive reserve and, at older ages, by female sex.

Site-dependent shaping of field potential waveforms.

The activity of neuron populations gives rise to field potentials (FPs) that extend beyond the sources. Their mixing in the volume dilutes the original temporal motifs in a site-dependent manner, a fact that has received little attention. And yet, it potentially rids of physiological significance the time-frequency parameters of individual waves (amplitude, phase, duration). This is most likely to happen when a single source or a local origin is erroneously assumed. Recent studies using spatial treatment of these signals and anatomically realistic modeling of neuron aggregates provide convincing evidence for the multisource origin and site-dependent blend of FPs. Thus, FPs generated in primary structures like the neocortex and hippocampus reach far and cross-contaminate each other but also, they add and even impose their temporal traits on distant regions. Furthermore, both structures house neurons that act as spatially distinct (but overlapped) FP sources whose activation is state, region, and time dependent, making the composition of so-called local FPs highly volatile and strongly site dependent. Since the spatial reach cannot be predicted without source geometry, it is important to assess whether waveforms and temporal motifs arise from a single source; otherwise, those from each of the co-active sources should be sought.

Testing Visual Binding by the TMA-93 in People Aged 75 and Over.

BACKGROUND: TMA-93 examines relational binding using images. The test has been proven to be discriminative for diagnosing early Alzheimer's disease by biomarkers. Norms for this test are available, but the elderly, at high risk for Alzheimer's disease, have not yet been widely represented. OBJECTIVE: To extend normative data on the TMA-93 for people aged 75 and over. METHODS: An extension of the Spanish TMA-93 normative study was undertaken. Only cognitively unimpaired people aged 75 and over were included. Age, gender, and educational attainment were registered as socio-demographic variables. Using histograms analysis, median comparisons, and linear regression analysis, we selected variables that demonstrated influence on TMA-93 total scores and provided percentile-base reference data according to combinations of those variables. RESULTS: We included 431 new participants, resulting in a total sample of 657 individuals (median age = 78, interquartile range = 76-81, range = 75-93). Percentile-base reference data stratified by a combination of age ranges (75-79, n = 428; and ≥80 years, n = 229), and educational attainment (< first grade, n = 253; first grade, n = 209; > first grade, n = 195) revealed that participants achieved a minimum TMA-93 total score of 26/30 at the 50th-percentile regardless of stratum. At the 10th-percentile, a maximum of 24/30 was achieved in the more educated stratum contrasting with a minimum of 19/30 in the less educated stratum. CONCLUSION: Although mitigated by lower levels of education, performance on the TMA-93 is widely preserved in cognitively unimpaired people aged 75 and over. The test could facilitate the screening of elderly patients with memory complaints.

Gamma rhythm communication between entorhinal cortex and dentate gyrus neuronal assemblies.

Gamma oscillations are thought to coordinate the spike timing of functionally specialized neuronal ensembles across brain regions. To test this hypothesis, we optogenetically perturbed gamma spike timing in the rat medial (MEC) and lateral (LEC) entorhinal cortices and found impairments in spatial and object learning tasks, respectively. MEC and LEC were synchronized with the hippocampal dentate gyrus through high- and low-gamma-frequency rhythms, respectively, and engaged either granule cells or mossy cells and CA3 pyramidal cells in a task-dependent manner. Gamma perturbation disrupted the learning-induced assembly organization of target neurons. Our findings imply that pathway-specific gamma oscillations route task-relevant information between distinct neuronal subpopulations in the entorhinal-hippocampal circuit. We hypothesize that interregional gamma-time-scale spike coordination is a mechanism of neuronal communication.

Pandemia y desigualdad social: los barrios populares del conurbano bonaerense en el aislamiento social preventivo y obligatorio / Pandemic and social inequiality: the popular neighborhoods of the Buenos Aires suburbs in preventive social isolation

INTRODUCTION research studies the impact of the social isolation measures on the living conditions of the popular neighborhoods of the Buenos Aires suburbs, the family and community strategies and the state intervention in this context. METHODS it is based on two successive collaborative surveys carried out by the National University of General Sarmiento, that collected 80 and 129 short interviews with territorial and health leaders in the first and third phase of isolation, respectively. RESULTS quarantine compliance was medium and high. The problems ranked by the referents were: i) the discontinuity of household income from work; ii) the difficulty of access to basic food; iii) gender violence inside homes; and iv) restrictions on access to health services. DISCUSSION the important presence of the state through the transfer of monetary income and direct food assistance is highlighted, as well as the central role of the network of social organizations that is activated in the crisis. The quality and scope of assistance are heterogeneous between and within municipalities, depending not only on their volume but also on the articulation between different levels of management and particularly between these and social organizations

INTRODUCCIÓN el objetivo del estudio fue conocer el impacto de las medidas de aislamiento social obligatorio sobre las condiciones de vida de los barrios populares del conurbano bonaerense, así como la intervención estatal y las estrategias familiares y comunitarias que se despliegan en ese contexto. MÉTODOS se basa en dos relevamientos colaborativos sucesivos realizados por la Universidad Nacional de General Sarmiento, en los que se reunieron 80 y 129 entrevistas cortas a referentes territoriales y sanitarios, en la primera y tercera fases del aislamiento, respectivamente. RESULTADOS se registró un acatamiento medio y alto a las medidas, y se identificaron los factores que dificultan su cumplimiento total. Las problemáticas jerarquizadas por las y los referentes fueron: i) la discontinuidad de ingresos laborales de los hogares, ii) la dificultad de acceso a la alimentación básica, iii) la violencia de género al interior de los hogares, y iv) las restricciones en el acceso a los servicios de salud. DISCUSIÓN se destacan tanto la presencia del Estado, mediante la transferencia de ingresos monetarios y de asistencia alimentaria directa, como el papel central del entramado de organizaciones sociales que se activa en la crisis. La calidad y el alcance de la asistencia son heterogéneas entre los municipios y al interior de estos, y dependen no sólo de su volumen, sino también de la articulación entre distintos niveles de gestión y, sobre todo, entre estos y las organizaciones sociales.

Pandemia y desigualdad Los barrios populares del conurbano bonaerense en el aislamiento social preventivo y obligatorio / Pandemic and social inequiality: the popular neighborhoods of the Buenos Aires suburbs in preventive social isolation

INTRODUCCIÓN: el objetivo del estudio fue conocer el impacto de las medidas de aislamiento social obligatorio sobre las condiciones de vida de los barrios populares del conurbano bonaerense, así como la intervención estatal y las estrategias familiares y comunitarias que se despliegan en ese contexto. MÉTODOS: se basa en dos relevamientos colaborativos sucesivos realizados por la Universidad Nacional de General Sarmiento, en los que se reunieron 80 y 129 entrevistas cortas a referentes territoriales y sanitarios, en la primera y tercera fases del aislamiento, respectivamente. RESULTADOS: se registró un acatamiento medio y alto a las medidas, y se identificaron los factores que dificultan su cumplimiento total. Las problemáticas jerarquizadas por las y los referentes fueron: i) la discontinuidad de ingresos laborales de los hogares, ii) la dificultad de acceso a la alimentación básica, iii) la violencia de género al interior de los hogares, y iv) las restricciones en el acceso a los servicios de salud. DISCUSIÓN: se destacan tanto la presencia del Estado, mediante la transferencia de ingresos monetarios y de asistencia alimentaria directa, como el papel central del entramado de organizaciones sociales que se activa en la crisis. La calidad y el alcance de la asistencia son heterogéneas entre los municipios y al interior de estos, y dependen no sólo de su volumen, sino también de la articulación entre distintos niveles de gestión y, sobre todo, entre estos y las organizaciones sociales.

Vaginal residence and pharmacokinetic preclinical study of topical vaginal mucoadhesive W/S emulsions containing ciprofloxacin.

The aim of this work is to test the in vivo behavior of a mucoadhesive vaginal emulsion resistant to the clearance of vaginal fluids using ciprofloxacin (CPX) as an anti-infective model of drug. CPX is a broad-spectrum antibiotic used in the treatment of sexual tissues infections, as intravenous injection in a dose of 20 mg every 12 h. In this study, CPX was incorporated in water in silicone (W/S) mucoadhesive emulsions and the in vivo residence time and the CPX in vivo absorption and distribution to the sexual organs was studied using the rat as animal model. W/S emulsion shows excellent in vitro bioadhesion having high resistance to the vaginal fluids clearance. The drug release profiles show a constant release of CPX during at least 6 h according to a zero-order kinetics. In vivo computerized PET/CT Image Analysis after intravaginal administration to rats indicates that W/S emulsions remain in the vaginal area for a long time and shows a good absorption of the radiotracers used as markers through the vaginal mucosa. Ciprofloxacin pharmacokinetic studies developed after the single intravaginal administration of W/S emulsion shows a good absorption and distribution of CPX on the uterus and ovarian tissue. A significant concentration of CPX in the sexual tissues was observed after 24 h of administration of W/S emulsion. Therefore, W/S emulsions have a good in vivo residence and drug release in the vaginal mucosae showing a great potential for the treatment of sexual tissues infections, as vaginal bioadhesive delivery systems of antinfectious drugs.

Learning Task-Related Activities From Independent Local-Field-Potential Components Across Motor Cortex Layers.

Motor cortical microcircuits receive inputs from dispersed cortical and subcortical regions in behaving animals. However, how these inputs contribute to learning and execution of voluntary sequential motor behaviors remains elusive. Here, we analyzed the independent components extracted from the local field potential (LFP) activity recorded at multiple depths of rat motor cortex during reward-motivated movement to study their roles in motor learning. Because slow gamma (30-50 Hz), fast gamma (60-120 Hz), and theta (4-10 Hz) oscillations temporally coordinate task-relevant motor cortical activities, we first explored the behavioral state- and layer-dependent coordination of motor behavior in these frequency ranges. Consistent with previous findings, oscillations in the slow and fast gamma bands dominated during distinct movement states, i.e., preparation and execution states, respectively. However, we identified a novel independent component that dominantly appeared in deep cortical layers and exhibited enhanced slow gamma activity during the execution state. Then, we used the four major independent components to train a recurrent network model for the same lever movements as the rats performed. We show that the independent components differently contribute to the formation of various task-related activities, but they also play overlapping roles in motor learning.

The right hippocampus leads the bilateral integration of gamma-parsed lateralized information.

It is unclear whether the two hippocampal lobes convey similar or different activities and how they cooperate. Spatial discrimination of electric fields in anesthetized rats allowed us to compare the pathway-specific field potentials corresponding to the gamma-paced CA3 output (CA1 Schaffer potentials) and CA3 somatic inhibition within and between sides. Bilateral excitatory Schaffer gamma waves are generally larger and lead from the right hemisphere with only moderate covariation of amplitude, and drive CA1 pyramidal units more strongly than unilateral waves. CA3 waves lock to the ipsilateral Schaffer potentials, although bilateral coherence was weak. Notably, Schaffer activity may run laterally, as seen after the disruption of the connecting pathways. Thus, asymmetric operations promote the entrainment of CA3-autonomous gamma oscillators bilaterally, synchronizing lateralized gamma strings to converge optimally on CA1 targets. The findings support the view that interhippocampal connections integrate different aspects of information that flow through the left and right lobes.

Diversity of LFPs Activated in Different Target Regions by a Common CA3 Input.

Identifying the pathways contributing to local field potential (LFP) events and oscillations is essential to determine whether synchronous interregional patterns indicate functional connectivity. Here, we studied experimentally and numerically how different target structures receiving input from a common population shape their LFPs. We focused on the bilateral CA3 that sends gamma-paced excitatory packages to the bilateral CA1, the lateral septum, and itself (recurrent input). The CA3-specific contribution was isolated from multisite LFPs in target regions using spatial discrimination techniques. We found strong modulation of LFPs by target-specific features, including the morphology and population arrangement of cells, the timing of CA3 inputs, volume conduction from nearby targets, and co-activated inhibition. Jointly they greatly affect the LFP amplitude, profile, and frequency characteristics. For instance, ipsilateral (Schaffer) LFPs occluded contralateral ones, and septal LFPs arise mostly from remote sources while local contribution from CA3 input was minor. In the CA3 itself, gamma waves have dual origin from local networks: in-phase excitatory and nearly antiphase inhibitory. Also, waves may have different duration and varying phase in different targets. These results indicate that to explore the cellular basis of LFPs and the functional connectivity between structures, besides identifying the origin population/s, target modifiers should be considered.

Learning improvement after PI3K activation correlates with de novo formation of functional small spines.

PI3K activation promotes the formation of synaptic contacts and dendritic spines, morphological features of glutamatergic synapses that are commonly known to be related to learning processes. In this report, we show that in vivo administration of a peptide that activates the PI3K signaling pathway increases spine density in the rat hippocampus and enhances the animals' cognitive abilities, while in vivo electrophysiological recordings show that PI3K activation results in synaptic enhancement of Schaffer and stratum lacunosum moleculare inputs. Morphological characterization of the spines reveals that subjecting the animals to contextual fear-conditioning training per se promotes the formation of large spines, while PI3K activation reverts this effect and favors a general change toward small head areas. Studies using hippocampal neuronal cultures show that the PI3K spinogenic process is NMDA-dependent and activity-independent. In culture, PI3K activation was followed by mRNA upregulation of glutamate receptor subunits and of the immediate-early gene Arc. Time-lapse studies confirmed the ability of PI3K to induce the formation of small spines. Finally, we demonstrate that the spinogenic effect of PI3K can be induced in the presence of neurodegeneration, such as in the Tg2576 Alzheimer's mouse model. These findings highlight that the PI3K pathway is an important regulator of neuronal connectivity and stress the relationship between spine size and learning processes.

Determining the true polarity and amplitude of synaptic currents underlying gamma oscillations of local field potentials.

Fluctuations in successive waves of oscillatory local field potentials (LFPs) reflect the ongoing processing of neuron populations. However, their amplitude, polarity and synaptic origin are uncertain due to the blending of electric fields produced by multiple converging inputs, and the lack of a baseline in standard AC-coupled recordings. Consequently, the estimation of underlying currents by laminar analysis yields spurious sequences of inward and outward currents. We devised a combined analytical/experimental approach that is suitable to study laminated structures. The approach was essayed on an experimental oscillatory LFP as the Schaffer-CA1 gamma input in anesthetized rats, and it was verified by parallel processing of model LFPs obtained through a realistic CA1 aggregate of compartmental units. This approach requires laminar LFP recordings and the isolation of the oscillatory input from other converging pathways, which was achieved through an independent component analysis. It also allows the spatial and temporal components of pathway-specific LFPs to be separated. While reconstructed Schaffer-specific LFPs still show spurious inward/outward current sequences, these were clearly stratified into distinct subcellular domains. These spatial bands guided the localized delivery of neurotransmitter blockers in experiments. As expected, only Glutamate but not GABA blockers abolished Schaffer LFPs when applied to the active but not passive subcellular domains of pyramidal cells. The known chemical nature of the oscillatory LFP allowed an empirical offset of the temporal component of Schaffer LFPs, such that following reconstruction they yield only sinks or sources at the appropriate sites. In terms of number and polarity, some waves increased and others decreased proportional to the concomitant inputs in native multisynaptic LFPs. Interestingly, the processing also retrieved the initiation time for each wave, which can be used to discriminate afferent from postsynaptic cells in standard spike-phase correlations. The applicability of this approach to other pathways and structures is discussed.

Long-term changes in pulmonary function after incidental lung irradiation for breast cancer: a prospective study with 7-year follow-up.

PURPOSE: To evaluate late pulmonary function changes after incidental pulmonary irradiation for breast cancer. METHODS AND MATERIALS: Forty-three consecutive female patients diagnosed with breast carcinoma and treated with postoperative radiation therapy (RT) at the same dose (50 Gy) and fractionation (2 Gy/fraction, 5 days/week) were enrolled. Pulmonary function tests (PFT) and ventilation/perfusion scans were performed before RT and 6, 12, 24, and 84 months afterward. RESULTS: Forty-one patients, mean age 55 years, were eligible for the analysis. No differences were found in the baseline PFT values for age, smoking status and previous chemotherapy; women undergoing mastectomy showed baseline spirometric PFT values lower than did women treated with conservative surgery. The mean pulmonary dose was 10.9 Gy, being higher in women who also received lymph node RT (15.8 vs 8.6, P<.01). Only 1 patient experienced symptomatic pneumonitis. All PFT values showed a reduction at 6 months. From then on, the forced vital capacity and forced expiratory volume in 1 second began their recovery until reaching, and even exceeding, their baseline values at 7 years. Diffusing capacity of the lungs for carbon monoxide and ventilation/perfusion scans continued to reduce for 24 months and then partially recovered their baseline values (-3.5%, -3.8%, and -5.5%, respectively). Only the percentage difference at 7 years in the ventilation scan correlated with the dosimetric parameters studied. Other variables, such as age, smoking status, previous chemotherapy, and concomitant tamoxifen showed no significant relation with changes in PFT (ΔPFT) values at 7 years. CONCLUSIONS: The study of reproducible subclinical parameters, such as PFT values, shows how their figures decrease in the first 2 years but practically recover their baseline values in the long term. The extent of the reduction in PFT values was small, and there was no clear association with several dosimetric and clinical parameters.

Chestnut shell as heavy metal adsorbent: optimization study of lead, copper and zinc cations removal.

The influence of initial cation concentration, temperature and pH was investigated to optimize Pb(2+), Cu(2+) and Zn(2+) removal from aqueous solutions using acid formaldehyde pre-treated chestnut shell as adsorbent. Experiments were planned according to an incomplete 3(3) factorial experimental design. Under the optimal conditions selected, the metal ion adsorption equilibrium was satisfactorily described by the Langmuir isotherm model. The maximum pre-treated chestnut shell adsorption capacity was obtained for Pb(2+) ions, 8.5 mg g(-1), and the order of cation affinity was Pb(2+)>Cu(2+)>Zn(2+). A model that considered the effect of axial dispersion was successfully used to describe the fixed-bed adsorption behaviour of Pb(2+), Cu(2+) and Zn(2+) ions at the flow rates essayed. Fourier transform infrared (FTIR) and X-ray photoelectron (XPS) spectroscopies showed that the functional groups involved in metal ions binding included carboxyl, hydroxyl, ether, alcoholic and amino groups.

End-stage renal disease and hepatitis C infection: comparison of alanine aminotransferase levels and liver histology in patients with and without renal damage.

BACKGROUND AND AIM: To what extent the serum levels of alanine aminotransferase (ALT) are related to histological characteristics of liver damage caused by hepatitis C virus (HCV) infection among patients with end-stage renal disease (ESRD) remains unclear. METHODS: Patients with a positive anti-HCV antibody titer confirmed by supplemental tests were evaluated by liver biopsy. We compared ALT levels in patients with and without renal damage, with similar histological grades and stages of inflammation and fibrosis. Results: Patients were divided into two groups: patients with ESRD (n = 25) and patients without ESRD renal damage (n = 39). RESULTS: The ALT level was 42.1 +/- 24.3 IU/L for the ESRD group, compared with 109.9 +/- 55.8 IU/L for the non-ESRD group (P < 0.001). Liver inflammation (modified Knodell grade) was 4.0 +/- 2.1 in the ESRD group versus 5.2 +/- 2.4 in the non- ESRD group; fibrosis (6-point scale) was 1.1 +/- 1.2 versus 1.7 +/- 1.5, respectively. CONCLUSIONS: Despite histological evidence of liver inflammation, ALT levels in the ESRD group were normal, while ALT levels were significantly higher in the non-ESRD group with similar levels of liver inflammation. In conclusion, ALT levels are not a useful indicator of HCV infection in patients with ESRD and liver biopsies should be recommended for kidney transplant candidates.

Clinicopathologic study of 275 cases of gastrointestinal stromal tumors: the experience at 3 large medical centers in Mexico.

It is important to distinguish gastrointestinal (GI) stromal tumors (GISTs) from other GI mesenchymal tumors (GIMTs) because of the availability of molecular-targeted therapy for GISTs. The aim of the study was to reclassify GIMTs and to determine the clinicopathologic features of GISTs in Mexico. Cases of GIMT identified from the database of 3 large diagnostic centers in Mexico between 1995 and 2004 were reclassified according to current criteria. Hematoxylin and eosin-stained sections and clinical histories were reviewed, and immunohistochemistry was performed using anti-CD117, CD34, smooth muscle actin, and S-100 protein. A total of 275 GISTs were identified. The tumors were located in the stomach (40%), small intestine (35%), colorectum (12%), abdominal cavity (11%), and esophagus (2%). There were equal numbers of men and women with a mean age at diagnosis of 61 years. The tumors ranged in size from 3.5 to 34 cm (mean, 9.1 cm); 95 tumors (34%) were larger than 10 cm. Colorectal and omental tumors were the largest. The cell types included pure spindle (68%), pure epithelioid (16%), and mixed epithelioid/spindle (14%). Whereas 17.8% of tumors were regarded as low risk, 43% of tumors were in the high-risk category. CD117 positivity was detected in most of the tumors (96%). In addition to CD117, 255 cases (92%) were positive for CD34, 82 cases (32%) were positive for smooth muscle actin, and 13 cases (4.7%) were positive for desmin. Gastrointestinal stromal tumors in Mexico have the same clinicopathologic and immunohistochemical features as those reported in other countries. It is not always easy to distinguish GISTs from other soft tissue lesions. The diagnosis can be difficult even for experienced pathologists.

Artroplastia de rodilla postosteotomia: revision casuistica banco de protesis 1986-2001 / Total knee replacement after osteotomy: revision between 1986 to 2001

Introduccion: Las artroplastias postosteotomia son cirugias de mayor complejidad, por presentar cicatrices previas, defectos oseos y un aparato extensor modificado. Material y metodos: Se evaluaron 2630 artroplastias entre 1986 y 2001 (6 por ciento de las cirugias). Valguizantes 142 y varizantes 11,6. Seguimiento promedio de 5,3 años. Se realizo evaluacion con protocolo y rx, utilizando el score del Hospital for Special Surgery (HSS). Resultados: El tiempo promedio de sobrevida de las osteotomias fue de 8 años, en un rango de 1 a 30 años. Se realizo, Snip de Insall en 26 casos y osteotomia de Whiteside en 3 casos; 1 alargamiento y 1 liberacion de cuadriceps. El 6,5 por ciento de las cirugias requirio protesis especiales. 78 casos tenian un HSS preoperatorio malo, 68 regular y 4 buenos. 103 casos mostraron un HSS postoperatorio excelente, 28 buenos, 3 regulares y 9 malos. Complicaciones: 11 por ciento, 9 casos de infeccion profunda (5,8 por ciento), 1 aguda y 8 tardias. Necrosis de piel y dificultad de cicatrizacion, 2 casos (1,3 por ciento). Desinsercion tendon rotuliano, 2 casos (1,3 por ciento). Falsa ruta, 2 casos (1,3 por ciento). Aflojamiento aseptico, 2 casos (1,3 por ciento). Conclusiones: Indice de complicaciones similar a las cirugias de revision. Se debe realizar una incision apropiada, asi como elegir el tipo de osteotomia osea a realizar, teniendo en mente la futura eventual artroplastia.(AU)

Artroplastia de rodilla postosteotomia: revision casuistica banco de protesis 1986-2001 / Total knee replacement after osteotomy: revision between 1986 to 2001

Introduccion: Las artroplastias postosteotomia son cirugias de mayor complejidad, por presentar cicatrices previas, defectos oseos y un aparato extensor modificado. Material y metodos: Se evaluaron 2630 artroplastias entre 1986 y 2001 (6 por ciento de las cirugias). Valguizantes 142 y varizantes 11,6. Seguimiento promedio de 5,3 años. Se realizo evaluacion con protocolo y rx, utilizando el score del Hospital for Special Surgery (HSS). Resultados: El tiempo promedio de sobrevida de las osteotomias fue de 8 años, en un rango de 1 a 30 años. Se realizo, Snip de Insall en 26 casos y osteotomia de Whiteside en 3 casos; 1 alargamiento y 1 liberacion de cuadriceps. El 6,5 por ciento de las cirugias requirio protesis especiales. 78 casos tenian un HSS preoperatorio malo, 68 regular y 4 buenos. 103 casos mostraron un HSS postoperatorio excelente, 28 buenos, 3 regulares y 9 malos. Complicaciones: 11 por ciento, 9 casos de infeccion profunda (5,8 por ciento), 1 aguda y 8 tardias. Necrosis de piel y dificultad de cicatrizacion, 2 casos (1,3 por ciento). Desinsercion tendon rotuliano, 2 casos (1,3 por ciento). Falsa ruta, 2 casos (1,3 por ciento). Aflojamiento aseptico, 2 casos (1,3 por ciento). Conclusiones: Indice de complicaciones similar a las cirugias de revision. Se debe realizar una incision apropiada, asi como elegir el tipo de osteotomia osea a realizar, teniendo en mente la futura eventual artroplastia

Artroplastia de rodilla postosteotomia: revision casuistica banco de protesis 1986-2001 / Total knee replacement after osteotomy: revision between 1986 to 2001

Introduccion: Las artroplastias postosteotomia son cirugias de mayor complejidad, por presentar cicatrices previas, defectos oseos y un aparato extensor modificado. Material y metodos: Se evaluaron 2630 artroplastias entre 1986 y 2001 (6 por ciento de las cirugias). Valguizantes 142 y varizantes 11,6. Seguimiento promedio de 5,3 años. Se realizo evaluacion con protocolo y rx, utilizando el score del Hospital for Special Surgery (HSS). Resultados: El tiempo promedio de sobrevida de las osteotomias fue de 8 años, en un rango de 1 a 30 años. Se realizo, Snip de Insall en 26 casos y osteotomia de Whiteside en 3 casos; 1 alargamiento y 1 liberacion de cuadriceps. El 6,5 por ciento de las cirugias requirio protesis especiales. 78 casos tenian un HSS preoperatorio malo, 68 regular y 4 buenos. 103 casos mostraron un HSS postoperatorio excelente, 28 buenos, 3 regulares y 9 malos. Complicaciones: 11 por ciento, 9 casos de infeccion profunda (5,8 por ciento), 1 aguda y 8 tardias. Necrosis de piel y dificultad de cicatrizacion, 2 casos (1,3 por ciento). Desinsercion tendon rotuliano, 2 casos (1,3 por ciento). Falsa ruta, 2 casos (1,3 por ciento). Aflojamiento aseptico, 2 casos (1,3 por ciento). Conclusiones: Indice de complicaciones similar a las cirugias de revision. Se debe realizar una incision apropiada, asi como elegir el tipo de osteotomia osea a realizar, teniendo en mente la futura eventual artroplastia.

Changes in pulmonary function after incidental lung irradiation for breast cancer: A prospective study.

PURPOSE: The aim of this study was to analyze changes in pulmonary function after radiation therapy (RT) for breast cancer. METHODS AND MATERIALS: A total of 39 consecutive eligible women, who underwent postoperative irradiation for breast cancer, were entered in the study. Spirometry consisting of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), carbon monoxide diffusing capacity (DLCO), and gammagraphic (ventilation and perfusion) pulmonary function tests (PFT) were performed before RT and 6, 12, and 36 months afterwards. Dose-volume and perfusion-weighted parameters were obtained from 3D dose planning: Percentage of lung volume receiving more than a threshold dose (Vi) and between 2 dose levels (V(i-j)). The impact of clinical and dosimetric parameters on PFT changes (Delta PFT) after RT was evaluated by Pearson correlation coefficients and stepwise lineal regression analysis. RESULTS: No significant differences on mean PFT basal values (before RT) with respect to age, smoking, or previous chemotherapy (CT) were found. All the PFT decreased at 6 to 12 months. Furthermore FVC, FEV(1), and ventilation recovered almost to their previous values, whereas DLCO and perfusion continued to decrease until 36 months (-3.3% and -6.6%, respectively). Perfusion-weighted and interval-scaled dose-volume parameters (pV(i-j)) showed better correlation with Delta PFT (only Delta perfusion reached statistically significance at 36 months). Multivariate analysis showed a significant relation between pV(10-20) and Delta perfusion at 3 years, with a multiple correlation coefficient of 0.48. There were no significant differences related to age, previous chemotherapy, concurrent tamoxifen and smoking, although a tendency toward more perfusion reduction in older and nonsmoker patients was seen. CONCLUSIONS: Changes in FVC, FEV1 and ventilation were reversible, but not the perfusion and DLCO. We have not found a conclusive mathematical predictive model, provided that the best model only explained 48% of the variability. We suggest the use of dose-perfused volume and interval-scaled parameters (i.e., pV(10-20)) for further studies.