Lesión vascular durante cirugía discal. Caso clínico y revisión de la literatura / Vascular injury during intervertebral surgery. Case report and review of the literature

Las lesiones viscerales (intestinales y ureterales) y vasculares durante la cirugía discal son infrecuentes por lo que, en ocasiones, se omiten en los protocolos de consentimiento informado. Sin embargo, estas lesiones son potencialmente muy graves y tienen un alto porcentaje de mortalidad. A pesar de su rareza, los anestesistas y cirujanos deben tenerlas en cuenta, ya que, en el caso de presentarse, un diagnóstico precoz resulta de vital importancia. Normalmente, los pacientes que logran sobrevivir presentan una recuperación completa sin secuelas de ningún tipo. Se presenta un caso clínico de una rotura de arteria y vena ilíaca común derechas producidas en el transcurso de una discectomía L4-L5 por vía posterior, que requirieron dos intervenciones vasculares. En los meses siguientes la paciente presentó como secuela una plexopatía lumbosacra que afectó a una extremidad y de la que se recuperó parcialmente (AU)

Introduction Visceral (intestinal, uretheral) and vascular damage during intervertebral disk surgery is uncommon; therefore sometimes is excluded of informed consents; however those damages, are potentially life-threatening with high risk of mortality; hence, in spite of their rarity, anaesthetists and surgeons should be watchful since in case of showing up, early diagnosis is vitally important. Usually, patients who survived restore completely without sequels. Clinical case A clinical case of common right iliac artery and vein disruption during posterior L4-L5 discectomy is here discussed. The patient required two vascular interventions. After the surgeries the patient presented a postoperative lower extremity neurologic deficit due to a lumbosacral plexopathy from which she partially recovered during the following months (AU)

[Classification of osteoporosis. Risk factors. Clinical manifestations and differential diagnosis]. / Clasificación de la osteoporosis. Factores de riesgo. Clínica y diagnóstico.

The fact that there are multiple factors that can intervene in the ethiopathology of osteoporosis, together with its scarce clinical expression until complications -fractures- are produced, poses a practical problem in medical practice when it comes to identifying those persons at risk of osteoporosis. These aspects, together with the difficulties in obtaining access to a complementary test that would confirm the diagnosis and the overload of tasks in our clinic, mean that the disease often passes unnoticed. Hence, in the section on diagnostic orientation of osteoporosis we attempt to clarify and give cohesion to this approach, offering highly useful guidelines for suspecting the presence of the disease and patterns of action that will make it possible to diagnose in a more efficient and accurate way

Medicina basada en la evidencia y rehabilitación / Evidence based medicine and rehabilitation

La evaluación económica de las tecnologías sanitarias se está convirtiendo en una prioridad para los sistemas de salud. Es una de las razones por las que la llamada Medicina Basada en la Evidencia está en plena actualidad y tiene una importancia cada vez mayor. En este trabajo se aborda el problema del estudio de la literatura científica. La obtención de evidencias resulta en muchas ocasiones complicado debido a la ingente cantidad de ensayos clínicos, a las limitaciones de las principales bases de datos, etc., por lo que el médico recibe muchas veces resultados contradictorios. Actualmente las revisiones sistemáticas (como las realizadas por la Colaboración Internacional Cochrane) están aportando los más altos niveles de evidencias sobre la eficacia de regímenes preventivos, terapéuticos y rehabilitadores, pudiendo proporcionar al médico rehabilitador que lo desee una guía de extraordinaria utilidad. Aunque asumiendo sus imperfecciones, la Medicina Basada en la Evidencia, junto con la experiencia y conocimientos clínicos del médico, puede llevar a una mejor, más racional y estimulante práctica de la medicina aunando los intereses colectivos con los individuales. (AU)

Bioconcentration of the insecticide pyridaphenthion by the green algae Chlorella saccharophila.

A study was undertaken to examine the uptake of the organophosphate insecticide pyridaphenthion in the chlorophyta Chlorella saccharophila. Algae cultures were exposed to the initial nominal concentration 10.0 mg l(-1) pyridaphention during seven days. The insecticide bioconcentrates in the biomass to the highest level of 441.5 +/- 25.9 mg kg(-1) on the fifth day of exposure and was followed by a decrease to 76.6 +/- 5.1 mg kg(-1) on the seventh day. A model was constructed to describe the dynamic process, which estimated a bioconcentration factor (BCF) equal to 28. The study demonstrates the potential of accumulation of pyridaphenthion in aquatic organisms and helps to expand the pyridaphenthion toxicity database. The replacement of fenitrothion by pyridaphenthion concerning their use in rice flooded cultures is discussed.

Endocrine and metabolic abnormalities involved in obesity associated with typical antipsychotic drug administration.

In this study, the authors assessed the endocrine system and glucose tolerance in obese and non-obese women chronically treated with typical antipsychotic drugs (AP). In particular, we tested the hypotheses that these subjects display hypogonadism and increased insulin resistance compared to healthy weight-matched controls, as these abnormalities create a tendency towards excessive body weight gain. Twenty-six AP-treated women were matched with 26 healthy women by age, body mass index and day of the menstrual cycle. The following serum variables were evaluated in each subject: glucose tolerance after an oral glucose overload, insulin, leptin, beta-endorphin, reproductive hormones, adrenal steroids and lipids. Compared to controls, AP-treated women displayed significantly higher levels of basal glucose, insulin after 60 min of the glucose overload, prolactin, thyroid stimulating hormone and beta-endorphin, with lower levels of C-Peptide, progesterone, 17-OH progesterone, androstenedione and high-density lipoprotein cholesterol. The levels of estradiol, estrone and leptin did not differ between the groups. Thus, women treated with typical AP appeared to display more insulin resistance than healthy controls, predisposing them to excessive weight gain. Insulin sensitivity might be further impaired when the subject switches to atypical AP administration. Metformin and related agents may reduce body weight in these subjects. The high levels of the opiate beta-endorphin suggest that opiate antagonists such as naloxone and naltrexone might be useful as well. Even though the luteal phase of the menstrual cycle appears to be severely disturbed, the normal serum levels of estradiol and estrone do not support the proposal derived from animal experimental studies about the use of estrogens or tamoxifen to counteract AP-induced obesity.

Body weight gain after administration of antipsychotic drugs: correlation with leptin, insulin and reproductive hormones.

Excessive body weight gain, hyperprolactinemia and low gonadal steroid serum levels are often observed during chronic administration of antipsychotic drugs (AP). Clinical and experimental findings suggest that leptin, the peptidic hormone involved in long-term body weight regulation, and reproductive hormones are interrelated. Therefore, we assessed circulating leptin levels in healthy, lean women (n = 12) and men (n = 7) before and after short-term administration of the AP sulpiride (SUL, 200 mg/day). In addition, we studied psychotic obese (n = 9) and lean women (n = 13) under chronic treatment with diverse AP. No significant weight changes were observed after SUL administration in healthy women--initial weight: 54.9+/-2.6 Kg; final weight: 55.04+/-2.6, NS. Leptin levels did not change either: 11.9+/-1.5 ng/ml. vs. 10.6+/-1.3, NS. By contrast, a small, but significant weight gain was found in SUL-treated men--60.6+/-1.9 Kg. vs. 61.3+/-2.1, p = 0.004. Leptin and insulin levels were significantly higher after SUL administration--leptin: 2.77+/-0.22 ng/ml. vs. 13.9+/-2.5, p=0.035; insulin: 3.59+/-0.17 mIU/ml vs. 8.81+/-0.81, p = 0.0001. In these subjects, leptin levels positively correlated with body weight change (p = 0.006), and serum prolactin change (p = 0.001). Obese psychotic women (Body Mass Index, BMI, Kg/m2 = 31.5+/-1.03) displayed higher leptin levels than non-obese psychotic women (BMI = 25.5+/-0.52): 26.8+/-4.8, vs. 12.8+/-3.4 ng/ml, p = 0.006. In these women, a significant positive correlation was found between leptin levels and BMI (p = 0.0001), and between leptin and basal insulin levels (p = 0.001). These results show that the expected circulating leptin elevation which is observed when body weight raises, is preserved in people treated with AP drugs.

MPB64 mycobacterial antigen: a new skin-test reagent through patch method for rapid diagnosis of active tuberculosis.

SETTING: A collaborative study between the Japan BCG Laboratory, Tokyo, Japan, and the Infectious Disease Section, Philippine General Hospital, Manila, the Philippines. Tuberculosis patients from four clinics in the vicinity of Manila, Our Lady of Grace Parish, Sto. Niño de Tondo Parish, the Canossa Health and Social Center, and the Health Care Development Center, were examined. OBJECTIVE: To develop a new, simple and rapid diagnostic method for active tuberculosis. Subjects were tested for skin reaction to a special antigen, MPB64, by the patch test method instead of intradermal injection of purified protein derivative (PPD). DESIGN: Fifty-three active tuberculosis patients and 43 healthy PPD-positive controls were tested to determine whether or not the reaction to MPB64 was positive only in active tuberculosis patients. RESULTS: Fifty-two of the 53 active tuberculosis patients showed a positive reaction to MPB64, while none of the 43 PPD-positive controls did. The specificity of MPB64 to active tuberculosis was 100%, and the sensitivity was 98.1%. The efficacy of the test was 98.9%. CONCLUSION: The patch test with MPB64 is a promising method for the diagnosis of active tuberculosis, distinguishing tuberculous patients from those who are infected but have not developed the disease, and also from BCG-vaccinated individuals. This new skin test is a subject for further evaluation and it is important to compare the results with PPD Mantoux.

Nature of drug resistance and predictors of multidrug-resistant tuberculosis among patients seen at the Philippine General Hospital, Manila, Philippines.

SETTING: This study was conducted at the University of the Philippines--Philippine General Hospital (UP-PGH), Manila, Philippines. OBJECTIVES: To determine the nature of drug resistance among patients with pulmonary tuberculosis (PTB), and to establish clinical predictors of drug-resistant tuberculosis. DESIGN: Descriptive, prospective study. METHODS: Patients with positive culture for Mycobacterium tuberculosis were interviewed regarding past history of anti-tuberculosis treatment, BCG vaccination, chest X-ray and family contact. M. tuberculosis isolates from 299 patients were tested for susceptibility to rifampicin, isoniazid (INH), ethambutol and streptomycin using the submerged disc proportion method. Pyrazinamide (PZA) susceptibility test was done with standard laboratory powder in 7H10 media. RESULTS: Of the 299 M. tuberculosis isolates, 17% were fully susceptible to the 5 primary drugs and 54% were resistant to 2 or more drugs (multidrug resistant TB [MDR-TB]). Initial drug resistance rate was high with ethambutol (39%) and INH (17%). Previous history of anti-tuberculosis treatment was significantly associated with MDR-TB (Odds Ratio [OR] 2.44, 95% confidence interval). Incomplete anti-TB treatment taken for longer than 3 months increased the likelihood of MDR-TB (OR 4.6, P < 0.0001). CONCLUSION: The high rate of MDR-TB was associated with previous anti-tuberculosis treatment. The chance of developing MDR-TB was significantly increased when inadequate prior treatment was given for more than 3 months.

Occurrence of infection with group B coxsackievirus in rheumatic and nonrheumatic Filipino children.

The pathogenesis of rheumatic fever has been linked to various immune mechanisms involving streptococcal antibodies and heart tissue antigens. Latent myocarditis due to group B coxsackievirus has also been considered as a possible conditioning factor. The validity of the role of infection with group B coxsackievirus in rheumatic fever was tested by determining the incidence of type-specific neutralizing antibodies in sera of Filipino children. Analysis of the results by means of a normal Z-test showed that the incidence in rheumatic children was not statistically significant in comparison to the incidence in asymptomatic children.