An expandable prosthesis with dual cage-and-plate function in a single device for vertebral body replacement: the clinical experience on 14 consecutive cases with vertebral tumors.

AIM: The aim of this paper was to test the hypothesis that an expandable prosthesis with dual cage-and-plate function can provide immediate and durable spine stabilization after corpectomy. METHODS: We designed an expandable vertebral body prosthesis with dual cage-and-plate function in a single device (JR-prosthesis). Anatomical studies were performed to design a titanium-made prosthesis. Cadaver assays were done with a stainless steal device to test fixation and adequacy to the human spine anatomy. Then, 14 patients with vertebral tumors (8 metastatic) underwent corpectomy and vertebral body replacement with the JR-prosthesis. RESULTS: All patients had neurological deficit, severe pain and spine instability (mean follow-up: 25.4 months). Mean pain score before surgery in a visual analog scale improved from 7.6 to 3.0 points after operation (P=0.002). All patients achieved at least one grade of improvement in the Frankel score (P=0.003), excepting the 3 patients with Frankel grade A presurgery. Two patients with renal cell carcinoma died during the following 4 days after surgery (renal failure and massive bleeding), the rest attained a painless and stable spine immediately and maintained for long periods. No significant infections or implant failures were registered. A non-fatal case of inferior vena cava surgical injury was observed (repaired during surgery without further complications). CONCLUSION: The JR-prosthesis stabilizes the spine immediately after surgery and for the rest of the patients' life. To our knowledge, this is the first report on the clinical experience of any expandable vertebral body prosthesis with dual cage-and-plate function in a single device. These observations await confirmation in different scenarios.

Transitory cognitive impairment in epileptic children during a CPT task.

EEGs and behavioral responses were studied in two sex matched groups of 58 epileptic and 20 healthy children between 8 and 12 years of age, during the execution of a go-no go CPT (X; A-X) task to determine transitory cognitive impairment (TCI) incidence. Paroxysmal discharges were found on 87.9% and 5% of the EEGs in the epileptic and control groups respectively, with no differences related to sex. The predominant EEG findings with respect to paroxysmal discharges were the association of two or more types of paroxysms with frequency higher than 5/minute, an average duration less than 0.5 second and topographical distribution over temporal-parietal-occipital areas without significant interhemispheric differences. TCI was detected in 36.2% of epileptic children. The epileptic group showed significantly higher numbers of behavioral errors and longer reaction times (RTs) in relation to the control group. Analyzing RTs on the two blocks of the task, linear discriminant analysis showed an acceptable classification of TCI incidence between groups.

[Effect of immunotherapy with allergens in asthmatic children with integral treatment]. / Efecto de la inmunoterapia con alergenos en niños asmáticos con tratamiento integral.

OBJECTIVE: To analyze the effect of the immunotherapy with allergens (ITA) in asthmatic pediatric patients with integral treatment. MATERIAL AND METHODS: We included children with allergic rhinitis and asthma to treatment in the Clinic of Asthma and Allergy. We made a monthly evaluation of symptoms and annual of laboratory tests. RESULTS: The results are described in averages, G1 followed by G2. They were 16 (12 M/4 F) and 17 (11 M/F) patients with ages of 6.1 +/- 2.8 and 6.2 +/- 2 years. They presented 1.2 +/- 0.5 and 1.3 +/- 0.5 crisis per month and also 4.9 +/- 3.4 and 4.8 +/- 3 hospitalizations per year. In all the treatment began with CGIDS in spray and in 8 and 7 BDP was also used. The use of b-agonists at home was bigger in G1: 3 +/- 2.1 vs 0.6 +/- 0.7 (p = 0.0004). Acute treatment in more occasions was granted in G1: 21 vs 2 (p < 0.0001). It was bigger the number of applications of CGIDS in G1: 30.1 +/- 5.3 vs 15.4 +/- 2.7 (p < 0.0001) and of immunotherapy with allergens 8.1 +/- 9.6 vs 5.1 +/- 6.4 (p = 0.1). CONCLUSIONS: The asthmatic pediatric patients on integral treatment present a bigger and quicker improvement of their rhinitic and asthmatic symptoms when they are also treated with specific IT, even from the beginning of the treatment, they also improve their general immunity and they present reduction of allergic markers. They also use less medications, they present less acute exacerbation's and less hospitalizations.

[Prevalence on acute asthma in children]. / Prevalencia de asma aguda en niños.

OBJECTIVE: In this descriptive study we considered age, sex, and admission's month of children under 15 years-old admitted to the emergency room for acute asthma between January 94 to july 95. MATERIAL AND METHOD: There were 594 boys and 421 girls. Male to female mean ratio was 1.4:1. We found a greater and significative admission's number in boys than in girls (x2: p < 0.001). Odds ratio was greater in boys. 1.18 (CI 95%: 1.04-1.35) than in girls, 0.85 (CI 95%: 0.750.96). RESULTS: The acute asthma admissions monthly trend was in third place (median) and second place (mode) when compared with other children's admission diagnoses. Total monthly admissions amount did not show a significative differences when compared the first seven months of 1994 and 1995 (Mann-Whitney's U: p > 0.05). CONCLUSIONS: The acute asthma admissions are currently predominant in boys over girls, and that bronchial asthma is one of the more frequent emergency admission's causes in children.

[Vestibular and oculomotor disorders in patients with congenital strabismus]. / Alteraciones vestibulares y oculomotoras en pacientes con estrabismo congénito.

A group of patients with congenital endotropia or exotropia was investigated in their capacity to perform reflex eye movements. Some patients had a successful surgical correction of their eye defect. The functions measured were the vestibulo-oculomotor reflex, the feedback control loop for searching and following eye movements and the optomotor reflex. A loss in the functional capacity was displayed in all the tests done. The average value of the losses found for the whole group, according to the test used, were from 8 to 27% for the vestibulo-oculomotor reflex; 22 to 42% for the eye tracking feedback loop, and 48% for the optomotor reflex. The deficit was not due to the incorrect eye position, because the successfully operated subjects had the same magnitude of the motor defect than the non-operated patients.