¿Se puede predecir el pronóstico de la cadera contralateral tras una artroplastia total de cadera? / Prognosis of the contralateral hip after primary total hip replacement: Can it be predicted?

Introducción: La coxartrosis es una de las patologías más frecuentes e incapacitantes. El 20% de los mayores de 60 años desarrollará coxartrosis sintomática y el 10% requerirá una prótesis total de cadera. La artroplastia total de cadera es uno de los procedimientos quirúrgicos que más aumenta la calidad de vida de estos pacientes. Cuando recomendamos la artroplastia en la práctica clínica, los pacientes a menudo preguntan sobre el pronóstico de su otra cadera: ¿Se deteriorará de la misma forma? ¿Será necesario operarla? ¿Cuándo? El objetivo es determinar si existe alguna variable o signo radiológico que prediga el pronóstico a medio plazo de la cadera contralateral tras una artroplastia total de cadera. Material y métodos: Se realizó un estudio retrospectivo de pacientes intervenidos de artroplastia total de cadera en nuestro hospital durante los años 2011 y 2012, con un total de 543 pacientes. Se determinó el grado de coxartrosis, según las clasificaciones JOA y Tönnis, en la radiografía de ambas caderas en el momento de la primera artroplastia y a intervalos regulares durante el seguimiento, analizando cada uno de los ítems incluidos en estas clasificaciones. Se estableció la relación de estos hallazgos radiográficos con la progresión de la artrosis y la necesidad de artroplastia contralateral. Resultados y conclusiones: Podría esperarse una progresión de la artrosis de la cadera contralateral en los próximos 3 años en el 10% de los pacientes. Esta progresión será mayor y más rápida en aquellos con grado JOA III-IV/Tönnis II-III y, especialmente, en aquellos con mayor estrechamiento articular y mayor alteración de la cabeza femoral, pudiendo alcanzar entre el 25 y el 30% de los pacientes. El grado de JOA/Tönnis inicial es un factor predictor de necesitar una prótesis de cadera contralateral.

Introduction: Coxarthrosis is one of the most frequent and disabling pathologies. 20% of individuals over 60 years of age will develop symptomatic coxarthrosis and 10% of them will need a hip replacement; it is probably one of the orthopaedic procedures that most increases quality of life. When we recommend arthroplasty in clinical practice, patients often ask about the prognosis of their other hip. Will it deteriorate in the same way? Will it be necessary to replace it? When? The aim of the study is to determine if there is any variable or radiological sign that predicts the medium-term prognosis of the contralateral hip after total hip arthroplasty. Material and methods: A retrospective review of patients who underwent total hip arthroplasty in our hospital during 2011 and 2012 was carried out, with a total of 543 patients. The coxarthrosis degree at X-ray was determined at the time of the first arthroplasty and at regular intervals during follow-up, according to the JOA and Tönnis classifications, analyzing each of the items included in these classifications. Its relation with the progression of osteoarthritis and the need of contralateral hip replacement was established. Results and conclusions: A progression of osteoarthritis of the contralateral hip could be expected in the next 3 years in 10% of patients. This progression will be greater and faster in those with JOA grade III–IV/Tönnis grade II–III, especially, in those with greater joint narrowing and femoral head shape score, and can reach between 25 and 30% of patients. The initial JOA/Tönnis degree is a predictive factor for requiring a hip replacement on the contralateral side.(AU)

[Translated article] Prognosis of the contralateral hip after primary total hip replacement: Can it be predicted? / ¿Se puede predecir el pronóstico de la cadera contralateral tras una artroplastia total de cadera?

Introduction: Coxarthrosis is one of the most frequent and disabling pathologies. 20% of individuals over 60 years of age will develop symptomatic coxarthrosis and 10% of them will need a hip replacement; it is probably one of the orthopaedic procedures that most increases quality of life. When we recommend arthroplasty in clinical practice, patients often ask about the prognosis of their other hip. Will it deteriorate in the same way? Will it be necessary to replace it? When? The aim of the study is to determine if there is any variable or radiological sign that predicts the medium-term prognosis of the contralateral hip after total hip arthroplasty. Material and methods: A retrospective review of patients who underwent total hip arthroplasty in our hospital during 2011 and 2012 was carried out, with a total of 543 patients. The coxarthrosis degree at X-ray was determined at the time of the first arthroplasty and at regular intervals during follow-up, according to the JOA and Tönnis classifications, analyzing each of the items included in these classifications. Its relation with the progression of osteoarthritis and the need of contralateral hip replacement was established. Results and conclusions: A progression of osteoarthritis of the contralateral hip could be expected in the next 3 years in 10% of patients. This progression will be greater and faster in those with JOA grade III–IV/Tönnis grade II–III, especially, in those with greater joint narrowing and femoral head shape score, and can reach between 25 and 30% of patients. The initial JOA/Tönnis degree is a predictive factor for requiring a hip replacement on the contralateral side.(AU)

Introducción: La coxartrosis es una de las patologías más frecuentes e incapacitantes. El 20% de los mayores de 60 años desarrollará coxartrosis sintomática y el 10% requerirá una prótesis total de cadera. La artroplastia total de cadera es uno de los procedimientos quirúrgicos que más aumenta la calidad de vida de estos pacientes. Cuando recomendamos la artroplastia en la práctica clínica, los pacientes a menudo preguntan sobre el pronóstico de su otra cadera: ¿Se deteriorará de la misma forma? ¿Será necesario operarla? ¿Cuándo? El objetivo es determinar si existe alguna variable o signo radiológico que prediga el pronóstico a medio plazo de la cadera contralateral tras una artroplastia total de cadera. Material y métodos: Se realizó un estudio retrospectivo de pacientes intervenidos de artroplastia total de cadera en nuestro hospital durante los años 2011 y 2012, con un total de 543 pacientes. Se determinó el grado de coxartrosis, según las clasificaciones JOA y Tönnis, en la radiografía de ambas caderas en el momento de la primera artroplastia y a intervalos regulares durante el seguimiento, analizando cada uno de los ítems incluidos en estas clasificaciones. Se estableció la relación de estos hallazgos radiográficos con la progresión de la artrosis y la necesidad de artroplastia contralateral. Resultados y conclusiones: Podría esperarse una progresión de la artrosis de la cadera contralateral en los próximos 3 años en el 10% de los pacientes. Esta progresión será mayor y más rápida en aquellos con grado JOA III-IV/Tönnis II-III y, especialmente, en aquellos con mayor estrechamiento articular y mayor alteración de la cabeza femoral, pudiendo alcanzar entre el 25 y el 30% de los pacientes. El grado de JOA/Tönnis inicial es un factor predictor de necesitar una prótesis de cadera contralateral.

[Translated article] Prognosis of the contralateral hip after primary total hip replacement: Can it be predicted?

INTRODUCTION: Coxarthrosis is one of the most frequent and disabling pathologies. 20% of individuals over 60 years of age will develop symptomatic coxarthrosis and 10% of them will need a hip replacement; it is probably one of the orthopaedic procedures that most increases quality of life. When we recommend arthroplasty in clinical practice, patients often ask about the prognosis of their other hip. Will it deteriorate in the same way? Will it be necessary to replace it? When? The aim of the study is to determine if there is any variable or radiological sign that predicts the medium-term prognosis of the contralateral hip after total hip arthroplasty. MATERIAL AND METHODS: A retrospective review of patients who underwent total hip arthroplasty in our hospital during 2011 and 2012 was carried out, with a total of 543 patients. The coxarthrosis degree at X-ray was determined at the time of the first arthroplasty and at regular intervals during follow-up, according to the JOA and Tönnis classifications, analyzing each of the items included in these classifications. Its relation with the progression of osteoarthritis and the need of contralateral hip replacement was established. RESULTS AND CONCLUSIONS: A progression of osteoarthritis of the contralateral hip could be expected in the next 3 years in 10% of patients. This progression will be greater and faster in those with JOA grade III-IV/Tönnis grade II-III, especially, in those with greater joint narrowing and femoral head shape score, and can reach between 25 and 30% of patients. The initial JOA/Tönnis degree is a predictive factor for requiring a hip replacement on the contralateral side.

Prognosis of the contralateral hip after primary total hip replacement: Can it be predicted? / ¿Se puede predecir el pronóstico de la cadera contralateral tras una artroplastia total de cadera?

INTRODUCTION: Coxarthrosis is one of the most frequent and disabling pathologies. 20% of individuals over 60 years of age will develop symptomatic coxarthrosis and 10% of them will need a hip replacement; it is probably one of the orthopaedic procedures that most increases quality of life. When we recommend arthroplasty in clinical practice, patients often ask about the prognosis of their other hip. Will it deteriorate in the same way? Will it be necessary to replace it? When? The aim of the study is to determine if there is any variable or radiological sign that predicts the medium-term prognosis of the contralateral hip after total hip arthroplasty. MATERIAL AND METHODS: A retrospective review of patients who underwent total hip arthroplasty in our hospital during 2011 and 2012 was carried out, with a total of 543 patients. The coxarthrosis degree at X-ray was determined at the time of the first arthroplasty and at regular intervals during follow-up, according to the JOA and Tönnis classifications, analyzing each of the items included in these classifications. Its relation with the progression of osteoarthritis and the need of contralateral hip replacement was established. RESULTS AND CONCLUSIONS: A progression of osteoarthritis of the contralateral hip could be expected in the next 3 years in 10% of patients. This progression will be greater and faster in those with JOA grade III-IV/Tönnis grade II-III, especially, in those with greater joint narrowing and femoral head shape score, and can reach between 25 and 30% of patients. The initial JOA/Tönnis degree is a predictive factor for requiring a hip replacement on the contralateral side.

Effects of repeated electroejaculations on kinematic sperm subpopulations and quality markers of Mexican creole goats.

Here we show the effects of repeated electroejaculation (EE) on mean values of motility, mitochondrial functionality, and expression of active caspases on goat sperm obtained by EE. Evaluations were done using CASA and flow cytometry. A strategy for identification of kinematic sperm subpopulations, when individual data of sperm are not provided by the CASA system, is provided. Fifty semen samples, five of each of ten adult creole goats, were obtained by electroejaculation. Mean values of total motility, progressive motility and flow cytometry evaluations were compared among EEs. Relationships among mean values of variables were investigated using Spearman correlation and principal component analysis (PCA). For identification of kinematic sperm subpopulations, PCA followed by hierarchical clustering was applied on data of the intervals provided automatically by the CASA system. Total motility does no change after repeated EE. Mean values of motility parameters and molecular markers were unrelated in multivariate space, but bivariate correlations were found. Values in upper and lower intervals defined clearly the sperm subpopulations, which had motility parameters changing over time. Taken together, our results show that repeated EE does not affect mean values of total motility, that molecular markers are not related with motility parameters, and that it is possible to identify kinematic sperm subpopulations when individual data, of motility parameters, are not provided by the CASA system.

[Migraine: clinical features and disability in a rural population in Cuba]. / Migraña: características clínicas y discapacidad en una población rural cubana.

AIM: To identify the clinical-epidemiological features and the factors related to the presence of disability in patients with migraine. SUBJECTS AND METHODS: A cross-sectional study was conducted in a rural population at the Policlinica Mabay in the province of Granma, Cuba. The second International Headache Society classification was used. Sample size, which was calculated using the program EpiInfo 2002, was 360 adult workers over 18 years of age, who were selected by simple random sampling. RESULTS: Sixty-one respondents were diagnosed with migraine (prevalence: 16.9%; 95% CI = 13.3-21.31). Prevalence among females was 24.3% (CI 95% = 18.7-30.82) and 7.1% (CI 95% = 3.8-12.73) among males. Chronic migraine was the most frequent, with 25 cases (prevalence: 6.9%; CI 95% = 4.63-10.21), followed by migraine without aura, with 18 diagnoses (prevalence: 5%; CI 95% = 3.08-7.93). Frequency of headaches was greater in females (30.17 Y 12 days versus 23.45 Y 10 days; p = 0.041), as was their duration (19.87 Y 6.95 h versus 15.73 Y 5.58 h in males; p = 0.027). Minimal disability affected 24.6% of patients with migraine and 39.3% suffered moderate disability. Higher degrees of disability were associated to being female, the time elapsed since onset of the disease (21.04 Y 10.1 years versus 15.33 Y 7.5 years; p = 0.017), the frequency of headaches in the last three months (30.28 Y 10.1 days with headache versus 25.25 Y 8.5; p = 0.042), the duration of the headache (23.3 Y 15.24 h versus 12.38 Y 10.9 h; p = 0.002) and chronic migraine (p = 0.016). CONCLUSIONS: There is a great social and occupational burden of disability in patients with migraine in the geographical area under study, and females are affected by this condition to a greater extent.

[Prevalence of primary headaches in a rural population in Cuba]. / Prevalencia de cefaleas primarias en una población rural cubana.

AIM: To determine the prevalence and the clinical-epidemiological and therapeutic characteristics of primary headaches in a rural population in Cuba. SUBJECTS AND METHODS: A cross-sectional study was conducted in a rural population of the Policlinica Mabay in the province of Granma, Cuba. The second International Headache Society classification was used. Sample size, which was calculated by means of the program EpiInfo 2002, was 360 adult workers over 18 years of age, who were selected by simple random sampling. RESULTS: The prevalence of primary headaches was 44.72%. There was a predominance of females (71.4%). 31.1% of cases were between 50 and 59 years old. 36.6% had a family history of headaches. Onset of headaches occurred before the age of 15 years in 44.1% of patients. The most frequent location was occipital (45.3% of cases). The most frequent precipitating factors were stress (27.9%) and menstruation (27.3%). The predominant accompanying symptom was dizziness (26.1%). Tension-type headache was the most prevalent, with 92 patients (25.56%), followed by migraine, with 61 diagnoses (16.94%). 78.3% of the patients with tension-type headache and 70.5% of those with migraine tried self-medication with dipyrone and paracetamol. Patients with migraine made more frequent use of prophylactic treatment than those who suffered from tension-type headache (32.8% versus 16.3%; p = 0.01). CONCLUSIONS: The prevalence of primary headaches is high in the rural population under study; the high rate of prescription drug abuse (mainly painkillers and non-steroidal anti-inflammatory drugs) has led to a significant number of headaches becoming chronic. This health problem is also seen to have an important effect on occupational affairs.

[The epidemiology of headaches in hospitalised psychiatric patients]. / Epidemiología de la cefalea en pacientes psiquiátricos hospitalizados.

AIM: To determine the frequency and characteristics of the headaches suffered by hospitalised psychiatric patients. PATIENTS AND METHODS: A descriptive, retrospective study was conducted among the patients admitted to the National Psychiatric Hospital in Zimbabwe who required consultation in Internal Medicine due to headaches. The International Headache Society classification was used. Demographic data (age and sex), alarm signals (age of onset of headaches after the age of 50 years, thunderclap headache, persistent unilateral location, presence of febrile symptoms, mental changes, new focal symptoms, history of traumatic head injury, Aids or cancer and the presence of meningeal signs) and definitive diagnosis. RESULTS: Altogether 180 (8.7%) patients visited mainly due to headaches, 28 (15.6%) of whom were attended for primary headaches and 152 (84.4%) had secondary type headaches. Chronic tension-type headache was the most common among primary headaches (39.3%); the most frequently diagnosed secondary headaches were those due to systemic disorders, with 119 cases; and a neurological cause was found in 33 patients. Most of the alarm signals appeared in patients with secondary headaches. CONCLUSIONS: Headache is a frequent reason for visiting in the Internal Medicine consultation at the National Psychiatric Hospital in Zimbabwe; the prevalence of secondary headaches due to neurological causes is high.

[The prevalence of primary headaches in the working population at a psychiatric hospital in Zimbabwe]. / Prevalencia de cefaleas primarias en la poblacion laboral de un hospital psiquiatrico de Zimbabwe.

AIM: To determine the rate of prevalence and the clinical-epidemiological and therapeutic characteristics of primary headaches in Zimbabwe. SUBJECTS AND METHODS: A descriptive study was carried out on the working population at the National Psychiatric Hospital in Zimbabwe. The International Headache Society classification was used. Sample size, which was calculated by means of the program EpiInfo 2002, was 175 workers, who were selected by simple random sampling. RESULTS: The rate of prevalence of primary headaches was 37.1%. 66.1% of cases were between 20 and 39 years old. 29.2% had a family history of headaches. Tension-type headaches (47.7%) and common migraine (30.8%) were the predominant types. Onset of headaches occurred before the age of 15 years in 46.12% of patients. The most frequent location was cervical, which was found in 40% of cases. The most frequent precipitating factors were menstruation (24.6%) and stress (21.5%). The most frequent accompanying symptom was tearing (27.7%). 40% suffered headaches three or more times a month. The predominant symptomatic treatment was paracetamol (83.1%) and non-steroidal anti-inflammatory drugs (52.3%). Beta blockers and amitriptyline were used as prophylactic therapy for the episodes of headache in 18.5% and 13.8% of cases, respectively. CONCLUSIONS: The prevalence of primary headaches is high among the working population under study.

Retroperitoneal and deep-seated lipoblastoma: diagnosis by CT scan and fine-needle aspiration biopsy.

Lipoblastomas are most commonly superficially-located tumors. Our experience with three examples of deep-seated lipoblastomas is reported. The CT scans of all cases showed low-attenuation densities (less than 0 Hansfield units), strongly suggesting fatty composition. Fine-needle aspiration biopsy (FNAB) smears contained uni- and multivacuolated lipoblasts, myxoid areas, and a plexiform capillary network. The combination of CT scan and FNAB findings seems to be enough for definitive preoperative diagnosis of lipoblastoma, allowing differential diagnosis with other deep-seated tumors.

Abnormal findings in "normal" research volunteers.

We report three cases in which medical students who participated in clinical studies as normal volunteers were discovered, during the course of the research, to have potentially serious abnormalities. Their previously unsuspected conditions included chronic persistent hepatitis, a lesion in the cerebral cortex, and seropositivity for hepatitis B and HIV antibodies. These findings were surprising and distressing to both subject and investigator, and raised questions of the need for institutional guidelines, and the potential legal liability of the investigator. We discuss how improvements in Informed Consent Forms might aid in reducing these problems, by alerting the researcher and the subject to the possibility that unsuspected disease might be discovered during the course of a clinical research study.

Pharmacodynamic differentiation of chronotropic and inotropic beta-adrenergic receptors in rabbit heart.

Isolated, perfused rabbit hearts were used to identify substituted phenylethylamines selective for either chronotropic or inotropic stimulation relative to norepinephrine. Heart rate and dF/dtmax were measured; the difference in their normalized values was used as an index of selectivity. p-Octopamine (OA) showed chronotropic preference, while phenylephrine (PE) showed a significant inotropic preference. Their effects were not prevented by reserpine pretreatment, cocaine, butoxamine, or phenoxybenzamine, but were antagonized by propranolol, which suggests that OA and PE exert their selective actions directly at beta 1-receptors. These findings provide further evidence for the existence of separate chronotropic and inotropic beta-adrenergic receptors in the heart.

Biochemical plasticity of synaptic transmission: a critical review of Dale's Principle.

"Dale's Principle" states that each neuron releases one and only one synaptic transmitter. Mental disorders and behavioral drug effects are attributed to activation or blockade of one or more of these specific transmitters. A series of biochemical, electrophysiological, and behavioral studies suggests the alternative view that at each monoaminergic synapse the action of the transmitter is modulated by several metabolically related substances: amine analogs (2-phenylethylamine [PEA], p-tyramine, etc.), deaminated products (aldehydes, acids, and alcohols), and possibly also amino acid precursors. In support of this view, the authors present evidence for the presence, synthesis, metabolism, and biological activity (at the cellular level, using microelectrode techniques) of amino acid, amines, and deaminated compounds metabolically related to catecholamines and sorotonin. That neuroamino acids exert direct effects (not mediated via their amine metabolites) is illustrated by the rapid effects of microiontophoretic dopa upon cortical unit activity, and by the observation that neither the lethargic effect of 5-hydroxytryptophan (considered to support Jouvet's serotonergic theory of sleep) nor the behavioral stimulant effects of dopa (considered to support the catecholamine theory of affective behavior) are significantly prevented by L-aromatic amino acid decarboxylase inhibitors. The biological activity of the deaminated metabolites of catecholamines and serotonin is illustrated by the effects of their microiontophoretic administration upon cortical units. Further, probenecid (an inhibitor of acid transport across the blood-brain barrier) is shown to qualitatively alter the effects of intraventricularly administered PEA and of its metabolite phenylacetic acid upon visual evoked potentials. Rabbit brain is shown to synthesize a series of pharmacologically active noncatecholic phenylethylamines as by-products of catecholamine metabolism. Amine modulators such as PEA differ from typical transmitters by their ability to cross biological barriers; inhibition of decarboxylase in peripheral tissues only (using alpha-methyldopa hydrazine) markedly depletes brain PEA (but not catecholamines). Because of the homeostatic control of the rate of transmitter synthesis and disposition, physiological, pharmacological, and pathological changes may be expected to affect more the tissue levels of related modulators. This modulator theory of drug action is illustrated by the effect of several psychotropic drugs upon the brain levels of PEA and of norepinephrine. For instance, amphetamine initially decreases and then increases brain PEA levels, without altering brain norepinephrine levels. The authors propose an expanded "Dale's Principle": each neuron is specific in that it releases at all its endings the same pool of chemical messengers, composed of one transmitter and metabolically related modulators, the relative proportion of which is determined by the physiological state of the cell (biochemical plasticity)...

Differential effects of phenobarbital and pentobarbital on isolated nervous tissue.

Epileptiform after discharges evoked by repetitive electrical stimulation of chronically isolated cortical slabs (cat) were shortened by low doses of phenobarbital but not affected by hypnotic doses of pentobarbital. Both pentobarbital and phenobarbital raised threshold and lowered spike amplitude in isolated sciatic nerves. The action of both drugs was increased by reducing Na in the medium and by decreasing the Ringer's pH. Similar to the action of other general anesthetics, the axonal effect of pentobarbital was enhanced by D2O replacement for H2O in the Ringer's (suggesting that tissue water is involved in pentobarbital action), whereas D2O replacement did not modify the action of phenobarbital or of local anesthetics. These results suggest that the varying in vivo effects of pentobarbital and phenobarbital may be due to a difference in their action upon excitable membranes (rather than to a different regional distribution in brain).

Behavioral and electrophysiological effects of phenylethanolamine and 2-phenylethylamine.

The electrophysiological and behavioral effects of phenylethanolamine (OHPEA) and of its precursor 2-phenylethylamine (PEA) were studied in mice and rabbits. In animals pretreated with MAOI, PEA was found to exert strong amphetamine-like effects, EEG alerting, reduction of visual evoked responses, increased locomotor activity, and blockade of tonic seizures induced by electroshock. OHPEA exerted weaker amphetamine-like effects. Inhibition of dopamine-beta-hydroxylase increased most of the effects of PEA. In non-pretreated animals, OHPEA was found to shorten electroshock latency and to prolong the duration of visual evoked responses. PEA (but not OHPEA) potentiated the excitement induced by delta9-tetrahydrocannabinol in MAOI-pretreated mice. Reserpine pretreatment reduced but did not abolish the CNS effects of OHPEA and PEA. One may speculate that endogenous PEA is more likely to serve as a modulator for ergotropic functions than is endogenous OHPEA.