Influence of comorbidities not associated with fibromyalgia on neuropathic pain in patients with psoriatic arthritis: relationship with clinical parameters.

Objective: Neuropathic pain (NP) may influence disease activity assessment in patients with psoriatic arthritis, this relationship being traditionally based on the presence of concomitant fibromyalgia. We analyzed the influence of other comorbidities on NP and the relationship between pain and various clinical parameters. Methods: A cross-sectional study was conducted in patients diagnosed with psoriatic arthritis, excluding patients with a previous diagnosis of fibromyalgia, depression, anxiety, diabetes and/or dyslipidemia under treatment. NP was identified using the painDETECT questionnaire (score > 18). Obesity and related clinical parameters, anxious and depressive symptoms, sleep quality and fatigue were assessed as comorbidities. Disease activity was measured using the clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) in peripheral involvement, the ASDAS-PCR in axial involvement, functioning and disease impact were measured using the Health Assessment Questionnaire-Disability Index and 12-item Psoriatic Arthritis Impact of Disease questionnaire, respectively. Results: Overall, 246 patients were included (136 men; 55%). The mean age was 53.4 ± 11.0 years. Forty-two patients had NP (17.1%). Patients with NP had higher leptin levels (OR: 1.03, 95% CI: 1.007-1.056; p < 0.01) and poor sleep quality (OR: 1.20, 95% CI: 1.09-1.297; p < 0.001). Patients with NP also had greater fatigue NRS (6.2 ± 2.2 vs. 2.4 ± 0.19, p < 0.001). Patients with NP had higher cDAPSA score (17.3 ± 5.4 vs. 8.9 ± 6.5, p < 0.001), poorer functioning (1.1 ± 0.5 vs. 0.4 ± 0.5, p < 0.001) and greater disease impact (6.1 ± 1.7 vs. 2.6 ± 1.9, p < 0.001). Conclusion: NP was correlated with sleep quality and serum leptin and may be associated with worse disease activity, functioning and disease impact.

SLEEP quality in patients with psoriatic arthritis and its relationship with disease activity and comorbidities: a cross-sectional study.

The assessment of psoriatic arthritis is complex and multidimensional. It is increasingly common to include the patient perspective using patient-reported outcomes. Although some research has explored sleep quality in patients with psoriatic arthritis, most studies have had small sample sizes, failed to assess sleep quality considering the inflammatory process together with the psychological well-being of patients, and have not described any use of sleep medication. Further, research to date has not provided data on the relationship of sleep quality with axial forms. In this context, the objective of this study was to assess sleep quality in patients with psoriatic arthritis and its relationship with clinical characteristics, disease activity, functioning, disease impact, fatigue and psychological status. A cross-sectional study was conducted including 247 consecutive patients with PsA recruited during 2021. Sleep quality was measured using the Pittsburgh Sleep Quality Index. We assessed correlations of Pittsburgh Sleep Quality Index score with peripheral disease activity (Disease Activity Index for PSoriatic Arthritis), axial disease activity (Ankylosing Spondylitis Disease Activity Score-C-reactive protein and Bath Ankylosing Spondylitis Disease Activity Index), functioning (Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire), impact (Psoriatic Arthritis Impact of Disease questionnaire), anxiety, depression (Hospital Anxiety and Depression Scale) and fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue) scores. A multiple linear regression model was constructed with PSQI as the dependent variable and as independent variables those that could influence sleep quality. Nearly two-thirds (63.15%) of patients had poor sleep quality. Poorer sleep quality was associated with being female, higher joint counts, greater peripheral and axial disease activity, fatigue, anxiety and depression, functioning and disease impact (p < 0.001). Multiple linear regression analysis found that pain (ß: 0.3; p < 0.007) and fatigue ß: - 0.1; p < 0.001 contributed 40% to the sleep quality model. Poor sleep quality was common among patients with psoriatic arthritis. Emotional factors (fatigue, anxiety) seemed more important than inflammatory factors in sleep quality.

Assessment of simulations of a polar low with the Canadian Regional Climate Model.

Polar lows (PLs), which are intense maritime polar mesoscale cyclones, are associated with severe weather conditions. Due to their small size and rapid development, PL forecasting remains a challenge. Convection-permitting models are adequate to forecast PLs since, compared to coarser models, they provide a better representation of convection as well as surface and near-surface processes. A PL that formed over the Norwegian Sea on 25 March 2019 was simulated using the convection-permitting Canadian Regional Climate Model version 6 (CRCM6/GEM4, using a grid mesh of 2.5 km) driven by the reanalysis ERA5. The objectives of this study were to quantify the impact of the initial conditions on the simulation of the PL, and to assess the skill of the CRCM6/GEM4 at reproducing the PL. The results show that the skill of the CRCM6/GEM4 at reproducing the PL strongly depends on the initial conditions. Although in all simulations the synoptic environment is favourable for PL development, with a strong low-level temperature gradient and an upper-level through, only the low-level atmospheric fields of three of the simulations lead to PL development through baroclinic instability. The two simulations that best captured the PL represent a PL deeper than the observed one, and they show higher temperature mean bias compared to the other simulations, indicating that the ocean surface fluxes may be too strong. In general, ERA5 has more skill than the simulations at reproducing the observed PL, but the CRCM6/GEM4 simulation with initialisation time closer to the genesis time of the PL reproduces quite well small scale features as low-level baroclinic instability during the PL development phase.

Metabolic control and satisfaction in a diabetes education programme in flash glucose monitoring through telemedicine in type 1 diabetes.

OBJECTIVE: To evaluate metabolic control and satisfaction with a telemedicine diabetes education programme for the initiation of flash glucose monitoring (FGM) in type 1 diabetes. MATERIAL AND METHODS: Prospective study in 48 patients (52.1% women, 22.9% on insulin pump) who started FGM. They were analysed at baseline and 3 months after the beginning of the FGM. The results were compared with an on-site learning cohort matched by age, sex and HbA1c. RESULTS: At the beginning and 3 months after the MFG, HbA1c improvement was observed (7.9±1.4 vs 7.3±1.1%), p<0.01; with a decrease in time below range - TBR - (4.7±4.9 vs 3.5±3.5%), p<0.05 and number of hypoglycaemic events (9.4±8.7 vs 6.9±5.7/15 days), p<0.05, associated with a worsening in time above range - TAR - (33.5±19.9 vs 37.0±20.9%), p<0.05. No significant differences were observed in the TIR 70-180mg/dl (61.7±18.6 vs 59.4±20.0%), glycemic variability or the use of FGM. Patient satisfaction with telemedicine training was 4.8±0.3 out of 5. No significant differences were observed in the follow-up, either in HbA1c or other glucometer parameters between on-site and online training. In a multivariate analysis adopting the HbA1c at follow-up as the dependent variable, only the TIR (ß=-0.034; p<0.001) and the initial HbA1c (ß=0.303; p<0.001) maintained statistical significance, unrelated to the on-site or online training (ß=0.136; p=ns). CONCLUSIONS: A telemedicine programme is an adequate tool for training in FGM, with results similar to on-site training, and it was associated with a high degree of satisfaction.

[Hyponatremia among patients with total enteral tube feeding: prevalence and associated clinical factors]. / Prevalencia y factores asociados a la hiponatremia en pacientes con nutrición enteral.

Introduction: Introduction: hyponatremia is the most frequent disturbance in hospitalized patients. This situation may influence the therapeutic approach in patients with total enteral tube feeding (TEN). Objective: to study the prevalence of hyponatremia and the clinical factors that are associated with increased risk in a population with TEN. Methods: a retrospective study from January 2014 to January 2020; 1,651 non-critically ill patients receiving TEN were included who were assessed by the Department of Endocrinology and Nutrition. Data collected included sex, age, body mass index (BMI) (kg/m2), and nutritional status by Mini Nutritional Assessment (MNA); main disease diagnosis and development of hyponatremia at onset or during TEN were also included. Results: in all, 53.9 % of the total sample were males aged 76.8 [65.7-85.3] years. Neurological pathology was the most frequent primary diagnosis on admission (37.3 %). We found hyponatremia in 26.1 % -11.0 % at onset and 16.7 % during TEN-. Hyponatremia was more frequent in patients with digestive disease (28.7 %) and infectious disease (27.65 %). According to the MNA questionnaire 41.1 % were malnourished and nutritional status was worse in patients with hyponatremia (76.3 % vs. 55.8 %; p < 0.001). By multivariate analysis, malnutrition was only associated with hyponatremia status; OR, 2.86 [95 % CI: 1.5-4.88]. Conclusions: in this study, hyponatremia was detected in a third of patients. This was up to two more times as common in malnourished patients; however, age, sex, BMI, and baseline pathology were not related.

Introducción: Introducción: la hiponatremia es el trastorno electrolítico más frecuente a nivel hospitalario. En pacientes con nutrición enteral (NE) puede influir en el abordaje terapéutico, así como en la selección del preparado nutricional. Objetivos: describir la prevalencia de la hiponatremia en pacientes con NE y factores asociados. Métodos: estudio retrospectivo de 1651 pacientes no críticos con NE, valorados por el Servicio de Endocrinología y Nutrición desde enero de 2014 hasta enero de 2020. Se recogieron la edad, el sexo, el índice de masa corporal (IMC) (kg/m2), el estado nutricional mediante el cuestionario Mini Nutritional Assessment (MNA), el diagnóstico principal y la presencia de hiponatremia al inicio y durante la NE. Resultados: del total, el 53,9 % fueron hombres, con una mediana de edad de 76,8 [65,7-85,3] años. El diagnóstico principal más frecuente fue la patología neurológica (37,3 %). El 26,1 % de los pacientes presentaron hiponatremia: un 11,0 % al inicio de la NE y el 16,7% durante su administración. La hiponatremia fue más frecuente en aquellos con patología digestiva (28,7 %) e infecciosa (27,65 %). Según el MNA, hasta el 41,1 % presentaron desnutrición y la frecuencia de esta fue estadísticamente superior en los pacientes con que en aquellos sin hiponatremia (76,3 % vs. 55,8 %; p < 0,001). En el análisis multivariante, únicamente la desnutrición se asoció de manera significativa con la presencia de hiponatremia, con una OR de 2,86 [IC 95 %: 1,5-4,88]. Conclusiones: la hiponatremia se detectó en un tercio de los pacientes con NE. Su presencia fue hasta 2 veces más frecuente en los pacientes desnutridos, independientemente de la edad, el sexo, el IMC y la patología basal.

Impact of flash glucose monitoring on quality of life and glycaemic control parameters in adults with type 1 diabetes mellitus⋆.

INTRODUCTION: Flash glucose monitoring (FGM) improves some glycaemic control variables and quality of life parameters. OBJECTIVE: Our aim was to evaluate the quality of life and glycaemic control parameters after initiating FGM in patients with type 1 diabetes (DM1) in clinical practice. MATERIAL AND METHODS: A prospective observational study in DM1 patients that started using FGM between June 2019 and April 2020. We analysed their scores on the Diabetes Quality of Life (DQOL) questionnaire, Diabetes Distress Scale (DDS), Diabetes Treatment Satisfaction Questionnaire (DTSQ) and glycaemic control parameters at baseline and 3 months after the FGM onset. RESULTS: We recruited 114 patients, 56% male, mean age 37.2 (standard deviation, SD 12.4), with 18.7 (SD 11.5) years of DM1, 24.6% of which used continuous subcutaneous insulin infusion. Differences were observed (baseline vs. 3 months) in the DTSQ score (22 [15.5-27] vs. 25 [22-28], P < 0.001) and in the DQOL score (88 [74-104] vs. 84 [70-101], P = 0.017) but not in the DDS score. HbA1c was 7.8% (SD 1.3) vs. 7.4% (SD 1.1) (P < 0.001), without improvement in other glycaemic control variables, except for the mean number of hypoglycaemic events/14 days: 14 (SD 9) at baseline vs. 11.5 (SD 7) at 3 months (P < 0.001). CONCLUSIONS: The initiation of FGM, combined with a structured educational programme, was associated with improvement in quality of life and patient satisfaction in DM1 patients. An improvement in HbA1c and a reduction in the number of hypoglycaemia events was observed, but not in the rest of glycaemic control parameters.

Next-Generation Sequencing for Confronting Virus Pandemics.

Virus pandemics have happened, are happening and will happen again. In recent decades, the rate of zoonotic viral spillover into humans has accelerated, mirroring the expansion of our global footprint and travel network, including the expansion of viral vectors and the destruction of natural spaces, bringing humans closer to wild animals. Once viral cross-species transmission to humans occurs, transmission cannot be stopped by cement walls but by developing barriers based on knowledge that can prevent or reduce the effects of any pandemic. Controlling a local transmission affecting few individuals is more efficient that confronting a community outbreak in which infections cannot be traced. Genetic detection, identification, and characterization of infectious agents using next-generation sequencing (NGS) has been proven to be a powerful tool allowing for the development of fast PCR-based molecular assays, the rapid development of vaccines based on mRNA and DNA, the identification of outbreaks, transmission dynamics and spill-over events, the detection of new variants and treatment of vaccine resistance mutations, the development of direct-acting antiviral drugs, the discovery of relevant minority variants to improve knowledge of the viral life cycle, strengths and weaknesses, the potential for becoming dominant to take appropriate preventive measures, and the discovery of new routes of viral transmission.

Author Correction: Development and long-term evaluation of a new 68Ge/68Ga generator based on nano-SnO2 for PET imaging.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Development and long-term evaluation of a new 68Ge/68Ga generator based on nano-SnO2 for PET imaging.

Radionuclide generator systems can routinely provide radionuclides on demand such as 68Ga produced by a 68Ge/68Ga generator without the availability of an on-site accelerator or a research reactor. Thus, in this work nano-SnO2 was used to develop a new 68Ge/68Ga generator which was evaluated over a period of 17 months and 305 elution cycles. The elution yield was 91.1 ± 1.8% in the first 7 mL (1 M HCl as eluent) when the generator was new and then it decreased with time and use to 73.8 ± 1.9%. Around 80% of the elutable 68Ga activity was obtained in 1 mL and the 68Ge content in the eluate did not exceed 1 × 10-4% over the investigation period when it was eluted regularly. The described generator provided adequate results for radiolabelling of DOTA-TOC with direct use of eluate. In addition, [68Ga]Ga-DOTA-TOC was tested satisfactorily for in vivo tumor detection by microPET/CT imaging in a lung cancer mouse model.

La Relación entre la Salud Oral y el Consumo de Tabaco. Un Estudio de los Habitantes de la Rioja Alta / The Relationship Between Oral Health and Tobacco Consumption. A Study of the Inhabitants of La Rioja Alta

RESUMEN: Estudiar los efectos del consumo de tabaco (producto adictivo) en la salud de los pacientes sigue siendo una prioridad para la sociedad. Tras la lectura de "La Historia Medicinal de las cosas que se traen de nuestras Indias Occidentales" de Nicolás Monardes se realizó una lista de todos los beneficios que se le atribuían al tabaco. Uno de los pocos que no han sido refutados es el del consumo de tabaco para el dolor de muelas. Por ello el objetivo del estudio es relacionar el consumo de tabaco con la salud bucodental (caries) para replicar la afirmación de Monardes. Estudio piloto con pacientes que acuden al dentista en el área de La Rioja Alta (España). Se pidió permiso a los individuos que acudían para tratar sus datos personales en el estudio. Se utilizó estadística descriptiva. Ochenta y tres pacientes cedieron sus datos para la realización del estudio, siendo la mayoría mujeres (59.13%). La mayoría no son consumidores de tabaco, los consumidores son en su totalidad fumadores diarios. El número medio de caries de la población es de 2.74, siendo el de los fumadores 3.90 y el de los no fumadores 2.10. El número tan bajo de la muestra no permite realizar un estudio de significatividad. Pero, un primer resultado evidencia que los fumadores tienen una peor salud bucodental, lo que los lleva a tener más caries. Esta diferencia no es tan acuciada si se realiza el estudio entre otras variables (sexo, localidad o edad).

ABSTRACT: Studying the effects of tobacco use (addictive product) on the health of patients continues to be a priority for society. After reading " La Historia Medicinal de las cosas que se traen de nuestras Indias Occidentales " by Nicolás Monardes, a list of all the benefits attributed to tobacco was made. One of the few that has not been refuted is the use of tobacco for toothache. Therefore, the objective of the study is to relate the consumption of snuff with oral health (caries) to replicate the claim of Monardes. A pilot study with patients who visit the dentist in La Rioja Alta (Spain) was carried out. Permission was sought from the individuals who came to discuss their personal data in the study. Descriptive statistics was used. Eighty-three patients gave their data for the study, with the majority being women (59.13%). The majority are not tobacco consumers; tobacco users are in their entirety daily smokers. The average number of caries of the population is 2.74, being that of smokers 3.90 and that of non-smokers 2.10. The low number of the sample does not allow a study of significance. However, initial results show that smokers have worse oral health, which leads them to have more cavities. This difference is not critical if the study includes other variables (sex, location or age).

MT1-MMP as a PET Imaging Biomarker for Pancreas Cancer Management.

Pancreatic ductal adenocarcinoma (PDAC) continues to be one of the deadliest cancers for which optimal diagnostic tools are still greatly needed. Identification of PDAC-specific molecular markers would be extremely useful to improve disease diagnosis and follow-up. MT1-MMP has long been involved in pancreatic cancer, especially in tumour invasion and metastasis. In this study, we aim to ascertain the suitability of MT1-MMP as a biomarker for positron emission tomography (PET) imaging. Two probes were assessed and compared for this purpose, an MT1-MMP-specific binding peptide (MT1-AF7p) and a specific antibody (LEM2/15), labelled, respectively, with 68Ga and with 89Zr. PET imaging with both probes was conducted in patient-derived xenograft (PDX), subcutaneous and orthotopic, PDAC mouse models, and in a cancer cell line (CAPAN-2)-derived xenograft (CDX) model. Both radiolabelled tracers were successful in identifying, by means of PET imaging techniques, tumour tissues expressing MT1-MMP although they did so at different uptake levels. The 89Zr-DFO-LEM2/15 probe showed greater specific activity compared to the 68Ga-labelled peptide. The mean value of tumour uptake for the 89Zr-DFO-LEM2/15 probe (5.67 ± 1.11%ID/g, n=28) was 25-30 times higher than that of the 68Ga-DOTA-AF7p ones. Tumour/blood ratios (1.13 ± 0.51 and 1.44 ± 0.43 at 5 and 7 days of 89Zr-DFO-LEM2/15 after injection) were higher than those estimated for 68Ga-DOTA-AF7p probes (of approximately tumour/blood ratio = 0.5 at 90 min after injection). Our findings strongly point out that (i) the in vivo detection of MT1-MMP by PET imaging is a promising strategy for PDAC diagnosis and (ii) labelled LEM2/15 antibody is a better candidate than MT1-AF7p for PDAC detection.

ACUTE VISION LOSS AS THE ONLY SIGN OF LEUKEMIA RELAPSE.

PURPOSE: To report a case of unilateral exudative retinal detachment as the sole presentation of relapsing B-type lymphoblastic leukemia in a 35-year-old man after 3 years of remission. METHODS: Case report. RESULTS: A 35-year-old man in complete remission of high-risk type B acute lymphoblastic leukemia (ALL-B) presented with acute vision loss in his left eye. Exudative retinal detachment was diagnosed at initial evaluation. Hematological and ocular studies were performed. Although there was no evidence of blood, cerebrospinal fluid, or bone marrow disease relapse, transvitreal retinochoroidal cytology identified the infiltration of lymphoblastic leukemic B cells with t(12:21) translocation as the only sign of relapsing ALL-B. CONCLUSION: At first sign of vision loss or ocular symptoms in a patient with a history of lymphoblastic leukemia, and regardless of the hematological findings, exhaustive ophthalmologic exploration and ocular biopsy should be performed without delay-this being crucial for clinical decision making because a prompt diagnosis improves the chances of survival.

Correlation Between Ischemic Retinal Accidents and Radial Peripapillary Capillaries in the Optic Nerve Using Optical Coherence Tomographic Angiography: Observations in 6 Patients.

BACKGROUND: Perfusion of the optic nerve has been widely studied using fluorescein angiography (FAG), which is currently regarded as the criterion standard. However, FAG has adverse effects associated with intravenous contrast administration and is limited in its capacity to characterize and stratify the different vascular layers of the optic nerve and retina. The use of new imaging techniques, such as optical coherence tomographic angiography (Angio-OCT), is therefore important. AIM: A qualitative description is made of the vascular layers of the optic nerve and of how vascular events affect radial peripapillary capillaries (RPC). Two patients with central retinal artery occlusion (CRAO), 1 with arteritic anterior ischemic optic neuropathy (AAION), and 3 healthy subjects were studied. RESULTS: The Angio-OCT imaging afforded better visualization of the depth of the RPC and rest of the vascular layers of the retina compared with FAG. Optic nerve surface perfusion was affected in AAION and proved normal in CRAO. CONCLUSIONS: Our results indicate that perfusion of the papilla and RPC mainly arises from the papillary plexus that depends on the posterior ciliary artery.

Polymer nanofilms with enhanced microporosity by interfacial polymerization.

Highly permeable and selective membranes are desirable for energy-efficient gas and liquid separations. Microporous organic polymers have attracted significant attention in this respect owing to their high porosity, permeability and molecular selectivity. However, it remains challenging to fabricate selective polymer membranes with controlled microporosity that are stable in solvents. Here we report a new approach to designing crosslinked, rigid polymer nanofilms with enhanced microporosity by manipulating the molecular structure. Ultrathin polyarylate nanofilms with thickness down to 20 nm are formed in situ by interfacial polymerization. Enhanced microporosity and higher interconnectivity of intermolecular network voids, as rationalized by molecular simulations, are achieved by using contorted monomers for the interfacial polymerization. Composite membranes comprising polyarylate nanofilms with enhanced microporosity fabricated in situ on crosslinked polyimide ultrafiltration membranes show outstanding separation performance in organic solvents, with up to two orders of magnitude higher solvent permeance than membranes fabricated with nanofilms made from non-contorted planar monomers.

Human laryngeal ganglia contain both sympathetic and parasympathetic cell types.

The presence of ganglia associated with the laryngeal nerves is well documented. In man, these ganglia have been less well studied than in other species and, in particular, the cell types within these ganglia are less well characterized. Using a panel of antibodies to a variety of markers found in the paraganglion cells of other species, we were able to show the existence of at least two populations of cells within human laryngeal paraganglia. One population contained chromogranin and tyrosine hydroxylase representing a neurosecretory population possibly secreting dopamine. A second population of choline acetyltransferase positive cells would appear to have a putative parasympathetic function. Further work is needed to characterize these cell populations more fully before it will be possible to assign functions to these cell types but our results are consistent with the postulated functions of these ganglia as chemoreceptors, neurosecretory cells, and regulators of laryngeal mucus secretion.

Anatomic study of human laryngeal ganglia: number and distribution.

We have studied 12 laryngeal nerves: six internal branches of the superior laryngeal nerve (ILN) and six recurrent laryngeal nerves (RLN) from three human adult larynges (two males and one female). After dissection of each individual laryngeal nerve using a surgical microscope, the nerves were preserved in 10% formalin, embedded in paraffin wax, serially sectioned transversely at a thickness of 10 microm and stained with hematoxylin and eosin. We found 2-4 ganglia associated with the ILN. At least two ganglia were always present (six out of six cases), the largest one being associated with the branch of the nerve innervating the vestibule and the smallest one associated with the branch innervating the aryepiglottic fold. Other ganglia were found associated with the branches for the glosso-epiglottic fold and vallecula (four out of six cases) and interarytenoid muscle (three out of six cases). The RLN showed from two to six ganglia, all of them located in its anterior terminal division. Two of the ganglia were located in the part of the nerve between the origin of the branches for the interarytenoid and lateral cricoarytenoid muscles (three out of six cases). The remaining ganglia were located close to or at the origin of the muscular branches innervating the intrinsic laryngeal muscles. The cytology of the ganglia reported suggests that they were all autonomic in nature, probably parasympathetic.

Balloon sphincteroplasty and transpapillary elimination of bile duct stones: 10 years' experience.

OBJECTIVE: The usual way for interventional radiology to treat stones in the bile duct involves their extraction with Dormia baskets. The technique of dilating the sphincter with a balloon and the transpapillary elimination of the stones has only sporadically been reported in the literature. In this article, we describe our experience with this technique. MATERIALS AND METHODS: Between 1992 and 2001, we used this technique on 100 patients between the ages of 17 and 93 years (mean age, 68 years). The minimum diameter of the stones varied between 4 and 22 mm (mean size, 11 mm), and in 46 patients, only a single stone was seen. The stones were located in the common bile duct, and in 11 patients, intrahepatic stones were also observed. The approach was performed through a percutaneous biliary drainage tract in 48 patients, following the surgical tract of the Kehr tube in 36 patients, through a surgical transcystic drainage catheter in 10 patients, and through a percutaneous cholecystostomy in six patients. RESULTS: The procedure was successful in 95% of the patients. The morbidity rate was 5%, and the procedure did not produce mortality in any of the cases. Eighty-nine patients required one session, 10 patients required two sessions, and the remaining patient required five sessions. The mean period of hospitalization after the procedure was 5.5 days (range, 1-40 days). CONCLUSION: Balloon sphincteroplasty and transpapillary elimination of bile duct stones is an effective and safe technique.

Variability of the nerve supply patterns of the human posterior cricoarytenoid muscle.

OBJECTIVES/HYPOTHESIS: To achieve a successful selective reinnervation of the larynx, an accurate knowledge of the nerve supply of each individual muscle is required. The posterior cricoarytenoid muscle, the only abductor or respiratory muscle of the larynx, plays a vital role in cases of recurrent palsy and orthotopic transplantation. Descriptions of the posterior cricoarytenoid muscle nerve supply pattern vary considerably. The goal of the present study was to establish an accurate morphological description of the posterior cricoarytenoid muscle nerve supply in a large sample of human larynges. STUDY DESIGN: Morphologic study of human larynges. METHODS: The posterior cricoarytenoid muscle nerve supply was studied in a total sample of 75 human larynges obtained from necropsies (47 male and 28 female samples; age range, 41-95 y) and examined by careful dissection using a surgical microscope. RESULTS: The posterior cricoarytenoid muscle nerve supply in all cases (100%) came from the anterior division of the recurrent nerve. However, in six cases (4%) a small branch also arose from the ramus anastomoticus. The number of branches coming from the anterior division varied, ranging from one to six. The two-branch pattern was the most frequent (42.7%), followed by the three-branch pattern (34%) and the one-branch pattern (7.3%). The remaining 16% of cases showed patterns of four, five, or six branches. When two or more branches were present, a connection between them was observed in 64% of cases. Five different types of origin of the various branches were observed along the course of the recurrent nerve in relation to the cricothyroid joint: type a, vertical segment below the cricothyroid joint (7.5%); type b) vertical segment behind the cricothyroid joint (40.5%); type c) vertical segment just above the cricothyroid joint (16%); type ) from the genu, in common with the arytenoid branch, above the cricothyroid joint and just below the cricoarytenoid joint (34%); and type e) oblique segment (2%). CONCLUSION: Despite the variability of the innervation of the posterior cricoarytenoid muscle and its strong connection with the interarytenoid nerve, this should not preclude successful reinnervation.