2-years retrospective observational case-control study on survival and marginal bone loss of implants in patients with hereditary coagulopathies.

BACKGROUND: Evaluating 2-years implant loss and marginal bone loss in patients with hereditary coagulopathies, comparing with a healthy control group. MATERIAL AND METHODS: 37 implants in 13 patients (17 haemophilia A, 20 Von-Willebrand disease) versus 26 implants in 13 healthy patients. Data measured through Lagervall-Jansson index (after surgery, at prosthetic loading, at 2 years). STATISTICS: Chi-square, Haberman's, ANOVA, Mann-Whitney-U. Significance p<0.05. RESULTS: Haemorrhagic accidents in 2 coagulopathies patients (non-statistical differences). Hereditary coagulopathies patients suffered more hepatitis (p<0.05), HIV (p<0.05) and less previous periodontitis (p<0.01). Non-statistical differences in marginal bone loss among groups. 2 implants were lost in the hereditary coagulopathies and none in the control group (non-statistical differences). Hereditary coagulopathies patients had longer (p<0.001), and narrower implants (p<0.05) placed. 43.2% external prosthetic connection in hereditary coagulopathies patients (p<0.001); change of prosthetic platform more frequent in control group (p<0.05). 2 implants lost: external connection (p<0.05). Survival rate 96.8% (hereditary coagulopathies 94.6%, control group 100%). CONCLUSIONS: Implant and marginal bone loss at 2 years is similar in patients with hereditary coagulopathies and control group. Precautions should be taken on the treatment for hereditary coagulopathies patients, through prior haematological protocol. Implant loss only occurred in in a patient with Von-Willebrand´s disease.

The Anterolateral TransPsoatic Approach (ALPA): a new technique for implanting prosthetic disc-nucleus devices.

Prosthetic disc-nucleus devices have traditionally been implanted via the same posterior approach that is standard for lumbar decompression surgery. To avoid disrupting the posterior structures of the spine and to facilitate device implantation, the AnteroLateral transPsoatic Approach (ALPA) has been developed. With ALPA, an incision is made in the lateral region overlying the disc, and the lateroabdominal muscles are bluntly dissected. The retroperitoneal area is accessed and followed to the psoas muscle, where blunt dissection in the direction of the muscle fibers is used to reach the affected disc. The disc anulus is cut to create a flap, the nucleus pulposus material is removed, and the prosthesis is implanted into the disc cavity. The procedure concludes with the anulus flap being sutured in place over the opening to the nucleus, and the wound is closed in a normal manner. A small study group of eight patients has been implanted with PDN prosthetic disc-nucleus devices by way of the ALPA technique. Preliminary results indicate minor adverse events related to the surgical technique. Clinical results are also encouraging with significant improvements in Oswestry and Prolo scores and with an associated increase in disc height. The ALPA technique is a good alternative to the posterior hemilaminotomy approach for implanting nucleus devices in degenerated lumbar discs.

Scapular hibernoma fortuitously discovered on myocardial perfusion imaging through Tc-99m tetrofosmin.

A 49-year-old man was hospitalized for precordial pain. The result of a resting electrocardiograph was normal. Tc-99m tetrofosmin stress myocardial imaging was performed and uptake in the area of the left scapula was seen. The abnormality was caused by a subcutaneous tumor. Histologic examination revealed a hibernoma.

Mesenteric actinomycosis with retroperitoneal involvement.

Mesenteric or retroperitoneal actinomycosis is an extremely rare disease. The international databases have revealed only 10 cases affecting the mesenterium and another 52 cases affecting the retroperitoneum. We report a 78-year-old female who was admitted with complaints of abdominal pain. Laboratory examination revealed anemia and the clinical examination revealed an irregular mass in the abdomen. Ultrasound and computed tomography (CT) scans showed a solid mass in the mesenteric-retroperitoneal region. Biopsy of the nonresectable mass revealed the presence of chronic inflammation in the mesenteric area with Actinomyces colonies. The patient was treated with oral amoxicillin, 500 mg every 6 hours for 6 months. The symptoms disappeared, but the mesenteric-retroperitoneal mass remains, but smaller in size. Based on the review of the literature and the case reported here, we conclude that mesenteric-retroperitoneal actinomycosis is difficult to diagnose by means of noninvasive techniques as it can masquerade as a malignant process. An accurate diagnosis is always obtained in a histological or microbiological examination, often requiring surgical intervention. Treatment with penicillin has proven to be effective.

Utilidad clínica de la elastasa polimorfonuclear en las pancreatitis agudas / Clinical utility of polymorphonuclear elastase in acute pancreatitis

Introducción. La elastasa polimorfonuclear es una proteasa localizada en los lisosomas de los leucocitos polimorfonucleares que se libera como mecanismo de defensa para eliminar los productos de degradación tisular en el lugar de la inflamación. En este trabajo se evalúa la utilidad de la determinación de la elastasa como factor pronóstico en pacientes con pancreatitis aguda. Pacientes y método. Se realiza un estudio prospectivo sobre la utilidad de la medida de la elastasa en una serie de 31 pacientes con pancreatitis aguda. Se les efectuó, dentro de los primeros 3 días del ingreso hospitalario, la determinación de hemograma, bioquímica, elastasa polimorfonuclear y proteína C reactiva, además de la evaluación clínica -mediante criterios de Ranson- como grave y leve. Resultados. Se ha encontrado una serie de 7 pacientes con una elastasa media (ñ DE) de 301 ñ 277 µg/l y proteína C reactiva de 14,3 ñ 17,1 mg/dl, que se asocian a una evolución tórpida. En los otros 24 pacientes, la elastasa fue 109 ñ 115 µg/l, y proteína C reactiva de 4,84 ñ 5,87 mg/dl, presentando una evolución favorable. Conclusiones. Existen diferencias significativas entre los dos grupos en ambos parámetros. Tanto la elastasa polimorfonuclear como la proteína C reactiva, junto con otros datos clínicos y el recuento leucocitario, constituyen unos parámetros útiles para diferenciar las pancreatitis agudas graves de las leves (AU)

[Stomach in inguinal-scrotal hernia]. / Estómago en hernias ínguino-escrotales.

We present two cases of inguinoscrotal hernia that contains stomach, both associated with a chronic obstructive pulmonary disease; one of them is shown with a intermittent gastric obstruction syndrome, the other being a radiological finding in a patient with dispeptic symptoms. The first one died of a respiratory infection, before operation, and the second refused operation because of his scarce symptomatology. A review of the literature shows 60 cases reported including our cases.

NADPH-diaphorase activity and vasopressin in the paraventricular nucleus of the hypothalamus following adrenalectomy.

In order to investigate novel neuroendocrine functions of the nitric oxide synthesizing enzyme a combined histochemical and immunocytochemical study focused on the paraventricular nucleus of the hypothalamus was conducted to check a possible influence of bilateral adrenalectomy on three different neuronal populations, NADPH diaphorase (ND)-positive, vasopressin (VP)-immunoreactive and neurons expressing both markers. In the adrenalectomized animals, a slight increase (P > 0.05) of the number of ND magnocellular neurons was detected, whereas no changes were observed in the ND-parvicellular population and in the neurons showing coexistence (magno- and parvicellular) (P > 0.05). By contrast, following bilateral adrenalectomy, a significant increase (P < 0.05) in the VP-parvicellular population (anterior, medial and periventricular subdivisions) was detected, which was reversed when the animals received daily doses of corticosterone. These results suggest that nitric oxide is not closely related to the hypothalamic regulation of the adenocorticotropin secretion exerted by the paraventricular nucleus.

Morphometric evidence of the regulation of the activity of LH-immunoreactive cells by corticosterone. An in vivo and in vitro study.

The present study was performed to investigate the morphometric effects of the administration of corticosterone on LH-immunoreactive cells of pituitary monolayer cultures. In addition, the effect of bilateral adrenalectomy on the LH-adenohypophyseal cells was explored. In vitro administration of corticosterone induced a marked decrease in the morphometric parameters considered (cellular, cytoplasmic and nuclear areas). In vivo, bilateral adrenalectomy produced a significant increase in these parameters when compared to those obtained in normal and sham-operated animals. However, when the bilaterally adrenalectomized rats received a daily dose of corticosterone no significant changes in the morphometric parameters were found. Morphometrically, these combined in vivo-in vitro findings confirm a corticosterone-induced hypoactivity of LH-cells together with a direct effect of this glucocorticoid on LH-adenohypophyseal cells.

Dopamine inhibits in vitro release of VIP and proliferation of VIP-immunoreactive pituitary cells.

A double immunohistochemical study for VIP and proliferating cell nuclear antigen (PCNA) was carried out on monolayer cultures from adult male rats pituitary glands treated with dopamine (ranging from 10(-9) to 10(-5) M), in order to establish whether or not dopamine is involved in the regulation of the proliferation rate of pituitary VIP-immunoreactive cells. For all doses of dopamine assayed, the release of VIP to the culture medium, the numerical density of VIP-immunoreactive cells and the percentages of VIP- and PCNA-immunoreactive cells decreased significantly after dopamine treatment. These results suggest that dopamine could be a physiological inhibitor involved in the modulation of pituitary VIP proliferation rate.

In vitro morphometric and proliferative variations in VIP-immunoreactive pituitary cells induced by estradiol.

Using double labelling for proliferating cell nuclear antigen (PCNA) and vasoactive intestinal peptide (VIP), a study was conducted to elucidate the repercussions of the addition of estradiol to monolayer pituitary cultures on the morphology, size, number, mitotic index and PCNA labelling index of VIP-immunoreactive cells, comparing the results with those obtained in control cultures. The addition of estradiol (100 nM) over 3 h of incubation led to a significant increase (p < 0.01) in the cellular, cytoplasmic and nuclear areas of VIP-immunoreactive cells and in the number of these cells. The same treatment elicited an even greater increase in the mitotic index (p < 0.01) and PCNA labelling index (p < 0.01) of VIP-immunoreactive cells. The results obtained suggest that estrogens induce proliferation and hyperplasia of in vitro VIP-immunoreactive pituitary cells.

Morphological findings of an interrelationship among the neurosecretory axons of the neural lobe of the hypophysis.

In order to establish whether osmotic stimuli induce variations in the contact regions among neurosecretory axons of the neural lobe of the hypophysis, adult Sprague-Dawley rats of both sexes were treated with furosemide, a diuretic drug. Contacts between adjacent membranes with no condensations of the axolemma but increase in their osmiophilia were observed. After treatment with furosemide interaxonal contacts were significantly increased (p < 0.01, in relation to control animals). Additionally, following treatment with furosemide, axo-axonic synapses among the axons of the neural lobe were found. These findings suggest the existence of interactions among activated neurosecretory axons of the neural lobe of the adult rat.

In vitro modifications in the proliferation rate of prolactin cells are accompanied by nuclear morphometric variations.

In order to establish the correlation between in vitro proliferation rate and morphometric variations of prolactin immunoreactive cells, a morphometric study was carried out in rat pituitary monolayer cultures by means of the double immunocytochemical staining methods employing mouse monoclonal antiproliferative cell nuclear antigen (PCNA) and rabbit anti-prolactin (PRL) as primary antibodies. PCNA was found to be an adequate marker for proliferation in pituitary monolayer cultures. 48.35 +/- 2.78% of the cells present in the culture were in active cell cycle after 3 days of incubation and a similar proportion, 54.93 +/- 2.83% was found after 7 days. On the 3rd day, PRL immunopositive cells accounted for 15.16 +/- 0.21% of the total cellular content in the dishes and 8.68 +/- 0.12% of the PCNA immunoreactive cells were also PRL immunopositive cells and, 60.95 +/- 2.65% of PRL cells stained for PRL and PCNA. On the 7th day, an increase to 32.18 +/- 0.60% of PRL cells was found; the PCNA and PRL cells accounted for 60.32 +/- 2.34% of the total PRL cells, and 19.88 +/- 1.09% of the PCNA reactive cells stained for PRL. Additionally, the morphometric analysis performed after 3 or 7 days of incubation showed that, while the size of PRL cells remained unmodified, the nuclear area had increased on the 7th day in relation to the 3rd day (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)