Livebirth and utero-placental insufficiency in Papio hamadryas baboons with uterus angiosome perfused by bilateral utero-ovarian microsurgical anastomoses alone.

STUDY QUESTION: Can the baboon uterus support a gestation to livebirth with an angiosome using microsurgically anastomosed utero-ovarian vessels and lacking uterine arteries and veins? SUMMARY ANSWER: Our angiosome model allows healthy livebirth albeit with risk of fetal growth restriction and stillbirth. WHAT IS KNOWN ALREADY: Uterine transplant can provide livebirth in humans, but requires a living donor to undergo a prolonged laparotomy for hysterectomy. In an attempt to avoid the time-consuming dissection of the uterine vein, our group has previously shown maintenance of baboon uterine menstrual function after ligation of the uterine vein and after ligation of both the uterine artery and uterine vein. STUDY DESIGN, SIZE, DURATION: In a 19-month timespan, three baboons underwent laparotomy to surgically alter uterine perfusion, and pregnancy outcomes were monitored after spontaneous mating in a breeding colony. PARTICIPANTS/MATERIALS, SETTING, METHODS: Three nulligravid female Papio hamadryas baboons in a breeding colony underwent laparotomy to ligate uterine arteries and veins along with colpotomy and cervico-vaginal anastomosis. During the same surgery, the utero-ovarian arteries and veins were microsurgically transected and re-anastomosed to themselves. Intraoperative organ perfusion was confirmed with laser angiography. After a recovery period, monitoring of menstrual cycling via menstrual blood flow and sex-skin cycling occurred, as well as uterine viability via sonography and cervical biopsy. Each baboon was released to the breeding colony for spontaneous mating and pregnancies dated by menstrual calendar and compared with early ultrasound. Delivery outcomes were monitored in each including neonate weight and placental pathology. In the event of a stillbirth, the animal was returned to the breeding colony for repeat mating attempts. After achieving a livebirth, the maternal baboon was removed from the study. MAIN RESULTS AND THE ROLE OF CHANCE: Each baboon in the trial underwent successful surgery with all uteri demonstrating viability and return of menstrual function within 10 weeks of surgery. Pregnancies occurred within two menstrual cycles in breeding colony. Baboons one and two initially had vaginal breech stillbirths, both with appearance of placental insufficiency, and one with fetal growth restriction. Baboon three underwent scheduled cesarean delivery resulting in a normally grown livebirth. Baboon one had a subsequent pregnancy resulting in a livebirth via cesarean delivery. LIMITATIONS, REASONS FOR CAUTION: Stillbirth in two of four gestations, and fetal growth restriction in one of four, are the largest concerns in our perfusion model. It remains uncertain whether the stillbirths resulted from placental insufficiency, or birth trauma from breech deliveries. WIDER IMPLICATIONS OF THE FINDINGS: The success of two livebirths warrants further attempts at improving consistency of our proposed uterine angiosome. This may allow living uterine donors to undergo less-invasive and shorter donor hysterectomy procedures. STUDY FUNDING/COMPETING INTEREST(S): The study had no external sponsors, and was supported by the Cleveland Clinic Foundation. Some equipment was loaned without cost to the research team including a laser angiography system courtesy of Novadaq Technologies, Inc. (Missaugua, ON, Canada) and a surgical microscope courtesy of DB Surgical (Coral Springs, FL, USA). B.B., K.A., M.S., K.R., M.M., P.F.E., A.T. and T.F. have no conflicts of interest. M.L.S. and S.Z. report activity as consultants for Medtronic-Covidien, and S.Z. also is a consultant to Applied Medical.

Comparison of two negative pressure systems and syringe irrigation for root canal irrigation: an ex vivo study.

AIM: To compare in a laboratory study two negative pressure systems and syringe irrigation, regarding the delivery of a contrast solution (CS) to working length (WL) and into simulated lateral canals and the effective volume of irrigant aspirated during negative pressure irrigation. METHODOLOGY: Twenty single-canaled incisor training models were constructed with six simulated lateral canals each (2, 4 and 6 mm to WL) and a size 40, 0.04 taper apical size canal. Each model underwent all irrigation procedures (EndoVac at WL (EndoVac-0) and WL-2 mm (EndoVac-2), iNP needle with negative pressure (iNPn) and syringe irrigation with the iNP needle (iNPs) and a 30-G side-slot needle placed at WL (SI0) and WL-2 (SI2) mm in a crossover design. CS was delivered at 4 mL min(-1) for 60 s with a peristaltic pump and a recovery device collected the volume (in mL) of irrigant suctioned by the negative pressure groups. The irrigation procedures were digitally recorded, and a still image of the 60-s time-point of irrigation was evaluated for CS distance to WL (in millimetres) after irrigation and penetration into lateral canals (3-point scale). Statistical tests used were Kruskal-Wallis and Dunn's test. RESULTS: EndoVac-0, iNPn and iNPs had median distances of CS to WL of 0 mm, followed by SI0 (0.2 mm), SI2 (0.7 mm) and EndoVac-2 (1.7 mm). There were no significant differences between EndoVac-0, iNPn, iNPs and SI0, but these were significantly different to SI2 and EndoVac-2 (P < 0.05). There were no significant differences between the volume of CS delivered by syringe irrigation and that collected by iNPn (4 mL), but these were significantly greater than EndoVac-0 (2.8 mL, P < 0.001) and EndoVac-2 (2.85 mL, P < 0.001), which were not different to each other (P = 1.0). The irrigation procedures were ineffective at penetration into lateral canals. CONCLUSION: iNPn, EndoVac-0, iNPs and SI0 achieved greater irrigant penetration to WL. iNPn was able to collect a median volume of CS (4 mL) similar to that delivered by syringe irrigation (iNPp, SI0 and SI2). An adequate irrigant penetration into lateral canals could not be achieved by any of the systems.

Evaluation of a heart failure knowledge questionnaire and its use in guiding the educational intervention.

INTRODUCTION AND OBJECTIVE: Patient education by nurses is a cornerstone of any heart failure (HF) program, but the models are widely heterogeneous and few specific instruments exist. Our objective is to evaluate our own questionnaire and its utility as a guide for educational intervention. METHODS: This work is a prospective cohort study of patients followed-up on in a specialized unit after diagnosis of HF. The intervention group received educational sessions guided according to their knowledge using the questionnaire and was compared to a group which received standard education. The validity and reliability of the questionnaire was evaluated. The utility of the educational model was determined by the primary composite endpoint of death and/or hospital admission or emergency care for HF. RESULTS: A total of 152 patients were included, 88 which received guided education and 64 which received standard education, with a mean follow-up time of 16±4 months. In the guided education group, the evaluation questionnaire score (qs) rose from 59% to 78.5% (p=0.018), which was associated with greater self-care (28.5-0.6*qs, p=0.04), a tendency toward better quality of life (51.1-1.1*qs, p=0.09), and adherence (5.02+0.04*qs, p=0.06), with acceptable reliability (Cronbach's alpha 0.75). The primary composite endpoint was met in 12 patients (13.6%) in the intervention group compared to 19 (29.7%) in the control group (hazard ratio: 0.46; 95% confidence interval: 0.24-0.88; p=0.019). Only educational level, age, NT-proBNP, and atrial fibrillation were predictors in the multivariate analysis. CONCLUSION: The HF knowledge questionnaire proposed is a valid, reliable tool and allows for quantifying learning. Its utility in guiding education requires a certain degree of skill from the patient that determines a group with better prognosis.

Stent for the management of Esophagic Stenosis by caustics in pediatry. / Stent para el manejo de las Estenosis Esofágicas por cáusticos en pediatría.

INTRODUCTION: Esophageal stricture is one of the most serious complications of caustic ingestion in children, and may occasionally recur or be refractory to management with repeated dilations. OBJECTIVE: To pre sent a case of the use of a silicone-coated metallic stent in a child with recurrent esophageal stricture secondary to caustic ingestion. CLINICAL CASE: A 6-year-old boy with accidental caustic ingestion, with evidence of Zargar grade IIIA esophagitis in all three portions of the esophagus and a 3 cm prepyloric gastric ulcer that received initial treatment with antibiotics and corticosteroids. After 21 days, the esophageal lumen diminished in relation to the healing process, which required serial di lations. Later, he developed a punctal stenosis, so it was decided to place two silicon-coated metallic esophageal stents, which were kept for 4 months, without new stenosis episodes. CONCLUSIONS: The silicone-coated metallic stent is an alternative for the treatment of recurrent esophageal stricture due to caustic ingestion in children.

First Report on the Occurrence of Grapevine leafroll-associated virus 5 in Chilean Grapevines.

Grapevine leafroll is one of the most widespread and economically damaging viral diseases of grapevines. At least eight distinct Grapevine leafroll-associated viruses (GLRaVs), all members of the Closteroviridae family, have been associated with this disease (4). GLRaV-5 was recently reported in vineyards from Argentina (2). To determine if GLRaV-5 was present in Chilean grapevines, in addition to the previously reported GLRaV-1, -2, -3, -4, -7, and -9 (1), 45 dormant cane samples from 12 different cultivars were collected from different geographic regions of Chile and screened by reverse transcription-PCR. Two of the forty-five samples (cvs. Sauvignon Blanc and Superior) collected from the III (700 km north of Santiago) and VI (150 km south of Santiago) regions of Chile, respectively, were found to be infected with GLRaV-5 using two different pairs of virus-specific primers. The first pair of primers, LR5-1F: 5'-CCCGTGATACAAGGTAGGACA-3' and LR5-1R: 5'-CAGACTTCACCTCCTGTTAC-3' (3), was used to amplify a 690-bp fragment corresponding to a partial region of the coat protein gene. The sequences obtained from the two positive samples (GenBank Accession Nos. HM214148 and HM214149) shared 97 and 94% of nucleotide identities, respectively, with the corresponding fragment of a reference GLRaV-5 isolate (GenBank Accession No. EU815935). Both samples shared 99% of amino acid identity with the same reference isolate. A second pair of primers, LR5upF: 5'-CTCTGCTTTTCTGCTGGCA-3' and LR5doR: 5'-TATCTTTTATCTCCCGATAAACGAG-3' (4) that amplified a 160-bp fragment of the HSP70h gene was also used. The positive Chilean samples (GenBank Accession Nos. HM214150 and HM214151) shared in both cases 98% nucleotide and 98% amino acid identities with the corresponding fragment of a reference GLRaV-5 isolate (Accession No. AF039552). The two GLRaV-5-positive plants were additionally infected with other viruses previously reported in Chile (1). The cv. Sauvignon Blanc sample was also infected with GLRaV-2, Grapevine fleck virus, and Grapevine rupestris stem pitting-associated virus. The cv. Superior sample was also infected with GLRaV-3, GLRaV-4, and Grapevine virus A. References: (1) E. A. Engel et al. J. Virol. Methods 163:445, 2010. (2) S. Gomez et al. Virus Genes 38:184, 2009. (3) X. Good and J. Monis. Phytopathology 91:274, 2001. (4) V. I. Maliogka et al. J. Virol. Methods 154:41, 2008.

Analysis of historical negative control group data from the rat in vivo micronucleus assay.

A database of micronuclei counts for historical negative control data from rat in vivo micronuclei tests performed in 10 different laboratories was established. Data were available from over 4000 negative control rats from 10 laboratories. The mean frequency of micronucleated cells (MN)/1000 cells ranged from 0.44 to 2.22, a 5-fold range. Overall there were no major sex or strain differences in frequency, although there were some small but statistically significant differences within laboratories. There was appreciable variability between experiments compared with variability within experiments in some laboratories. No specific factor was identified which could explain this variability although it was noted that many different vehicles were used in the experiments. It is hoped that these data will help laboratories beginning studies with the rat micronucleus assay and those involved in the assessment of micronucleus assay results.

[Treatment with plantar supports in Müller-Weiss disease. Preliminary report]. / Tratamiento con soportes plantares en la enfermedad de Müller-Weiss. Reporte preliminar.

The objective of this work is to assess the efficacy of conservative treatment with orthopedic insoles in Müller-Weiss disease (EMW). The plantar support aims to pronounce the hindfoot and immobilize the talo-navicular, and naviculo-cuneiform joints or both at the same time, as an alternative to the valguizing osteotomy of the calcaneus and arthrodesis. The clinical and radiological characteristics of 10 cases of EMW in 8 patients under study are analyzed and the results obtained are evaluated. The manufacturing process of the plantar supports is commented, as well as the materials used. The sample size is not significant, however, preliminary, conservative treatment is possible in certain cases of EMW to relieve pain, improve gait dynamics and limit disease progression in the short-term.

El objetivo de este trabajo es valorar la eficacia del tratamiento conservador con plantillas ortopédicas en la enfermedad de Müller-Weiss (EMW). El soporte plantar tiene como objetivo pronar el retropié e inmovilizar las articulaciones talonavicular y naviculocuneiforme o ambas a la vez como alternativa a la osteotomía valguizante de calcáneo y las artrodesis. Se analizan las características clínicas y radiológicas de 10 casos de EMW en ocho pacientes objeto del estudio y se valoran los resultados obtenidos. Se comenta el proceso de fabricación de los soportes plantares así como los materiales empleados. El tamaño de la muestra no es significativo; sin embargo, de manera preliminar, el tratamiento conservador es posible en determinados casos de la EMW para aliviar el dolor, mejorar la dinámica de la marcha y limitar la progresión de la enfermedad en el corto plazo.

Lysophosphatidic acid downregulates tissue inhibitor of metalloproteinases, which are negatively involved in lysophosphatidic acid-induced cell invasion.

Ovarian cancer is a highly metastatic disease. Lysophosphatidic acid (LPA) levels are elevated in ascites from ovarian cancer patients, but its potential role in ovarian cancer metastasis has just begun to be revealed. In this work, we show that LPA stimulates invasion of primary ovarian cancer cells, but not ovarian epithelial or borderline ovarian tumor cells, although these benign cells indeed respond to LPA in cell migration. We have found that LPA downregulates tissue inhibitor of metalloproteinases (TIMPs). TIMP2 and TIMP3 play functional role in LPA-induced invasion as negative regulators. G(i) protein, phosphatidylinositol-3 kinase (PI3K), p38 mitogen-activated protein kinase (MAPK), cytosolic phospholipase A(2) and urokinase type plasminogen activator (uPA) are required for LPA-induced cells invasion. TIMP3 may affect two independent downstream targets, vascular endothelial growth factor receptor and p38 MAPK. In vivo, LPA stimulates tumor metastasis in an orthotopic ovarian tumor model, which can be inhibited by a PI3K inhibitor, LY294002. In summary, LPA is likely a key component for promoting ovarian metastasis in vivo. LPA downregulates TIMP3, which may have targets other than metalloproteinases. Our in vivo metastasis mouse model is useful for studying the efficacy of therapeutic regimes of ovarian cancer.

Ureteroarterial fistulas after radical pelvic surgery: pathogenesis, diagnosis, and therapeutic modalities.

Ureteroarterial fistulas (UAF) are a rare but potentially life-threatening complication of intra-abdominal malignancy, typically occurring after vascular or pelvic surgery. Patients with a history of radical pelvic surgery, chronic indwelling ureteral stents, and prior pelvic radiation appear to be at increased risk. The predisposing risk factors suggest that gynecological oncologists are the likely specialty to face this problem and should be familiar with the clinical presentation and etiology of UAF. We present two such cases to illustrate these salient points of clinical diagnosis and management.

First Detection of Grapevine leafroll-associated virus 4 in Chilean Grapevines.

Grapevine leafroll is one of the most widespread and economically relevant viral diseases of grapevines. At least nine distinct Grapevine leafroll-associated viruses (GLRaVs), all members of the Closteroviridae family, have been associated with this disease in grapevine. Grapevine leafroll-associated virus 4 (GLRaV-4), currently classified as a Closteroviridae member under the Ampelovirus genus, was initially described in California. To determine if GLRaV-4 was present in Chilean grapevines, in addition to the previously reported GLRaV-1, -2, -3, -7, and -9 (1,2), 35 dormant cane samples from 12 different cultivars were collected from different regions of Chile and screened by reverse transcription-PCR. Two of the 35 samples (both cv. Thompson Seedless) collected from the III and VI regions of Chile were found to be infected with GLRaV-4 using two different pairs of GLRaV-4 specific primers. The first pair of primers, HSPV-F: 5'- ACA TTC TCC ACC TTG TGC TTT T -3' and HSPC-R: 5'- CAT ACA AGC GAG TGC AAT TAC -3' (3), was used to amplify a 321-bp fragment corresponding to a partial region of the HSP70h gene. The sequence (GenBank Accession Nos. EU746618 and EU746619) from both positive samples shared 98.4% nucleotide identity and approximately 99% identity with the corresponding fragment of a Californian GLRaV-4 isolate (GenBank Accession No. AF039553). Since there are no commercial antibodies available for GLRaV-4 detection, a second pair of primers, LR4CPINT-F: 5'- GAG AGT GAC AAG CAC CAG GTG C -3' and LR4CPFIN-R: 5'- TCA CCT CCT GTT GCC CA -3' (4), that amplified a 492-bp fragment of the coat protein gene was also used. The sequences of the 492-bp fragment from both Chilean samples (GenBank Accession Nos. EU746620 and EU746621) shared 99.6% nucleotide identity with one another and had 96.5% identity with an Israeli GLRaV-4 isolate (GenBank Accession No. AM176759). To our knowledge, this is the first report of GLRaV-4 in Chile. Further studies will help to establish the effects and incidence of this virus in Chilean grapevines. References: (1) E. Engel et al. Plant Dis. 92:1252, 2008 (2) N. Fiore et al. J. Plant Pathol. 90:125, 2008. (3) F. Osman et al. J. Virol. Methods 141:22, 2007. (4) P. Saldarelli et al. J. Plant Pathol. 88:203, 2006.

First Report on the Occurrence of Grapevine leafroll-associated virus 7 and 9 in Chilean Grapevines.

Grapevine is one of the oldest horticultural crops and represents a highly valuable agricultural commodity. So far, nine distinct Grapevine leafroll-associated viruses (GLRaVs) within the Closteroviridae family have been found to be associated with grapevine leafroll disease (3). Previous studies have demonstrated a high incidence of GLRaV-1, -2, and -3 in Chile (2). To determine if other GLRaVs were present, 21 dormant cane samples were screened with a comprehensive 70-mer oligonucleotide microarray designed to simultaneously detect all grapevine viruses with total or partial genomic sequence available. The array contained 570 unique probes designed against specific regions of more than 40 viral genomes (E. Engel et al., 15th ICVG [Abstr.], 2006). One sample (cv. Black Seedless) showing a microarray hybridization pattern compatible with a mixed infection of GLRaV-7 and GLRaV-1 was analyzed by ELISA using GLRaV-7 specific antibodies (Agritest, Valenzano, Italy) and reverse transcription (RT)-PCR using virus-specific primers LR7-F: 5'- TAT ATC CCA ACG GAG ATG GC -3' and LR7-R: 5'- ATG TTC CTC CAC CAA AAT CG -3' (based on GenBank Accession No. Y15987). The serological analysis confirmed the presence of GLRaV-7 with further confirmation by the RT-PCR product of 502 bp corresponding to a fragment of the HSP70h gene that was cloned and sequenced. The Chilean GLRaV-7 sequence (GenBank Accession No. EU334662) showed 94% nucleotide and 95% amino acid identity when compared with a corresponding region of another GLRaV-7 isolate from Albania (GenBank Accession No. Y15987). GLRaV-1 infection was confirmed by ELISA (Bioreba AG, Reinach, Switzerland) and RT-PCR. A second sample (cv. Tintorera) showing microarray hybridization pattern compatible with a mixed infection of GLRaV-9 and Grapevine virus A (GVA) was analyzed by RT-PCR using virus-specific primers LR9-F: 5'- CGG CAT AAG AAA AGA TGG CAC -3' and LR9-R: 5'- TCA TTC ACC ACT GCT TGA AC -3' (1). The RT-PCR product of 393 bp corresponding to a fragment of the HSP70h gene was cloned and sequenced (GenBank Accession No. EU334663), showing 94% nucleotide and 95% amino acid identity when compared with a corresponding region of another GLRaV-9 isolate from the United States (GenBank Accession No. AY297819). Since there are no commercial antibodies available for GLRaV-9 detection, a second pair of primers, LR9-F1: 5'- AAA GGT TTC TGC TGG TTA CC -3' and LR9-R1: 5'- CTT TCA GAA CAG TCC TCC TC -3' that amplified a fragment of ORF1a was also used. The 301-bp product was cloned and sequenced (GenBank Accession No. EU588989) showing 93.7% nucleotide and 98% amino acid identity when compared with a corresponding region of another GLRaV-9 isolate (GenBank Accession No. AY297819). GVA infection was confirmed by ELISA (Bioreba AG) and RT-PCR. To our knowledge, this is the first report of GLRaV-7 and GLRaV-9 in Chile. Further studies will help determine the effect and incidence of these viruses in Chilean grapevines. References: (1) R. Alkowni et al. J. Plant Pathol. 86:123, 2004. (2) N. Fiore et al. J. Plant Pathol. 90:125, 2008. (3) G. P. Martelli and E. Boudon-Padieu. Options Méditerr. B55, 2006.

Breast papillomas: current management with a focus on a new diagnostic and therapeutic modality.

Breast papilloma is a term that describes an intraductal papillary configuration of the mammary epithelium on macroscopic or microscopic examination. It includes solitary intraductal papillomas, multiple papillomas, papillomatosis, and juvenile papillomatosis (JP).Recent advances in mammary ductoscopy (MD) have raised new possibilities in the diagnosis and treatment of breast papillomas. This technique represents an important diagnostic adjunct in patients with pathological nipple discharge (PND) by allowing direct visualisation and biopsy of intraductal lesions and guiding duct excision surgery. Treatment of breast papillomas often entails surgical duct excision for symptomatic relief and histopathological examination. Recently, more conservative approach has been adapted. MD-assisted microdochectomy should be considered the procedure of choice for a papilloma-related single duct discharge. Furthermore, there is increasing evidence that MD has the potential to reduce the number of duct excision procedures and minimise the extent of surgical resection. Imaging-guided vacuum-assisted core biopsy can be diagnostic and therapeutic for papillomas seen on mammography and/or ultrasound. Patients with multiple papillomas do have an increased risk of developing cancer and should be kept under annual review with regular mammography (preferably digital mammography) if treated conservatively. Magnetic resonance (MR) can be also used in surveillance in view of its high sensitivity. Because the risk is small, long term and affects both breasts, long-term follow-up is more appropriate than prophylactic mastectomy. Patients who prove to have solitary duct papilloma have insufficient increase in the risk of subsequent malignancy to justify routine follow-up.

A New Synthetic Peptide with In vitro Antibacterial Potential Against Escherichia coli O157:H7 and Methicillin-Resistant Staphylococcus aureus (MRSA).

In this work, we performed the rational design of a cationic antimicrobial peptide, GIBIMPY4, using the software DEPRAMPs developed at the GIBIM research group. GIBIMPY4 has a length of 17 amino acids, it is amphipathic, its structure is α-helix and it has a net charge of (+5). Solid-phase peptide synthesis was performed using the Fmoc strategy in acid medium. The primary structure was confirmed by MALDI-TOF mass spectrometry. The antimicrobial activity of the peptide was evaluated by broth microdilution method by measuring optical density in 96-well microplates. The minimal inhibitory concentration of GIBIMPY4 to kill 50 % of the bacterial cells (MIC50) was 6.20 ± 0.02 µM for MRSA and 4.55 ± 0.02 µM for E. coli O157:H7, while also reporting a bacteriostatic effect for the later. GIBIMPY4 activity was sensitive to salt concentration in E. coli but insignificant effect in its activity against MRSA. The peptide seems to be a broad-spectrum antimicrobial agent based on the results against Gram-positive and Gram-negative bacteria and was specific for bacterial cells E. coli O157:H7 with index of specificity equal to 9.01 in vitro assays.

Tratamiento con soportes plantares en la enfermedad de Müller-Weiss. Reporte preliminar / Treatment with plantar supports in Müller-Weiss disease. Preliminary report

Resumen: El objetivo de este trabajo es valorar la eficacia del tratamiento conservador con plantillas ortopédicas en la enfermedad de Müller-Weiss (EMW). El soporte plantar tiene como objetivo pronar el retropié e inmovilizar las articulaciones talonavicular y naviculocuneiforme o ambas a la vez como alternativa a la osteotomía valguizante de calcáneo y las artrodesis. Se analizan las características clínicas y radiológicas de 10 casos de EMW en ocho pacientes objeto del estudio y se valoran los resultados obtenidos. Se comenta el proceso de fabricación de los soportes plantares así como los materiales empleados. El tamaño de la muestra no es significativo; sin embargo, de manera preliminar, el tratamiento conservador es posible en determinados casos de la EMW para aliviar el dolor, mejorar la dinámica de la marcha y limitar la progresión de la enfermedad en el corto plazo.

Abstract: The objective of this work is to assess the efficacy of conservative treatment with orthopedic insoles in Müller-Weiss disease (EMW). The plantar support aims to pronounce the hindfoot and immobilize the talo-navicular, and naviculo-cuneiform joints or both at the same time, as an alternative to the valguizing osteotomy of the calcaneus and arthrodesis. The clinical and radiological characteristics of 10 cases of EMW in 8 patients under study are analyzed and the results obtained are evaluated. The manufacturing process of the plantar supports is commented, as well as the materials used. The sample size is not significant, however, preliminary, conservative treatment is possible in certain cases of EMW to relieve pain, improve gait dynamics and limit disease progression in the short-term.

The effect of levodopa on vocal function in Parkinson's disease.

Phonatory and articulatory dysfunctions are frequent observations in Parkinson's disease. We have investigated, using acoustic measures, the effects of levodopa treatment on vocal function in 20 patients with Parkinson's disease before and after levodopa. These patients were also compared with a matched control group. The mean age was 63.5 +/- 9.66 years, Hoehn-Yahr stage was 2.38 +/- 0.45, and onset mean age was 56.5 +/- 10.36 years. Paired Wilcoxon tests were performed to compare measurements before and after levodopa. The acoustic analysis using Computerized Speech Lab and MultiDimensional Voice Program software programs (Kay Elemetrics, Lincoln Park, NJ, USA) showed that measurements of fundamental frequency (p < 0.017) were significantly increased after medication, whereas short-term frequency perturbation jitter (p < 0.033), soft phonation index (noise parameter) (p < 0.015 ), and frequency tremor intensity index (p < 0.018) were significantly decreased after medication. The objective measurements of acoustic analysis are useful in evaluating the dopaminergic pharmacologic response in Parkinson's disease. The improvement in fundamental frequency and other vocal parameters may be a result of decrease in laryngeal hypokinesia and rigidity.

[Changes in plasma lipoproteins in Mediterranean boutonneuse fever]. / Modifications des lipoprotéines plasmatiques au cours de la fièvre boutonneuse méditerranéenne.

We report 25 cases of boutonneuse fever with, in the acute phase, an increase of plasma transaminases, triglycerides and apoprotein B levels, a decrease of total, HDL and LDL cholesterol and a decrease of apoprotein A. These changes disappeared 1 to 4 weeks after the beginning of treatment. They might be due to a reduced activity of lecithin-cholesterol acetyltransferase and lipoprotein lipase, probably caused by the hepatic and vascular disorders frequently found in this disease.

Management of chronic pain.

Pain is an unpleasant, subjective experience which escapes objective measurements. It is the normal response to the disruption of healthy tissues, but its persistence beyond the period of healing should alert the practitioner to other unrecognized causes. On the other hand, learned pain is a condition resulting mainly from socio-emotional factors in the absence of progressive, invasive and, most of the time, demonstrable pathology. The key to success in the management of a painful condition is an accurate diagnosis followed by appropriate intervention and treatment. A complete history and a detailed physical examination, complemented by ancillary laboratory tests and consultations, when necessary, offer the best approach to initial management. This article discusses the pathophysiology of pain, the diagnostic approach and therapeutic interventions for evaluation and management of pain patients. The role of multiple factors as reinforcers of pain behavior deserves careful attention, and a comprehensive, multi-disciplinary approach may be indicated in selected cases.

[Giant ethmoid neurinoma with intracranial extension]. / Neurinoma etmoidal gigante con extensión intracraneal.

The schwannomas are tumors arising from nervous tissue. It appears very rarely in the nose and paranasal sinuses. Intra and extracraneal extension of these tumors are even more uncommon. In this paper we report a case of a esfeno-ethmoidal schwannoma with anterior skull fossa extension. We describe the CT scan and magnetic resonance imaging and the histological features. Surgical resection was carried through a craniofacial approach. Some data about diagnosis, treatment and outcome of these tumors are revised.

[Lymphoma of the nasal cavity, clinical and anatomo-pathologic considerations]. / Linfomas de fosas nasales, consideraciones clínicas y anatomo-patológicas.

Six cases of high-grade lymphoma affecting the nasal cavity are presented. Their main symptoms were nasal obstruction, epistaxis and rhinorrea. Clinical exploration showed an ulcerated lesion in four patients (all of them T/NK cell lymphomas) and an exofitic tumour in the other two (B cell lymphomas). Pathology was diagnostic for high grade lymphoma in all the six cases, immunohistochemical studies revealed that the atypical cells were T/NK in 4 cases and B in the other two cases. Genotypic analysis was done looking for rearrangement of the genes for Ig H or T-cell receptors. In situ hybridisation was done to detect Epstein-Barr virus RNA. Malignant lymphomas arising in the nasal cavity are unusual, its major prognostic factor is the clinical stage at presentation. To perform an early diagnosis this neoplasia must be suspected in the presence of an exofitic tumour (B cell lymphoma) or necrotic and ulcerated lesion (T/NK cell lymphoma).