Myotonometry as a measure to detect myofascial trigger points: an inter-rater reliability study.

OBJECTIVE: Several diagnostic methods have been used in the identification of mechanical properties of skeletal muscle, including myofascial trigger points (MTrPs), however, they are not suitable for daily clinical use. Myotonometry offers an easy noninvasive alternative to assess these muscle properties. Nevertheless, previous research has not yet studied the mechanical properties of MTrPs by myotonometry. The purposes of this study were (1) to analyze the differences in the mechanical properties between latent MTrPs and their taut bands by myotonometry, (2) to investigate the inter-rater reproducibility of myotonometric measurements, and (3) to examine the association between myotonometry and passive isokinetic dynamometry. APPROACH: Fifty individuals (58% male; age 24.6 ± 7.9 years) with a latent medial MTrP of the right soleus muscle participated. The mechanical properties of this MTrP area of soleus muscle and its taut band area were measured using a myotonometer (MyotonPRO). Additionally, passive resistive torque and extensibility of triceps surae muscle were assessed using a Kin-Com dynamometer. MAIN RESULTS: Statistical analysis indicated higher values for the stiffness parameter in the taut band with respect to the MTrP (P < 0.05). The inter-rater reliability of the myotonometric measurements was good for all variables (ICC3,1 > 0.75). The standard error of measurement (SEM) and minimal detectable difference (MDD) indicated a small measurement error for frequency and stiffness variables (SEM% < 10%; MDD95% < 20%). Significant fair correlations between myotonometric parameters and passive isokinetic parameters ranged from -0.29 to 0.48 (P < 0.05). SIGNIFICANCE: The myotonometer was demonstrated to be a reliable tool and was able to quantify differences in the mechanical properties of myofascial tissues. The potential of this method for the assessment of myofascial pain syndromes requires further investigation.

[Musculoskeletal hydatidosis: an unusual location]. / Hidatidosis musculoesquelética: una localización atípica.

Hydatidosis is a zoonosis with a continuing high prevalence in our environment. The most commonly affected organs are the lungs and the liver, with the musculoskeletal location being considered an unusual one. We comment the case of a patient who presented a series of lesions in his left iliac crest and middle left buttock with spontaneous fistulization to the skin surface. In this case a combined treatment was given; prior to the surgical operation we administered a cycle of albendazol. Following removal of the lesion, the patient was given two further cycles of albendazol in order to minimize the risk of a recurrence of the illness. This patient is currently free of any symptoms relating to this illness.

Team-teaching in an integrated classroom: perceptions of deaf and hearing teachers.

This study examined the perceptions of teams of two teachers, one deaf and one hearing, team-teaching students who are deaf and hard-of-hearing (D/HH) in co-enrolled classrooms. Five teachers who had worked in teams and their supervisor were interviewed about their team-teaching experiences and their perception of the effectiveness of this approach. Informants' responses were videotaped, transcribed, and analyzed. From the interview data, four main categories were identified: (1) philosophy of education, (2) perception of roles, (3) benefits of team-teaching, and (4) challenges. Findings revealed that team-teaching in co-enrolled classrooms gave all students access to their own and each other's cultures, languages, and social identities; deaf and hearing people were seen to have equality of status and students who are D/HH were seen to benefit from teachers' high expectations.

Is it possible to increase bioavailability but not environmental risk of PAHs in bioremediation?

The current poor predictability of end points associated with the bioremediation of polycyclic aromatic hydrocarbons (PAHs) is a large limitation when evaluating its viability for treating contaminated soils and sediments. However, we have seen a wide range of innovations in recent years, such as an the improved use of surfactants, the chemotactic mobilization of bacterial inoculants, the selective biostimulation at pollutant interfaces, rhizoremediation and electrobioremediation, which increase the bioavailability of PAHs but do not necessarily increase the risk to the environment. The integration of these strategies into practical remediation protocols would be beneficial to the bioremediation industry, as well as improve the quality of the environment.

Peritonectomía con quimioterapia intraperitoneal hipertérmica en el tratamiento del tumor de Krukenberg. A propósito de un caso clínico / Peritonectomy with hyperthermic intraperitoneal chemotherapy in the treatment of Krukenberg tumor. A clinical case

Resumen ANTECEDENTES: el tumor de Krukenberg es una neoplasia caracterizada por metástasis ováricas de origen digestivo. El diagnóstico se establece en estadios avanzados de la enfermedad, mediante pruebas de imagen y determinación de marcadores inmunorreactivos relacionados con enfermedades del aparato digestivo. En la mayoría de los casos existe afectación bilateral en ambos anejos. OBJETIVO: reportar el caso de una paciente con tumor de Krukenberg. CASO CLÍNICO: paciente de 41 años de edad, intervenida de cáncer de mama hacía 10 años como único antecedente ginecológico de interés. Se diagnosticó con metástasis ovárica de adenocarcinoma gástrico primario, tratada con cirugía radical y quimioterapia hipertérmica intraperitoneal, con supervivencia de casi dos años entre el diagnóstico del tumor y su fallecimiento. CONCLUSIÓN: el tratamiento de estas neoplasias es muy agresivo, incluye cirugías radicales (peritonectomía) asociadas con quimioterapia para la carcinomatosis concomitante y técnicas hipertérmicas intraperitoneales. La supervivencia varía en función de las series reportadas y, en términos generales, se considera una neoplasia de muy mal pronóstico

Abstract BACKGROUND: These tumors are defined as metastatic ovarian adenocarcinomas of usually digestive origin. The few symptoms usually occurs when the disease is in advanced stages and, in most cases, with bilateral extension to both annexes. Krukenberg tumors frequently appear in young patients. Diagnosis is based on imaging tests and on the sensitivity of these tumors to specific immunoreactive markers, especially to those related to diseases of the digestive tract. OBJECTIVE: report the case of a patient with Krukenberg tumor. CLINICAL CASE: present the case of a patient who underwent breast cancer surgery 10 years ago as the only gynecological history of interest, who was diagnosed with ovarian metastases of primary gastric adenocarcinoma, treated with radical surgery plus intraperitoneal hyperthermic chemotherapy, and with survival of almost two years between tumor diagnosis and patient exitus. CONCLUSION: These therapies include radical surgeries such as peritonectomy, chemotherapy treatments aimed at treating associated carcinomatosis, and hyperthermic intraperitoneal techniques. Survival can vary depending on the series, and it is generally considered a disease of very poor prognosis.

Muerte materna por embolismo de líquido amniótico después de una cesárea. Patología obstétrica de alta morbilidad y mortalidad / Maternal death due to amniotic fluid embolism after cesarean section. Obstetric pathology with high morbimortality

Resumen OBJETIVO: reportar el caso de una paciente embarazada, a quien se le efectuó una cesárea por situación fetal transversa, con descompensación hemodinámica provocada por hemorragia posparto de origen desconocido y que finalizó en muerte materna. CASO CLÍNICO: gestante de 40 años, multípara, a quien se efectuó una cesárea por situación fetal transversa y posteriormente sufrió descompensación hemodinámica como consecuencia de hemorragia postparto. La paciente falleció y en la autopsia se confirmó, como causa de muerte, embolia de líquido amniótico. La embolia de líquido amniótico es una alteración extremadamente rara, asociada con el paso de componentes amnióticos y fetales a la circulación pulmonar materna. Su diagnóstico es poco frecuente, cuya confirmación se establece mediante autopsia en la mayoría de los casos.

Abstract OBJECTIVE: To report the clinical case of a pregnant patient, who underwent a cesarean section due to a transverse fetal situation, with hemodynamic decompensating caused by postpartum haemorrhage of unknown origin and ending in maternal death. CLINICAL CASE: a 40-year-old multiparous patient, who in the context of a caesarean section for fetal transverse situation, suffers hemodynamic decompensating as a result of postpartum hemorrhage. The patient died, whose autopsy later confirmed amniotic fluid embolism as the cause of death Amniotic fluid embolism is a condition of extreme gravity produced by the anaphylactic reaction and obstruction of maternal circulation, derived from the passage of amniotic fluid with cells, fetal hair, or mother fluids to the bloodstream.

[Self-perception of health in non-institutionalised elderly]. / Autopercepción de salud en ancianos no institucionalizados.

OBJECTIVE: To evaluate the self-perception of health (SH) of non-institutionalised over-65s. To relate this SH to age, sex, social and economic level, and use of health services. DESIGN: Descriptive cross-sectional study on a sample stratified by age and sex. SETTING: City of Avila.Participants. 425 interviews representative of the census of the over-65s, using the SF-36 Health Questionnaire and a complementary questionnaire to gather information on social and economic levels and use of health services. MAIN RESULTS: The QWB well-being index was at 0.67 (0.69 men; 0.65 women), dropping with age (0.70 in < 70s; 0.59 in > 84 years old). The highest scores on the questionnaire were in the dimensions social function (81.1) and emotional role (79.8); and the worst in general health (51.9) and vitality (58.5), with men always having higher scores (p < 0.05, except in physical function [p = 0.05] and general health [p = 0.47]). At greater ages the scores were worse, with physical function (-50.6%) and physical role (-45.7%) more affected by age, and mental health (-12.1%), general health (-16.1%) and emotional role (-17.8%) less affected. Men perceived their health as more stable than women did (63.7% vs. 44.6%; p < 0.001). There was self-perception of better health, the higher the social and economic levels (p < 0.05 in all dimensions), the greater the educational level reached (p < 0.05 except in social function) and the less the health services were used (p < 0.05, except for mental health-hospital admission). CONCLUSIONS: The Index of Well-being of our elderly people is comparable to that recorded in other samples. Men had self-perception of better health than women and saw their health as more stable. SH gets significantly worse with age. Higher economic and social levels and less use of health services are related to better SH.