Appraisal of surgical treatment of 47 cases of patellofemoral instability

INTRODUCTION: Patellofemoral instability is a common knee disease. Its etiology is complex and variable, with many components making different contributions in each individual, resulting in several distinct clinical presentations. Our goal was to analyze the results of surgical treatment in our hospital over a period of 10 years. PATIENTS AND METHODS: We analyzed 55 knees of 47 patients who underwent surgery for patellofemoral instability and were classified into 2 main groups: proximal realignment and combined proximal and distal realignment. Three other groups were analyzed according to the duration of preoperative symptoms: less than 1 year (group I); 1 to 10 years (group II); and more than 10 years (group III). RESULTS: There were 62% good results overall, with 78% good results in groups I and II. Group III had 81% bad results, showing that a late diagnosis of advanced disease results in a poor prognosis. In addition to late diagnosis, bad results were usually associated with incorrect diagnosis or choice of surgical technique. There was no significant difference between isolated proximal realignment and combined proximal and distal realignment in groups I or II, but in group III, the combined technique yielded better results. DISCUSSION: Our results indicate that patellofemoral instability should be addressed in its early stages. Patients with long-lasting symptoms or more severe disease seem to achieve better results with combined techniques. CONCLUSION: Proximal and distal realignments produce better results than isolated proximal realignment in patients with joint degeneration or with greater duration of disease. The realignment surgery does not produce good results in patients with advanced disease.

Epidemiologie und Behandlung von Brustkrebs im Wallis 2008-2010

Im Rahmen der Zusammenarbeit zwischen dem Walliser Krebsregister (WKR), dem Walliser Gesundheitsobservatorium (WGO) und dem Walliser Departement Onkologie wurde beschlossen, eine Studie über die Epidemiologie und die Behandlung von Brustkrebs im Wallis zwischen 2008 und 2010 durchzuführen. Ziel dieser Studie ist es, die Häufigkeit, die Art der Entdeckung, die Behandlungen sowie die 1- und 2-JahresÜberlebensraten von Brustkrebs im Wallis zu beschreiben. Brustkrebs ist die häufigste Krebserkrankung und die zweithäufigste Krebstodesursache bei den Frauen im Wallis. Zwischen 2008 und 2010 wurden im Wallis 836 Fälle von Brustkrebs diagnostiziert. 90% der Karzinome sind invasiv und 10% in situ. Das Durchschnittsalter bei der Diagnosestellung beträgt 62 Jahre. 10% der Karzinome befinden sich im Stadium 0 (Carcinoma in situ), 38% im Stadium I, 36% im Stadium II, 10% im Stadium III und 4% im Stadium IV. 55% der Fälle werden durch ein individuelles (31%) oder organisiertes (23%) Screening entdeckt. 78% der Fälle werden an einem Tumorboard besprochen.

Spectrum of gluten sensitive enteropathy in first degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.

Background: Limited data on a short series of patients suggest that lymphocytic enteritis (classically considered as latent coeliac disease) may produce symptoms of malabsorption, although the true prevalence of this situation is unknown. Serological markers of coeliac disease are of little diagnostic value in identifying these patients. Aims: To evaluate the usefulness of human leucocyte antigen-DQ2 genotyping followed by duodenal biopsy for the detection of gluten-sensitive enteropathy in first-degree relatives of patients with coeliac disease and to assess the clinical relevance of lymphocytic enteritis diagnosed with this screening strategy. Patients and methods: 221 first-degree relatives of 82 DQ2+ patients with coeliac disease were consecutively included. Duodenal biopsy (for histological examination and tissue transglutaminase antibody assay in culture supernatant) was carried out on all DQ2+ relatives. Clinical features, biochemical parameters and bone mineral density were recorded. Results: 130 relatives (58.8%) were DQ2+, showing the following histological stages: 64 (49.2%) Marsh 0; 32 (24.6%) Marsh I; 1 (0.8%) Marsh II; 13 (10.0%) Marsh III; 15.4% refused the biopsy. 49 relatives showed gluten sensitive enteropathy, 46 with histological abnormalities and 3 with Marsh 0 but positive tissue transglutaminase antibody in culture supernatant. Only 17 of 221 relatives had positive serological markers. Differences in the diagnostic yield between the proposed strategy and serology were significant (22.2% v 7.2%, p<0.001). Relatives with Marsh I and Marsh II¿III were more often symptomatic (56.3% and 53.8%, respectively) than relatives with normal mucosa (21.1%; p=0.002). Marsh I relatives had more severe abdominal pain (p=0.006), severe distension (p=0.047) and anaemia (p=0.038) than those with Marsh 0. The prevalence of abnormal bone mineral density was similar in relatives with Marsh I (37%) and Marsh III (44.4%). Conclusions: The high number of symptomatic patients with lymphocytic enteritis (Marsh I) supports the need for a strategy based on human leucocyte antigen-DQ2 genotyping followed by duodenal biopsy in relatives of patients with coeliac disease and modifies the current concept that villous atrophy is required to prescribe a gluten-free diet.

Restrição alimentar e atividade ovariana luteal cíclica pós-parto em vacas girolanda

Objetivou-se neste trabalho verificar se a restrição alimentar no pós-partoem vacas Girolanda, multíparas, de bom escore de condição corporal (ECC = 3,5 a 4,5) ao parto será suficiente para impedir o reinício da atividade ovariana luteal cíclica (AOLC) pós-parto.Os animais foram distribuídos em três tratamentos: Grupo I (n = 15), mantença; Grupo II (n = 10) e Grupo III (n = 13), sendo que os grupos II e III receberam restrição alimentar até 90 e 180 dias pós-parto, respectivamente. As pesagens e avaliações do ECC foram efetuadas logo após o parto, e depois semanalmente. A AOLC foi avaliada por palpação retal, observação de cio e concentração de progesterona no leite. Os intervalos do parto ao primeiro cio foram de 53,1, 63,2 e 51,2 dias (P>0,05), respectivamente para os Grupos I, II e III, que apresentaram perdas de peso de 7,3 kg, 57,0 kg e 63,7 kg nesse período; e de 14,2 kg, 63,8 kg e 78,4 kg do parto até 90 dias pós-parto, repectivamente. Em vacas Girolanda de bom escore de condição corporal ao parto, a perda de 15,2% do peso nos três primeiros meses de lactação, e de 16,3% do peso até 180 dias pós-parto, não é suficiente para atrasar o reinício ou interromper a AOLC nos respectivos períodos.

Les critères STOPP/START.v2 : adaptation en langue française. [STOPP/START.v2 criteria: Adaptation into French language]

Objectif STOPP/START est un outil de détection de la prescription médicamenteuse potentiellement inappropriée chez la personne de 65 ans ou plus. La version initiale de 2008 vient d'être mise à jour et améliorée par ses auteurs. Nous en présentons l'adaptation et la validation en langue française. Méthodes L'adaptation en français de l'outil STOPP/START.v2 a été réalisée par deux experts, confirmée par la méthode de traduction-inverse, et finalisée d'après les commentaires de neufs évaluateurs francophones, gériatres, pharmaciens cliniciens, et médecin généraliste de quatre pays (France, Belgique, Suisse, Canada). La validation a été complétée par une analyse de concordance inter-juge (CCI) des critères STOPP/START.v2 appliqués à dix vignettes cliniques standardisées. Résultats Les 115 critères de STOPP/START.v2 en français sont, par rapport à la version originale anglaise, identiques par leur classification mais adaptés en termes de présentation (critères START.v2 commençant par la condition clinique, et accompagnés par une justification du caractère inapproprié de l'omission) voire de formulation de certains critères. Cette adaptation en français est validée par (i) la traduction-inverse montrant le respect du sens clinique de la version originale, (ii) l'identification semblable des critères lorsque appliqués à dix vignettes cliniques par les neuf évaluateurs, et (iii) le haut niveau de concordance de ces neuf évaluations tant pour STOPP.v2 (CCI 0,849) que pour START.v2 (CCI 0,921). Conclusion L'adaptation en langue française des critères STOPP/START.v2 fournit aux cliniciens un outil de détection de la prescription médicamenteuse potentiellement inappropriée chez les personnes de 65 ans et plus qui est logique, fiable et facile à utiliser. Objective STOPP/START is a screening tool to detect potentially inappropriate prescribing in persons aged 65 or older. Its Irish authors recently updated and improved the initially published version of 2008. We present the adaptation and validation into French language of this updated tool. Methods STOPP/START.v2 was adapted into French by two experts, then confirmed by a translation-back translation method and finalised according to the comments of nine French-speaking assessors - geriatricians, pharmacologists and a general physician - from four countries (France, Belgium, Switzerland, and Canada). The validation was completed by an inter-rater reliability (IRR) analysis of the STOPP/START.v2 criteria applied to 10 standardized clinical vignettes. Results In comparison to the original English version, the 115 STOPP/START.v2 criteria in French language classify in identical manner, but the presentation has been adjusted (START.v2 first specifies the clinical condition followed by an explanation of the inappropriateness of the prescription or omission). This adaptation into French language was validated by means of (i) the translation/back-translation, which showed that the French version complied with the clinical meaning of the original criteria; (ii) the similar screening results when applied by the nine specialists to the 10 cases; and (iii) the high level of inter-rater reliability of these 9 evaluations, for both STOPP (IRR 0.849) and START.v2 (IRR 0.921). Conclusion The adaptation into French of the STOPP/START.v2 criteria provides clinicians with a screening tool to detect potentially inappropriate prescribing in patients aged 65 and older that is more logical, more reliable and easier to use.

Peritonite infecciosa com quantitativos e qualitativos bacterianos conhecidos: estudo experimental em ratos

O objetivo deste estudo é o desenvolvimento de peritonite difusa com qualitativos e quantitativos bacterianos conhecidos. Foram analisados 150 ratos, adultos, machos, da raça Wistar, com peso médio de 150 gramas. Inocularam-se, percutaneamente, na cavidade peritoneal, suspensões constituídas de Escherichia coli e Bacteróides fragilis em concentrações conhecidas, na proporção de 1 ml para cada 100 gramas de peso. Os animais foram distribuídos em cinco grupos de trinta ratos. No grupo I (grupo-controle) inoculou-se solução de cloreto de sódio a 0,9%. Nos demais grupos a concentração do inóculo foi a seguinte: grupo II, com suspensão a 10 (9); grupo III, com suspensão a 10 (8): grupo IV, suspensão a 10 (7) e grupo V com suspensão a 10 (6). Sempre que se detectou o óbito, o animal era submetido à necropsia para avaliação da cavidade peritoneal e colheita de secreções para cultura. Os ratos sobreviventes foram aleatoriamente alocados em dois subgrupos. Os animais do subgrupo A foram sacrificados 24 horas após a inoculação e os do subgrupo B, 120 horas após a inoculação. Observou-se que os ratos do grupo I (controle) evoluíram sem o desenvolvimento de peritonite. Nos grupos II e III,100% dos ratos do subgrupo A e 95,83% dos ratos do subgrupo B desenvolveram peritonite aguda e óbito em menos de 24 horas. No grupo IV, somente 4,17% desenvolveram peritonite e foram a óbito em 72 horas, e no grupo V não ocorreu a formação de peritonite e não houve óbito. Os animais que foram a óbito dos grupos II e III, 96,67% mostraram alterações macroscópicas com exsudato peritoneal difuso, aderências peritoneais mas sem abscesso. Todos os animais com peritonite, desenvolveram derrame pleural bilateral. Nos animais que foram a óbito, nos grupos II e III, evidenciou-se a presença de Escherichia coli e Bacteroides fragilis como causadores das alterações peritoneais e pleurais. Este modelo mostrou que os animais que receberam altas concentrações bacterianas mostraram maior perda de peso, alterações clínicas de sepsis, peritonite difusa aguda, derrame pleural e óbito precoce.

Influência do grau de bipartição escrotal sobre parâmetros reprodutivos de caprinos

Avaliou-se a influência do grau de bipartição escrotal sobre os parâmetros reprodutivos em caprinos. Foram utilizados 30 animais, distribuídos em três grupos: Grupo I, animais que apresentavam escroto sem bipartição (n =10); Grupo II, animais com bipartição escrotal até 50% do comprimento dos testículos (n=10); e Grupo III, caprinos com bipartição escrotal acima de 50% do comprimento testicular (n=10). Os parâmetros avaliados foram peso corporal, perímetro escrotal, comprimento testicular, características físicas e morfológicas do sêmen, concentração plasmática de testosterona e libido dos animais, comparando caprinos com escroto bipartido e não bipartido. Os animais que apresentavam bipartição escrotal expressaram maior peso corporal e comprimento testicular, quando comparados com os animais do grupo sem escroto bipartido, sendo que estes apresentaram maior número de células espermáticas defeituosas. Conclui-se que a bipartição escrotal influencia positivamente alguns parâmetros biométricos bem como a qualidade do sêmen em caprinos.

Doença do disco intervertebral cervical em cães: 28 casos (2003-2008)

O objetivo deste estudo foi identificar cães com doença do disco intervertebral (DDIV) cervical atendidos no Hospital Veterinário Universitário (HVU) da Universidade Federal de Santa Maria (UFSM) entre janeiro de 2003 e outubro de 2008 e obter informações a respeito de raça, sexo, idade, sinais neurológicos, resposta ao tratamento cirúrgico, complicações, tempo de recuperação funcional após a cirurgia e ocorrência de recidiva. Hiperestesia cervical foi observada em todos os cães (n=28). Quanto ao grau de disfunção neurológica foram verificados: grau I (8/28[28,5%]), grau II (3/28 [10,7%]), grau III (5/28[17,8%]) e grau V (12/2 [42,8%]). A duração dos sinais neurológicos antes da cirurgia em sete cães (25%) permaneceu por até 15 dias, em 14 cães (50%) entre 15 e 30 dias e nos outros sete cães (25%) por mais de 30 dias. A recuperação satisfatória e sem recidiva foi observada em todos os cães submetidos ao tratamento cirúrgico e que sobreviveram (n=21). Pode-se concluir que a DDIV cervical em nossa rotina acomete principalmente cães adultos, machos, de raças condrodistróficas e não condrodistróficas, incluindo as de grande porte; a hiperestesia cervical é a principal manifestação clínica; a técnica de fenda ventral promove recuperação funcional satisfatória e sem recidiva; as principais complicações trans-operatórias são a hemorragia do plexo venoso, a bradicardia e a hipotensão; e a duração dos sinais clínicos não interfere no tempo de recuperação pós-operatória dos cães.

Prolactin and cortisol levels in women with endometriosis

Endometriosis is a progressive estrogen-dependent disease affecting women during their reproductive years. The objective of the present study was to investigate whether endometriosis is associated with stress parameters. We determined cortisol and prolactin levels in serum, peritoneal and follicular fluid from infertile women with endometriosis and fertile women without the disease. The extent of the disease was staged according to the revised American Fertility Society classification (1997). Serum and peritoneal fluid were collected from 49 women aged 19 to 39 years undergoing laparoscopy. Eighteen women had stage I-II endometriosis and 10 had stage III-IV. Controls were 21 women undergoing laparoscopy for tubal sterilization. Follicular fluid was obtained from 39 women aged 25-39 years undergoing in vitro fertilization (21 infertile women with endometriosis and 18 infertile women without endometriosis). Serum prolactin levels were significantly higher in infertile women with stage III-IV endometriosis (28.9 ± 2.1 ng/mL) than in healthy controls (13.2 ± 2.1 ng/mL). Serum cortisol levels were significantly higher in infertile women with stage III-IV endometriosis (20.1 ± 1.3 ng/mL) than in controls (10.5 ± 1.4 ng/mL). Cortisol and prolactin levels in follicular fluid and peritoneal fluid did not differ significantly between groups. The high levels of cortisol and prolactin in the serum from women with endometriosis might contribute to the subfertility frequently associated with the disease. Moreover, since higher levels of cortisol and prolactin are often associated with stress, it is probable that stress might contribute to the development of endometriosis and its progression to advanced stages of the disease.

Implicaciones de los canales sostenidos y transitorios en la memoria icónica.

El objetivo es tratar de verificar en qué medida el modelo transitorio-sostenido permite reinterpretar el fenómeno molar de la memoria icónica. Experimento I: 11 sujetos; Experimento II: 10 sujetos; Experimento III: 10 sujetos. Exp. I: Se utilizó un diseño intragrupo de tipo factorial 2x3 con ambos factores cruzados. El primer factor es el tipo de presentación del estímulo: presentación por aparición súbita del estímulo crítico y presentación por desaparición de todos los estímulos irrelevantes excepto el estímulo crítico. El segundo factor es la zona retiniana sobre la que se proyecta el estímulo: zona foveal, zona media y zona periférica; Exp. II: Se trata también de un diseño intragrupo de tipo factorial 3x3. El factor uno es el tipo de presentación del estímulo y tiene tres niveles: presentación por aparición súbita del estímulo, presentación por desaparición súbita de todas las figuras que acompañan al estímulo y presentación súbita del estímulo inmediatamente después de presentar las figuras. El factor dos, la zona retiniana, fue análoga al exp.I y así mismo la variable dependiente fue el tiempo de reacción del juicio discriminativo (círculos versus cruces); Exp. III: Intragrupo de tipo factorial 2x2x2. El factor uno y dos son los mismos que en el experimento I, aún cuando en el presente exp. sólo se utilizaron dos zonas retinianas (foveal y retiniana). El factor 3, clase de estímulo con dos niveles: discriminación fácil (cruz-círculo) y discriminación difícil (cruz-aspa). Taquistoscopio, cronoscopio, hoja de instrucciones, estímulos, hojas de recogida de datos. Exp. I: Se encontró una gran diferencia entre las dos modalidades de presentación del estímulo (aparición-desaparición); Exp. II: Igual que en el experimento anterior existen diferencias significativas en la zona retiniana y altamente signiticativa en la modalidad de presentación del estímulo y, sorprendentemente, también aparece significativa la interacción. Esta interacción resulta difícil de explicar ya que de tener algún significado debería haber aparecido también en el experimento anterior; Exp. III: Se observa cómo los tiempos de reacción de la discriminación difícil son mayores en todos los casos que los TR de la discriminación fácil. Existen diferencias altamente significativas entre las zonas retinianas confirmando los exp. anteriores. También son significativas las diferencias entre las modalidades de discriminación, la interacción también es significativa. Los tres experimentos demuestran de forma claramente significativa que los estímulos presentados bruscamente necesitan menos tiempo para ser procesados que aquéllos otros que estando ya dentro del campo visual permanecen en él de forma estática. Son por lo tanto, un apoyo más a la teoría que defiende la existencia de dos componentes en el sistema visual: un componente transitorio que responde rápidamente a los estímulos en movimiento y un componente sostenido que responde más lentamente a los estímulos estáticos. Fecha de finalización tomada del código del documento.

Integración : beyond the linguistic skills.

Contiene: Vol. III. Modules A, C, D - Vol. IV. 1er. ciclo ESO: Modules B - Vol. V. 2o. ciclo ESO: Modules B. Trabajo financiado por el MEC al amparo del Concurso Nacional para la elaboración de materiales curriculares

Nitric oxide detection in cell culture exposed to LPS after Er:YAG laser irradiation

P>Aim To evaluate in vitro the effect of calcium hydroxide [Ca(OH)(2)] and Er:YAG laser on bacterial endotoxin [also known as lipopolysaccharide (LPS)] as determined by nitric oxide (NO) detection in J774 murine macrophage cell line culture. Methodology Samples of LPS solution (50 mu gmL-1), Ca(OH)(2) suspension (25 mg mL-1) and LPS suspension with Ca(OH)(2) were prepared. The studied groups were: I - LPS (control); II - LPS + Ca(OH)(2); III - LPS + Er:YAG laser (15 Hz 140 mJ); IV - LPS + Er:YAG laser (15 Hz 200 mJ); V - LPS + Er:YAG laser (15 Hz 250 mJ), VI - Pyrogen-free water; VII - Ca(OH)(2). Murine macrophage J774 cells were plated and 10 mu L of the samples were added to each well. The supernatants were collected for NO detection by the Griess reaction. Data were analysed statistically by one-way anova and Tukey`s test at 5% significance level. Results The mean and SE (in mu mol L-1) values of NO release were: I - 10.48 +/- 0.58, II - 6.41 +/- 0.90, III - 10.2 +/- 0.60, IV - 8.35 +/- 0.40, V - 10.40 +/- 0.53, VI - 3.75 +/- 0.70, VII - 6.44 +/- 0.60; and the values for the same experiment repeated after 1 week were: I - 21.20 +/- 1.50, II - 9.10 +/- 0.60, III - 19.50 +/- 1.00, IV - 18.50 +/- 0.60, V - 21.30 +/- 0.90, VI - 2.00 +/- 0.20, VII - 6.80 +/- 1.70. There was no significant difference (P > 0.05) between the control and the laser-treated groups (III, IV and V), or comparing groups II, VI and VII to each other (P > 0.05). Group I had significantly higher NO release than group II (P < 0.05). Groups II and VI had similar NO release (P > 0.05). Conclusions Calcium hydroxide inactivated the bacterial endotoxin (LPS) whereas none of the Er:YAG laser parameter settings had the same effectiveness.

A multicommuted flow-system for spectrophotometric determination of tannin exploiting the Cu(I)/BCA complex formation

A flow system exploiting the multicommutation approach is proposed for spectrophotometric determination of tannin in beverages. The procedure is based on the reduction of Cu(II) in the presence of 4,4`-dicarboxy-2,2`-biquinoline, yielding a complex with maximum absorption at 558 nm. Calibration graph was linear (r=0.999) for tannic acid concentrations up to 5.00 mu mol L-1. The detection limit and coefficient of variation were estimated as 10 nmol L-1 (99.7% confidence level) and 1% (1.78 mu mol L-1 tannic acid, n=10), respectively. The sampling rate was 50 determinations per hour. The proposed procedure is more sensitive and selective than the official Folin-Denis method, also minimizing drastically waste generation. Recoveries within 91.8 and 115% were estimated for total tannin determination in tea and wine samples. (C) 2007 Elsevier B.V. All rights reserved.