A morphological grading of spinal stenosis: a radiological study on LSS and LBP patients : P173

Introduction: Clinical symptoms and degree of spinal stenosis based on cross sectional dural sac area correlate only weakly in lumbar spinal stenosis (LSS) patients. We conceived a four grade classification system (A, B, C & D) based on the morphology of the dural sac and its contents as seen on T2 axial MRI images. The categories take into account the rootlet/CSF ratio. We applied this grading to three patient groups: LSS scheduled for surgery; LSS following conservative treatment and patients with low back pain (LBP) without leg pain. Materials/Methods: A total of 346 T2 axial MRI images taken from LSS and LBP patients were included in this retroperspective study. 37 patients had decompressive surgery (132 MRI images), 31 conservative treatment (116 MRI images) and 27 patients had unspecific LBP (98 MRI images). Dural sac cross-sectional surface area and morphological grading of the canal were measured digitally both at disc and pedicle level. Intra- and inter-observer reliability were assessed (weighted Cohen's kappa statistics) from 50 MRI images taken from the surgery group. Results: At the most severe disc level, grade A (mild stenosis) was found in 3% of MRI images of the surgical group as opposed to 51% in the conservatively treated group and 85% in the LBP group. Grade B occurred in 8% of the surgical, 20% of the conservative and was negligible in LBP group (below 1%). Grade C and D (severe stenosis) was found in 89% of the surgical group, as opposed to 30% in conservative group and 11% in LBP group. The grades of all groups were comparable at the pedicle levels, exhibiting in 94% a grade A with a maximum at the A1 grade. Pedicle and disc level cross-sectional area were smallest in the surgery group and smaller in the conservative group as compared to the LBP group at the levels L2, L3 and L4. According to cross-sectional area measurements patients from the surgery group seems to have smaller vertebral canal although this was not related to smaller stature. Validation of grading: Average intra-and inter observer kappas were 0.76 and 0.69 respectively, for physicians working in the study originating institution. Combining all observers the kappa values were 0.57 +/- 0.19. and 0.44 +/- 0.19 respectively. Dural sac cross-sectional area measurements showed no statistically significant differences between observers. Conclusion: Since no specific measurement tools are needed the grading suits everyday clinical practice and favours communication of degree of stenosis between practising physicians. In our institution Grade A stenosis was less likely to require surgical treatment. This grading can therefore be an aid in surgical patient selection in teaching units.

Binding of d-methadone, l-methadone, and dl-methadone to proteins in plasma of healthy volunteers: role of the variants of alpha 1-acid glycoprotein.

The plasma concentrations of alpha 1-acid glycoprotein (AAG), albumin, triglycerides, cholesterol, and total proteins, as well as the plasma binding of racemic, d-methadone, and l-methadone were measured in 45 healthy subjects. The AAG phenotypes and the concentrations of AAG variants were also determined. The measured free fractions for racemic, d-methadone, and l-methadone were, respectively, 12.7% +/- 3.3%, 10.0% +/- 2.9%, and 14.2% +/- 3.2% (mean +/- SD). A significant correlation was obtained between the binding ratio (B/F) for dl-methadone and the total AAG concentration (r = 0.724; p less than 0.001). A multiple stepwise regression analysis showed that AAG was the main explanatory variable for the binding of the racemate. When concentrations of AAG variants were considered, a significant correlation was obtained between the binding ratio of dl-methadone and orosomucoid2 A concentration (r = 0.715; p less than 0.001), a weak correlation between dl-methadone and orosomucoid1 S concentration (r = 0.494; p less than 0.001), and no correlation between dl-methadone and orosomucoid1 F1 concentration (r = 0.049; not significant). Similar findings were obtained with the enantiomers. This study shows the importance of considering not only total AAG but also concentrations of AAG variants when measuring the binding of methadone and possibly of other drugs in plasma.

Clinical outcome after trimipramine in patients with delusional depression - a pilot study

The treatment of delusional depression is a major challenge in psychopharmacology. Hypothalamic-pituitary-adrenocortical (HPA) overdrive may contribute, via increased dopaminergic activity, to the pathophysiology of the disorder. Trimipramine appears to be an interesting potential candidate, since it is an atypical antidepressant that is known to inhibit HPA activity. In a four-week open trial we investigated its effects in 15 inpatients with delusional depression. The dosage was increased within 7 days up to 300 - 400 mg/d and was then maintained for three weeks. Psychometric assessments and safety monitoring were conducted weekly. Assessment of the HPA activity was achieved by a combined dexamethasone suppression/corticotropin-releasing hormone stimulation (Dex/CRH) test before and after four weeks of treatment. Therapeutic response was defined as a decrease in the HAMD-score of at least 50 %. Eight out of 13 completers were rated as responders. Therapeutic response was associated with L, D-trimipramine concentrations higher than 160 ng/ml. Intent-to-treat analysis showed significant improvement in psychometric variables. Despite the high dosage, the substance was generally well tolerated, with the exception of one patient who suffered from a hypotensive reaction. Mean +/- SD concentration of L-trimipramine and D-trimipramine were 138 +/- 61 ng/ml and 119 +/- 50 ng/ml at a final dose of 346 +/- 50 mg/d. The ACTH and cortisol area under the curve in the Dex/CRH tests decreased significantly, reflecting a decrease of activity in the HPA system. We suggest that the clinical use of high-dose trimipramine in delusional depression seems to be a promising treatment strategy.

Comentarios al Proyecto de modificación de la ley de Propiedad Intelectual

S'aborda el tema de la Llei de Propietat Intel·lectual de la mà de Patrícia Riera, Comentarios al proyecto de modificación de la Ley de Propiedad Intelectual, on s'estudia en profunditat la reforma de la Llei de Propietat Intel·lectual per incorporar la Directiva Europea de 2001 sobre l'harmonització d'alguns aspectes del dret d'autor.

Characterization of the tonoplast Ca2+/H+ antiport system from maize roots.

The tonoplast calcium Ca2+/H+ antiport system of maize (Zea mays L. cv LG 11) roots was characterized using the ''pH jump'' technique in order to avoid interference from the tonoplast proton and Ca2+ pumps. Ca2+ uptake was recorded in the presence of different inhibitors and divalent ions. Chemical modification of amino acid residues of the antiport was used to elucidate the amino acid residues participating in the Ca2+ transport activity. The Ca2+/H+ antiport activity was found to be strongly inhibited by ruthenium red and verapamil, whereas diethylstilbestrol was less effective. Vanadate, erythrosin B, cyclopiazonic acid, bafilomycin, thapsigargin, N,N'-dicyclohexylcarbodiimide (DCCD) and 4,4'-diisothiocyanatostilbene-2,2'-disulfonate (DIDS) were without effect. Lanthanum and divalent ions were strongly inhibitory (Cd2+ > Mn2+ > Sr2+ > Ba2+). While reagents modifying sulfhydryl groups (N-ethylmaleimide and 5,5'-dithio-bis(2-nitrobenzoate)) did not affect the antiport activity, modification of trytophan residues (N-bromosuccinimide) was strongly inhibitory. We conclude that ruthenium red, verapamil, lanthanum and divalent cations directly inhibit Ca2+ uptake independent of the function of the proton and Ca2+ pumps. Moreover, the results of chemically modified amino acid residues suggest that sulfhydryl groups are not involved in Ca2+ transport, while tryptophan residues seem important for this translocation.

Validation of the Spanish version of the Index of Spouse Abuse

Background: Partner violence against women is a major public health problem. Although there are currently a number of validated screening and diagnostic tools that can be used to evaluate this type of violence, such tools are not available in Spain. The aim of this study is to analyze the validity and reliability of the Spanish version of the Index of Spouse Abuse (ISA). Methods: A cross-sectional study was carried out in 2005 in two health centers in Granada, Spain, in 390 women between 18 and 70 years old. Analyses of the factorial structure, internal consistency, test-retest reliability, and construct validity were conducted. Cutoff points for each subscale were also defined. For the construct validity analysis, the SF-36 perceived general health dimension, the Rosenberg Self-Esteem Scale and the Goldberg 12-item General Health Questionnaire were included. Results: The psychometric analysis shows that the instrument has good internal consistency, reproducibility, and construct validity. Conclusions: The scale is useful for the analysis of partner violence against women in both a research setting and a healthcare setting

Breviarium Catalaunense, pars hiemalis.

F. 1 Calendrier de Châlons-sur-Marne (avec addit.) : — « Dedic. ecclesiae Sancti Stephani Catalaunensis » (26 oct.). F. 7 Psautier. F. 96v Litanies de Châlons. F. 99 Office des morts. F. 106v Commendaces. F. 108 Temporal d'hiver. F. 324-426 Sanctoral d'hiver : — Translat. de s. Memme (346) ; — Translat. de s. Alpin (413v) ; — « In adventu reliquiarum s. Stephani » (425v). F. 427 Commun des saints. F. 455 Hymnaire. F. 466 Essais de plume, prière à la Vierge, et note sur diverses calamités. survenues au mois de mai 1620.

Cancer pulmonaire: lobectomie par thoracoscopie [VATS lobectomy for early-stage primary lung cancer].

Lobectomy via video-assisted thoracoscopic surgery (VATS) is now considered as a valid alternative to conventional thoracotomy for early-stage primary lung cancer. Various studies have reported that VATS lobectomy is a safe technique associated with fewer postoperative complications and better post-operative recovery than open thoracotomy. Furthermore, studies suggest oncological equivalence between VATS and open lobectomy.

Left ventricular assist device.

To the Editor: The value of angiotensin-converting– enzyme (ACE) inhibitors, beta-blockers, and spironolactone has been well established by the results of numerous clinical trials. About 70 percent of the patients described by Rose et al. were treated with ACE inhibitors or angiotensin II–receptor antagonists; 35 to 40 percent received spironolactone, and only about 20 percent received beta-blockers. Thus, this population cannot have been considered to be optimally treated from the point of view of medical therapy.

Results from a multicentre international registry of familial Mediterranean fever: impact of environment on the expression of a monogenic disease in children.

BACKGROUND AND AIM: Familial Mediterranean fever (FMF) is an autoinflammatory disease caused by mutations of the MEFV gene. We analyse the impact of ethnic, environmental and genetic factors on the severity of disease presentation in a large international registry. METHODS: Demographic, genetic and clinical data from validated paediatric FMF patients enrolled in the Eurofever registry were analysed. Three subgroups were considered: (i) patients living in the eastern Mediterranean countries; (ii) patients with an eastern Mediterranean ancestry living in western Europe; (iii) Caucasian patients living in western European countries. A score for disease severity at presentation was elaborated. RESULTS: Since November 2009, 346 FMF paediatric patients were enrolled in the Eurofever registry. The genetic and demographic features (ethnicity, age of onset, age at diagnosis) were similar among eastern Mediterranean patients whether they lived in their countries or western European countries. European patients had a lower frequency of the high penetrance M694V mutation and a significant delay of diagnosis (p<0.002). Patients living in eastern Mediterranean countries had a higher frequency of fever episodes/year and more frequent arthritis, pericarditis, chest pain, abdominal pain and vomiting compared to the other two groups. Multivariate analysis showed that the variables independently associated with severity of disease presentation were country of residence, presence of M694V mutation and positive family history. CONCLUSIONS: Eastern Mediterranean FMF patients have a milder disease phenotype once they migrate to Europe, reflecting the effect of environment on the expression of a monogenic disease.

IoWoman, September/October 2002, Vol. 32, no. 5

Newsletter for Commission on the Status of Women.

Late Pliensbachian-Early Toarcian (Early Jurassic) environmental changes in an epicontinental basin of NW Europe (Causses area, central France): A micropaleontological and geochemical approach

We present an integrated work based on calcareous nannofossil and benthic foraminiferal assemblages, and geochemical analyses of two Upper Pliensbachian-Lower Toarcian sections located in the central-South France. The studied sections, Tournadous and Saint-Paul-des-Fonts, represent the proximal and the distal part, respectively, of the Jurassic Causses Basin, one of the small, partly enclosed basins belonging to the epicontinental shelf of the NW Tethys. At the transition from Late Pliensbachian to Early Toarcian, the Causses Basin recorded an emersion in response to the global sea-level fall. Our data indicate severe environmental conditions of marine waters, including salinity decrease and anoxia development, occurring in the Early Toarcian. The acme of this deterioration coincides with the Early Toarcian Anoxic Event (T-OAE) but, due to the restricted nature of the basin. anoxia persisted until the end of the Early Toarcian. mainly in the deeper parts of the basin. The micronutrients and organic organic-matter fluxes were probably high during the entire studied time interval, as shown by nannofossil and foraminiferal assemblages. However, nannoplankton production drastically decreased during the T-OAE, as demonstrated by very low nannofossil fluxes, and only taxa tolerant to low-saline surface waters could thrive. At the same time, benthic foraminifers temporarily disappeared in response to sea-bottom anoxia. Our study demonstrates that environmental changes related to the T-OAE are well-recorded even in small, partly enclosed basins of NW Europe, like the Causses Basin. Within this area, the effects of global changes. like sea sea-level and temperature fluctuations, are modulated by local conditions mainly controlled by the morphology of the basin. (C) 2008 Elsevier B.V. All rights reserved.