La paciente embarazada: repercusión en la cavidad bucal y consideraciones respecto al tratamiento odontológico

El embarazo conlleva una serie de cambios orgánicos, fisiológicos (del sistema cardiovascular y gastrointestinal, de la función pulmonar, hematológicos...) y de conducta que pueden repercutir en la cavidad bucal. El granuloma gravídico se considera una entidad patológica propia del embarazo. Podremos observar también en las pacientes gestantes un aumento en la incidencia de caries, asociado fundamentalmente a un incremento de Jos factores locales cariogénicos (descuido de la higiene bucal, cambio de Jos hábitos dietéticos y horarios...), y un posible empeoramiento de la patología gingival y periodontal asociado a las variaciones hormonales que acompañan al embarazo y a factores locales irritativos. El segundo trimestre de gestación será el momento ideal para llevar a cabo cualquier tratamiento dental rutinario. Deberemos ir con sumo cuidado en lo que se refiere a la administración de fármacos (penicilina, eritromicina, cefalosporinas de primera generación, paracetamol y lidocaína con vasoconstrictor se consideran fármacos de prescripción segura durante el embarazo) y la realización de radiografías dentales (es imprescindible colocar un delantal plomado a la paciente).

Quality of life following third molar removal under conscious sedation

Aim: The aim of this study was to assess quality of life (QoL) and degree of satisfaction among outpatients subjected to surgical extraction of all four third molars under conscious sedation. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after extraction. Study design: Fifty patients received a questionnaire assessing social isolation, working isolation, eating and speaking ability, diet modifications, sleep impairment, changes in physical appearance, discomfort at suture removal and overall satisfaction at days 4 and 7 after surgery. Pain was recorded by patients on a 100-mm pain visual analogue scale (VAS) every day after extraction until day 7. Results: Thirty-nine patients fulfilled correctly the questionnaire. Postoperative pain values suffered small fluctuations until day 5 (range: 23 to 33 mm in a 100-mm VAS), when dicreased significantly. A positive association was observed between difficult ranked surgeries and higher postoperative pain levels. The average number of days for which the patient stopped working was 4.9. Conclusion: The removal of all third molars in a single appointment causes an important deterioration of the patient"s QoL during the first postoperative week, especially due to local pain and eating discomfort.

Comparative phylogeography and postglacial colonization routes in Europe.

The Quaternary cold periods in Europe are thought to have heavily influenced the amount and distribution of intraspecific genetic variation in both animals and plants. The phylogeographies of 10 taxa, including mammals (Ursus arctos, Sorex spp., Crocidura suaveolens, Arvicola spp.), amphibians (Triturus spp.), arthropods (Chorthippus parallelus), and plants (Abies alba, Picea abies, Fagus sylvatica, Quercus spp.), were analysed to elucidate general trends across Europe. Only a small degree of congruence was found amongst the phylogeographies of the 10 taxa, but the likely postglacial colonization routes exhibit some similarities. A Brooks parsimony analysis produced an unrooted area phylogram, showing that: (i) the northern regions were colonized generally from the Iberic and Balkanic refugia; and (ii) the Italian lineages were often isolated due to the presence of the Alpine barrier. The comparison of colonization routes highlighted four main suture-zones where lineages from the different refugia meet. Some of the intraspecific genetic distances among lineages indicated a prequaternary divergence that cannot be connected to any particular cold period, but are probably related mainly to the date of arrival of each taxon in the European continent. As a consequence, molecular genetics so far appears to be of limited use in dating Quaternary events.

Diagnosis and management of blunt great vessel trauma.

Traditionally, thoracic aortic rupture, suspected after blunt thoracic trauma, is characterized by a chest radiograph showing a widened mediastinum. The diagnostic machinery consecutively activated still depends heavily on the pressure as additional traumatic lesions. A patient with additional cranio-cerebral trauma would typically undergo contrast-enhanced computed tomography or magnetic resonance imaging of head, chest, and other regions. In a number of patients these analyses would confirm the presence of blood in the mediastinum without formal proof of an aortic disruption. This is because mediastinal hematomas may be caused not only by an aortic rupture, but also by numerous other blood sources including fractures of the spine and other macro- and microvascular lesions providing similar images. Therefore, aortic angiography became our preferred diagnostic tool to identify or rule out acute traumatic lesions of not only the aorta but with great vessels. However recently, a number of traumatic aortic transsections have been identified by transoesophageal echocardiography (TEE). TEE has the additional advantage of being a bed-side procedure providing additional information about cardiac function. The latter analysis allows for identification and quantification of cardiac contusions, post-traumatic myocardial infarctions, and valvar lesions which are of prime importance to develop an adequate surgical strategy and to assess the risk of the numerous emergency procedures required in patients with polytrauma. The standard approach for repair of isthmic aortic rupture is through a lateral thoracotomy. Distal and proximal control of the aorta can be achieved in a substantial number of cases before complete aortic rupture occurs and a higher proportion of direct suture repair can be achieved under such circumstances. Most proximal descending aortic procedures are performed without cardiopulmonary bypass (clamp and go) but paraplegia may occur before, during, or after the procedure. Ascending aortic lesions and disruption of the aortic arch, the supra-aortic vessels, the main pulmonary arteries, the great veins as well as cardiac lesions are best approached through a sternotomy, which may have to be extended. Cardiopulmonary bypass allowing for deep hypothermia and circulatory arrest is often required and carries its own complications. It is not clear whether the increasing proportion of ascending aortic and cardiac lesions which are observed nowadays are due to a change in trauma mechanics (i.e., speed limits, seat belts, air-bags), an improvement of the diagnostic tools or both.

A new classification of the Turkish terranes and sutures and its implication for the paleotectonic history of the region

The Turkish part of the Tethyan realm is represented by a series of terranes juxtaposed through Alpine convergent movements and separated by complex suture zones. Different terranes can be defined and characterized by their dominant geological background. The Pontides domain represents a segment of the former active margin of Eurasia, where back-arc basins opened in the Triassic and separated the Sakarya terrane from neighbouring regions. Sakarya was re-accreted to Laurasia through the Balkanic mid-Cretaceous orogenic event that also affected the Rhodope and Strandja zones. The whole region from the Balkans to the Caucasus was then affected by a reversal of subduction and creation of a Late Cretaceous arc before collision with the Anatolian domain in the Eocene. If the Anatolian terrane underwent an evolution similar to Sakarya during the Late Paleozoic and Early Triassic times, both terranes had a diverging history during and after the Eo-Cimmerian collision. North of Sakarya, the Küre back-arc was closed during the Jurassic, whereas north of the Anatolian domain, the back-arc type oceans did not close before the Late Cretaceous. During the Cretaceous, both domains were affected by ophiolite obduction, but in very different ways: north directed diachronous Middle to Late Cretaceous mélange obduction on the Jurassic Sakarya passive margin; Senonian synchronous southward obduction on the Triassic passive margin of Anatolia. From this, it appears that the Izmir-Ankara suture, currently separating both terranes, is composite, and that the passive margin of Sakarya is not the conjugate margin of Anatolia. To the south, the Cimmerian Taurus domain together with the Beydağları domain (part of the larger Greater Apulian terrane), were detached from north Gondwana in the Permian during the opening of the Neotethys (East-Mediterranean basin). The drifting Cimmerian blocks entered into a soft collision with the Anatolian and related terranes in the Eo-Cimmerian orogenic phase (Late Triassic), thus suturing the Paleotethys. At that time, the Taurus plate developed foreland-type basins, filled with flysch-molasse deposits that locally overstepped the lower plate Taurus terrane and were deposited in the opening Neotethys to the south. These olistostromal deposits are characterized by pelagic Carboniferous and Permian material from the Paleotethys suture zone found in the Mersin mélange. The latter, as well as the Antalya and Mamonia domains are represented by a series of exotic units now found south of the main Taurus range. Part of the Mersin exotic material was clearly derived from the former north Anatolian passive margin (Huğlu-type series) and re-displaced during the Paleogene. This led us to propose a plate tectonic model where the Anatolian ophiolitic front is linked up with the Samail/Baër-Bassit obduction front found along the Arabian margin. The obduction front was indented by the Anatolian promontory whose eastern end was partially subducted. Continued slab roll-back of the Neotethys allowed Anatolian exotics to continue their course southwestward until their emplacement along the Taurus southern margin (Mersin) and up to the Beydağları promontory (Antaya-Mamonia) in the latest Cretaceous-Paleocene. The supra-subduction ocean opening at the back of the obduction front (Troodos-type Ocean) was finally closed by Eocene north-south shortening between Africa and Eurasia. This brought close to each other Cretaceous ophiolites derived from the north of Anatolia and those obducted on the Arabian promontory. The latter were sealed by a Maastrichtian platform, and locally never affected by Alpine tectonism, whereas those located on the eastern Anatolian plate are strongly deformed and metamorphosed, and affected by Eocene arc magmatism. These observations help to reconstruct the larger frame of the central Tethyan realm geodynamic evolution.

Inhibition of inducible nitric oxide synthase protects against liver injury induced by mycobacterial infection and endotoxins.

BACKGROUND/AIMS: Bacillus Calmette Guerin (BCG) infection causes hepatic injury following granuloma formation and secretion of cytokines which render mice highly sensitive to endotoxin-mediated hepatotoxicity. This work investigates the role of inducible nitric oxide synthase (iNOS) in liver damage induced by BCG and endotoxins in BCG-infected mice. METHODS: Liver injury and cytokine activation induced by BCG and by LPS upon BCG infection (BCG/LPS) were compared in wild-type and iNOS-/- mice. RESULTS: iNOS-/- mice infected with living BCG are protected from hepatic injury when compared to wild-type mice which express iNOS protein in macrophages forming hepatic granulomas. In addition, iNOS-/- mice show a decrease in BCG-induced IFN-gamma serum levels. LPS challenge in BCG-infected mice strongly activates iNOS in the liver and spleen of wild-type mice which show important liver damage associated with a dramatic increase in TNF and IL-6 and also Th1 type cytokines. In contrast, iNOS-/- mice are protected from liver injury after BCG/LPS challenge and their TNF, IL-6 and Th1 type cytokine serum levels raise moderately. CONCLUSIONS: These results demonstrate that nitric oxide (NO) from iNOS is involved in hepatotoxicity induced by both mycobacterial infection and endotoxin effects upon BCG infection and that inhibition of NO from iNOS protects from liver injuries.

Tracheo-carinal reconstructions using extrathoracic muscle flaps.

OBJECTIVES: Prospective evaluation of tracheo-carinal airway reconstructions using pedicled extrathoracic muscle flaps for closing airway defects after non-circumferential resections and after carinal resections as part of the reconstruction for alleviation of anastomotic tension. METHODS: From January 1996 to June 2006, 41 patients underwent tracheo-carinal airway reconstructions using 45 extrathoracic muscle flaps (latissimus dorsi, n=25; serratus anterior, n=18; pectoralis major, n=2) for closing airway defects resulting from (a) bronchopleural fistulas (BPF) with short desmoplastic bronchial stumps after right upper lobectomy (n=1) and right-sided (pleuro) pneumonectomy (n=13); (b) right (n=9) and left (n=3) associated with partial carinal resections for pre-treated centrally localised tumours; (c) partial non-circumferential tracheal resections for pre-treated tracheal tumours, tracheo-oesophageal fistulas (TEF) and chronic tracheal injury with tracheomalacia (n=11); (d) carinal resections with the integration of a muscle patch in specific parts of the anastomotic reconstruction for alleviation of anastomotic tension (n=4). The airway defects ranged from 2 x 1 cm to 8 x 4 cm and involved up to 50% of the airway circumference. The patients were followed by clinical examination, repeated bronchoscopy, pulmonary function testing and CT scans. The minimum follow-up time was 6 months. RESULTS: Ninety-day mortality was 7.3% (3/41 patients). Four patients (9.7%) sustained muscle flap necrosis requiring re-operation and flap replacement without subsequent mortality, airway dehiscence or stenosis. Airway dehiscence was observed in 1/41 patients (2.4%) and airway stenosis in 1/38 surviving patients (2.6%) responding well to topical mitomycin application. Follow-up on clinical grounds, by CT scans and repeated bronchoscopy, revealed airtight, stable and epithelialised airways and no recurrence of BPF or TEF in all surviving patients. CONCLUSIONS: Tracheo-carinal airway defects can be closed by use of pedicled extrathoracic muscle flaps after non-circumferential resections and after carinal resections with the muscle patch as part of the reconstruction for alleviation of anastomotic tension.

Alps, genes, and chromosomes: their role in the formation of species in the Sorex araneus group (Mammalia, Insectivora), as inferred from two hybrid zones.

During the Pleistocene glaciations, the Alps were an efficient barrier to gene flow between isolated populations, often leading to allopatric speciation. Afterwards, the Alps strongly influenced the post-glacial recolonization of Europe and represent a major suture zone between differentiated populations. Two hybrid zones in the Swiss and French Alps between genetically and chromosomally well-differentiated species-the Valais shrew, Sorex antinorii, and the common shrew, S. araneus-were studied karyotypically and by analyzing the distribution of seven microsatellite loci. In the center of the Haslital hybrid zone the two species coexist over a distance of 900 m. Hybrid karyotypes, among them the most complex known in Sorex, are rare. F-statistics based on microsatellite data revealed a strong heterozygote deficit only in the center of the zone, due to the sympatric distribution of the two species with little hybridization between them. Structuring within the species (both F(IS) and F(ST)) was low. An hierarchical analysis showed a high level of interspecific differentiation. Results were compared with those previously reported in another hybrid zone located at Les Houches in the French Alps. Genetic structuring within and between species was comparable in both hybrid zones, although chromosomal incompatibilities are more important in Haslital, where a linkage block of the race-specific chromosomes should additionally impede gene flow. Evidence for a more restricted gene flow in Haslital comes from the genetically intermediate hybrid karyotypes, whereas in Les Houches, hybrid karyotypes are genetically identical to individuals of the pure karyotypic races. Genic and chromosomal introgression was observed in Les Houches, but not in Haslital. The possible influence of a river, separating the two species at Les Houches, on gene flow is discussed.

Osteoid osteoma-like lesions: MDCT features and treatment by radiofrequency ablation : 46

Purpose: To assess the MDCT features of bone lesions that mimic osteoid osteoma (OO-like lesions) and evaluate their treatment by radiofrequency (RF) ablation. Methods and materials: All percutaneous RF ablations performed between May 2002 and June 2009 for a presumed (clinical and MDCT features) diagnosis of OO were retrospectively reviewed. Per-procedural biopsies were always performed and histopathological diagnoses were noted. The following MDCT features of all bone lesions were assessed by two musculoskeletal radiologists in consensus: skeletal distribution and location within the bone, size, central calcification, surrounding osteosclerosis and periosteal reaction. Clinical success was also evaluated. Results: Eighty patients (54 males, 26 females, mean age 24.1 years, range 5-48) underwent RF ablation. The histopathological diagnoses were: 54 non-contributory biopsies, 16 OO, 10 OO-like lesions (5 chronic osteomyelitis, 3 chondroblastoma, 1 eosinophilic granuloma, 1 fibrous dysplasia). The OO-like lesions were significantly greater in size (p = 0.001) and exhibited trends toward medullary location within the bone, moderate surrounding osteosclerosis and less periosteal reaction, compared to OO. Primary clinical success for OO-like lesions was 100% at 1 month, 85.7% at 6 and 12 months, and 66.7% at 24 months. Secondary success was 100%. Conclusion: Greater size, medullary location within the bone, lesser surrounding osteosclerosis and periosteal reaction on MDCT may help differentiate OO-like lesions from OO. OO-like lesions are safely and successfully treated by RF ablation.

Outcome of a Modified Broström-Gould Procedure for Lateral Ankle Instability

Introduction: Ankle sprains affect 200'000 persons/year in Switzerland. Most incidences are successfully treated by conservative measures but 20% require reconstruction for symptomatic chronic lateral ankle instability. This study evaluates the functional outcome after a modified Broström-Gould technique as measured by different clinical scores and compares the functional outcome of this technique with other surgical treatments of ankle instability. Methods: This retrospective cohort study evaluates 47 patients who underwent a modified Broström-Gould procedure using suture anchors to refix the lateral ankle capsuloligamentary structures at our institution from 2005 to 2009 with a minimum follow-up of one year (13-72 Mo). All patients were operated by one single surgeon and evaluated by an independent examiner. The function was assessed using 4 scores including: the AOFAS (American Orthopaedic Foot and Ankle Society's Score) hindfoot score; the FAAM (Foot and Ankle Ability Measurement); the CAIT (Cumberland Ankle Instability Tool); the CAIS (Chronic Ankle Instability Scale). Results: Six patients were excluded leaving 41 patients for examination. 34 patients (83%) thought that their ankle was more stable after the surgery, 7 (17%) did not feel any difference. 27 patients were very satisfied, 11 satisfied and 3 not satisfied. Reasons for non satisfaction included persistent instability and pain. Ankle mobility returned to normal in 93% of patients. Five patients had transcient hypoesthesy in the area of the superficial peroneal nerve. One patient suffered from a superficial infection treated successfully by local measures. 80% had the perception of a normal ankle, 20% thought to be below normal. At follow-up the AOFAS was 89/100 (37-100), the FAAM 85/100% (35-100%), the CAIT 20/30 (5-30), and the CAIS 74/100% (27-100%). Conclusions: The modified Broström-Gould procedure, which belongs to the anatomic ankle stabilizations is relatively simple and offers good outcome that satisfied 93% of the patients in the present study. No active stabilisator is sacrificed. Preservation of the ankle mobility is better and the complication rate is lower than after non-anatomical procedures described in the literature. The CAIT appeared as the most severe score compared to the other scales used in our study.

Mesozoic oceanic terranes of southern Central America : geology, geochemistry and gedynamics

Abstract The Northwestern edge of the modern Caribbean Plate, located in central Middle America (S-Guatemala to N-Costa Rica), is characterized by a puzzle of oceanic and continental terranes that belonged originally to the Pacific façade of North America. South of the Motagua Fault Zone, the actual northern strike slip boundary of the Caribbean Plate, three continental slivers (Copán, Chortis s. str. and Patuca) are sandwiched between two complex suture zones that contain HP/LT mafic and ultramafic oceanic rocks: The Motagua Mélanges to the North, extensively studied in the last ten years and the' newly defined Mesquito Composite Oceanic Terrane (MCOT) to the South. No modem geological data were available for the oceanic terrane located in the southern part of the so called continental "Chortis Block". Classically, the southern limit of this block with the Caribbean Large Igneous Province (CLIP) was placed at a hypothetical fault line connecting the main E-W fault in the Santa Elena Peninsula (N-Costa Rica) with the Hess Escarpment. However, our study in eastern Nicaragua and northwestern Costa Rica evidences an extensive assemblage of oceanic upper mantle and crustal rocks outcropping between the Chortis/Patuca continental blocks and the CLIP. They comprise collided and accreted exotic terranes of Pacific origin recording a polyphased tectonic history. We distinguish: 1- The MCOT that comprises a Late Triassic to Early Cretaceous puzzle of oceanic crust and arc-derived rocks set in a serpentinite matrix, and 2- The Manzanillo and Nicoya Terranes that are made of Cretaceous plateau-like rocks associated with oceanic sediments older than the CLIP. This study has been focused on the rocks of the MCOT. The MCOT comprises the southern half of the former "Chortis Block" and is defined by 4 comer localities characterized by ultramafic and mafic oceanic rocks of Late Triassic, Jurassic and Early Cretaceous age: 1- The Siuna Serpentinite Mélange (NE-Nicaragua), 2- The El Castillo Mélange (Nicaragua/Costa Rica border), 3- DSDP Legs 67 and 84 (Guatemala fore-arc basin), and 4- The Santa Elena Peridiotite (NW-Costa Rica). The Siuna Serpentinite Mélange (SSM) is a HP/LT subduction zone mélange set in a serpentinite matrix that contains oceanic crust and arc-related greenschist to blueschist/eclogite facies metamafic and metasedimentary blocks. Middle Jurassic (Bajocian-Bathonian) radiolarites are found in original sedimentary contact with arc-derived greenstones. Late Jurassic black detrital chert possibly formed in a marginal (fore-arc?) basin shortly before subduction. A phengite 40Ar/39Ar -cooling age dates the exhumation of the high pressure rocks as 139 Ma. The El Castillo Mélange (ECM) is composed of serpentinite matrix with OIB metabasalts and Late Triassic (Rhaetian) red and green radiolarite blocks. Recent studies of the DSDP Legs 67/84 show that the Guatemala/Nicaragua fore-arc basin is composed of a pile of ultramafic, mafic (OIB-like) and arc related rocks with ages ranging from Late Triassic to Campanian. Finally, the Santa Elena peridiotites that mark the limit of the MCOT with the Manzanillo/Nicoya Terranes and correspond to an association of ultramafic rocks that comprise peridiotites, dunites and chromites of abyssal and fore-arc origin. The SSM is the result of a collision between a Middle Jurassic island arc and the Patuca Terrane, a fragment of the Western N-American active continental margin. The Siuna Mélange (SSM) and the South Montagna Mélange share common characteristics with the Pacific N-American suture zone (E-Franciscan and Vizcaino mélanges), in particular, the Mesozoic ages of HP/LT metamorphic and the arc-derived blocks. For us, these mélanges imply an originally continuous, but slightly diachronous suture that affected the entire W-American active margin. It may imply the arrival and collision of an exotic intraoceanic arc (Guerrero-Phoenix) related to the origin of the Pacific Plate that initiated as a back arc basin of this arc. The present disposition of the fragments of this suture zone is the result of a northward shift of the active left-lateral strike slip motion between the N-American and the Caribbean Plates. Résumé Le coin nord-ouest de la Plaque Caraïbe moderne se trouve en Amérique Centrale, entre le sud du Guatemala et le nord du Costa Rica. Cette région est composée d'un puzzle de terrains océaniques et continentaux dont les origines se situent sur la façade pacifique de l'Amérique du Nord. Au sud de la faille de Motagua, la limite septentrionale actuelle, décrochante, de la Plaque Caraïbe, se trouvent 3 copeaux continentaux (Copàn, Chortis s. str. et Patuca) coincés entre deux zones de suture complexes à roches mafiques et ultramafiques qui ont subi un métamorphisme de haute pression/basse température (HP/LT). Il s'agit des Mélanges de Motagua au nord, largement étudiés ces dernières années, et du Mesquito Composite Oceanic Terrane (MCOT), récemment défini par nous, au sud. En vue de l'absence de données géologiques modernes concernant les terrains océaniques qui se trouvent dans la partie sud du "Chortis Block" considérée comme continentale, nous avons dédié cette étude à cette région. Classiquement, la limite méridionale entre le "Chortis Block" et la "Caribbean Large Igneous Province" (CLIP) a été associée à une faille hypothétique reliant la faille E-W de Santa Elena (nord du Costa Rica) à l'Escarpement de Hess. Notre étude au Nicaragua oriental et au Costa Rica nord-occidental a révélé l'existence de larges terrains composés d'assemblages de roches mantéliques et océaniques qui se placent entre les blocs continentaux Chortis/Patuca et le CLIP. Ces assemblages révèlent des terrains collisionnés et accrétés d'origine pacifique enregistrant une histoire tectonique polyphasée. Nous distinguons: 1- Le MCOT, un puzzle de roches océaniques d'arc d'âge Triassique supérieur au Crétacée inférieur, 2- Les terrains de Manzanillo et de Nicoya, des morceaux de plateaux océaniques associés à des sédiments océaniques plus âgés que le CLIP. Cette étude se focalisera sur les roches du MCOT. Le MCOT occupe la moitié sud de l'ancien "Chortis Block" et peut se définir par 4 localités de référence qui montrent des roches mafiques et ultramafiques océaniques d'âges compris entre le Trias supérieur et le Crétacée inférieur. 1- Le Siuna Serpentinite Mélange (NE-Nicaragua), 2- Le El Castillo Mélange (Nicaragua/Costa Rica border), 3- Le DSDP Legs 67/84 (Guatemala fore-arc basin) et 4- La Santa Elena Peridiotite (nord-ouest du Costa Rica). Le Siuna Serpentinite Mélange (SSM) est un mélange de subduction HP/BT dans une matrice de serpentinite. On y trouve des éléments de croûte océanique et d'arc insulaire en faciès de schistes verts et schistes bleus. Des radiolarites du Jurassique moyen se trouvent en contact sédimentaire sur des roches vertes d'arc. En revanche, des cherts noirs détritiques datent du Jurassique supérieur et sont probablement issus d'un bassin marginal (fore-arc ?) peu avant leur subduction, car un âge 40Ar/39Ar de refroidissement des phengites date l'exhumation des roches de haute pression à 139 Ma. Le Mélange d'El Castillo (ECM) est constitué d'une matrice serpentinitique et contient des blocs de metabasaltes OIB et des blocs de radiolarites du Trias terminal. Des études récentes ont repris les roches forées lors des DSDP Legs 67 et 84 et montrent que le soubassement du bassin d'avant-arc du Guatemala-Nicaragua est composé de roches ultramafiques et mafiques (OIB et arc), dont les âges isotopiques vont du Trias au Crétacé supérieur. Finalement, les péridiotites de Santa Elena forment la limite sud du MCOT par rapport aux terrains de Manzanillo et Nicoya. Elles contiennent des serpentinites et localement des dunites et chromites à affinité abyssale et de fore-arc. Le SSM témoigne d'une collision entre un arc insulaire d'âge Jurassique moyen et le Patuca Terrane, un fragment de la marge active nord-américaine. Le SSM et le South Motagua Mélange ont des caractéristiques en commun avec les zones de suture de la façade pacifique de l'Amérique du nord (E-Franciscan et Vizcaino mélanges), notamment les âges Mésozoïques du métamorphisme HP/BT et les blocs de roches d'arc. Ce fait nous conduit à penser qu'il s'agit d'une grande zone de suture qui était à l'origine continue sur toute la marge ouest-américaine, mais légèrement diachrone. Cette suture implique l'arrivée et la collision d'un arc intraocéanique exotique (Guerrero-Phoenix) qui est à l'origine de la Plaque Pacifique qui s'ouvrait en back arc par rapport à celui-ci. La disposition actuelle des fragments de cette suture est due à la migration vers le nord du décrochement actif senestre entre la Plaque nord-américaine et la Plaque Caraïbe. K. Flores, 2009 Mesozoic oceanic terranes of southern central America Résumé Grand Public La présente thèse est le résultat de travaux de terrain effectués de 2005 à 2008 au nord-est et au sud du Nicaragua et au nord du Costa Rica, en Amérique Centrale, des analyses pétrologiques et géochimiques en laboratoire ainsi que de la modélisation de l'évolution géodynamique. La région étudiée se situe en bordure nord - ouest de la Plaque Caraïbe moderne. Dans la majorité des publications récentes cette région est représentée comme un vaste bloc continental (le "Bloc Chortis") qui serait limité, (i) au nord, par la faille décrochante de Motagua, la limite actuelle entre la Plaque Nord-Américaine et la Plaque Caraïbe, et (ii) au sud, par une suture hypothétique qui se trouverait aux confins entre le Nicaragua et le Costa Rica. La région du Costa Rica a été considérée presque entièrement comme une partie du Plateau Caraïbe ("Caribbean Large Igneous Province" (CLIP)). L'étude détaillée des affleurements nous a permis de mettre en évidence : - Au nord-est du Nicaragua (Siuna) : Des roches océaniques datées du Jurassique moyen, grâce aux faunes à radiolaires qui ont été extraites des radiolarites rouges. Ces roches ont subi un métamorphisme de haute pression typique des zones de collision. L'étude radio-isotopique Ar/Ar a permis de dater la collision du Crétacé basal (139 Ma). - Au sud du Nicaragua : Des roches océaniques d'âge Trias terminal (200 millions d'années), également datées à l'aide de faunes à radiolaires. Il s'agit actuellement des roches océaniques les plus anciennes connues de l'Amérique Centrale. - L'étude géochimique et les âges des fossiles démontrent que le tiers septentrional du Costa Rica possède un soubassement construit d'au moins deux terrains (Nicoya et Manzanillo), qui ont des caractéristiques de Plateau océanique (Nicoya) et d'arc volcanique du Crétacé moyen (Manzanillo). Ces deux terrains sont plus anciens que le CLIP. En conclusion, nous constatons que la région étudiée est constituée d'un puzzle de 3 blocs continentaux et d'un vaste terrain océanique composite que nous appelons Mesquito Composite Oceanic Terrane (MCOT). En plus, nous définissons les terrains de Nicoya et de Manzanillo comme plus âgés et distincts du CLIP. Le MCOT est caractérisé par la présence de roches du manteau supérieur (les serpentinites) et de la croûte océanique, ainsi que des morceaux d'arcs, d'âge allant du Trias supérieur au Crétacé. Ce terrain est comparable à d'autres zones de suture de la façade pacifique de l'Amérique du nord, notamment en ce qui concerne les âges Mésozoïques, le métamorphisme de haute pression et l'association de roches mantéliques et crustales océaniques. Ce fait nous conduit à penser qu'il s'agit d'une grande zone de suture qui était à l'origine continue sur toute la marge ouest-américaine. Cette suture implique l'arrivée et la collision d'un arc infra-océanique exotique qui serait à l'origine de la Plaque Pacifique qui se serait ouverte en bassin d'arrière arc par rapport à celui-ci. La disposition actuelle des fragments de cette suture est due à la migration vers le nord du décrochement actif senestre entre la Plaque nord-américaine et la Plaque Caraïbe.

Transrectal specimen extraction after laparoscopic left colectomy: a case-matched study.

Aim  Avoiding 'mini-laparotomy' to extract a colectomy specimen may decrease wound complications and further improve recovery after laparoscopic surgery. The aim of this study was to develop a new technique for transrectal specimen extraction (TRSE) and to compare it with conventional laparoscopy (CL) for left sided colectomy. Method  Eleven patients with benign disease requiring either sigmoid or left colon resection underwent TRSE. The unfired circular stapler was inserted transanally and used as a guide to suture-close the recto-sigmoid junction laparoscopically and as a handle to pull the sutured sigmoid through the opened rectum inside a laparoscopic camera bag. The anvil was inserted into the lumen of the intussuscepted sigmoid and pushed to the level of the anastomosis. The anastomosis was fashioned end-to-end in the first patients and side-to-end in the following patients to improve safety. Intra-operative and postoperative outcomes of patients undergoing TRSE were compared with those of a group of 20 patients undergoing CL, who were matched for type of resection, body mass index and age. Results  The procedure was successful in all but the first patient who was converted to conventional laparoscopic colectomy without any additional morbidity. Two patients in the end-to-end anastomosis group, but none in the side-to-end group, developed peri-anastomotic sepsis. Compared with CL, patients undergoing TRSE did not show any significant differences in operative time, recovery or morbidity. Conclusion  Transrectal specimen extraction after left colectomy using the circular stapler technique is feasible. A side-to-end anastomosis appears safer than an end-to-end anastomosis. Further studies are needed to explore the potential advantages of this procedure over CL.

The JNK inhibitor XG-102 protects from ischemic damage with delayed intravenous administration also in the presence of recombinant tissue plasminogen activator.

BACKGROUND: XG-102 (formerly D-JNKI1), a TAT-coupled dextrogyre peptide which selectively inhibits the c-Jun N-terminal kinase, is a powerful neuroprotectant in mouse models of middle cerebral artery occlusion (MCAo) with delayed intracerebroventricular injection. We aimed to determine whether this neuroprotection could also be achieved by intravenous injection of XG-102, which is a more feasible approach for future use in stroke patients. We also tested the compatibility of the compound with recombinant tissue plasminogen activator (rtPA), commonly used for intravenous thrombolysis and known to enhance excitotoxicity. METHODS: Male ICR-CD1 mice were subjected to a 30-min-suture MCAo. XG-102 was injected intravenously in a single dose, 6 h after ischemia. Hippocampal slice cultures were subjected to oxygen (5%) and glucose (1 mM) deprivation for 30 min. rtPA was added after ischemia and before XG-102 administration, both in vitro and in vivo. RESULTS: The lowest intravenous dose achieving neuroprotection was 0.0003 mg/kg, which reduced the infarct volume after 48 h from 62 +/- 19 mm(3) (n = 18) for the vehicle-treated group to 18 +/- 9 mm(3) (n = 5, p < 0.01). The behavioral outcome was also significantly improved at two doses. Addition of rtPA after ischemia enhanced the ischemic damage both in vitro and in vivo, but XG-102 was still able to induce a significant neuroprotection. CONCLUSIONS: A single intravenous administration of XG-102 several hours after ischemia induces a powerful neuroprotection. XG-102 protects from ischemic damage in the presence of rtPA. The feasibility of systemic administration of this promising compound and its compatibility with rtPA are important steps for its development as a drug candidate in ischemic stroke.

Surgical treatment of perforated peptic ulcer. Is there a need for a change?

The aim of this study is to evaluate the risk and the results of surgical treatment for perforated peptic ulcer (PPU), to compare them through time, and to determine the current optimal surgical treatment. In a retrospective study, the charts of all the patients admitted for PPU between January 1976 and October 1991 were reviewed. The features believed to be of importance in the outcome were assessed for statistical analysis. A comparison was made between three periods of the study (1976-1980, 1981-1985, 1986-1991). 247 patients were included. Mortality was 11.7% (29/247). Factors associated with an increased mortality were: shock on admission (p = 0.01), age (p < 0.001), severe associated medical illnesses (p < 0.001) and the form of treatment (p < 0.01). After multivariate analysis, only shock on admission and associated disease remained significant. Chronic peptic ulcer disease occurred in 76% of the patients. Comparing the periods showed that age, associated illnesses, percentage of acute or subacute ulcers, mortality, as well as the number of patients, are increasing. The main determinant of surgical treatment for PPU is the patient and his/her general state. Because of the high frequency of chronic peptic ulcer disease, we believe that the gold standard in the treatment for PPU remains definitive surgery. However, in the presence of more than one risk factor, suture and patch are probably safer.

Palaeozoic deformation and magmatism in the northern area of the Anatolide block (Konya), witness of the Palaeotethys active margin

The study area. located north of Konva (Central Turkey), is composed of Silurian to Cretaceous metamorphosed rocks. The lower unit of the oldest formation (Silurian-Early Permian) is mostly made up of Silurian-Early Carboniferous metacarbonates. These rocks pass laterally and vertically to Devonian-Early Permian series having continental margin, shallow water and pelagic characteristics. They are intruded or juxtaposed to different kinds of metamagmatic rocks. which show MORB. continental arc and within plate characteristics. The Palaeozoic units are covered unconformably by Triassic-Cretaceous metasedimentary units. All these rocks are overthrusted by Mesozoic ophiolites. The Palaeozoic sequence can be seen as a northern Palaeotethys passive, then active margin. The northward subduction of the Palaeotethys ocean during the Carboniferous-Triassic times, induced the development of a magmatic arc and fore-arc sequence (Carboniferous-Permian). Before the Early Triassic (?Late Permian) time. the fore-arc sequence was uplifted above sea level and eroded. The Triassic sequences are regarded as marking the onset of back-arc opening and detachment of the Anatolian Konya block from the active Eurasian margin. Finally. a suture zone formed during the Carman between the Konya region and the Menderes-Tauride Cimmerian block due to the closing of Palaeotethvs. This geodynamic evolution can be correlated with the evolution of the Karaburun sequence in western Turkey.