Effects of Carnoy's solution on blood vessels of the axillary fossa of rats

Carnoy's solution is applied to reduce the recurrence of odontogenic keratocysts and unicystic ameloblastomas. The deleterious action of this fixative on nerves has been studied but no attention has been paid to its effects on nearby vessels. The aim of this study was to investigate the effects of Carnoy's solution on blood vessels. The rat axillary artery and vein were surgically exposed, soaked with Carnoy's solution and kept in place for 2, 5 or 10 min, depending on the treatment group. The 5-min group was followed for 1, 2 and 3 weeks postoperatively. The vessels in the 2-min and 5-min exposure groups showed histological changes to the vessels, represented by focal loss of the endothelium and hyalinization of the wall. These alterations increased in the 10-min group. The vessels in the 3-week observation period revealed signs of recovery. It is concluded that Carnoy's solution can damage blood vessels but the process is reversible for exposure times less than 5 min.

Neuropsychological long-term sequelae after posterior fossa tumour resection during childhood

The importance of the cerebellum for non‐motor functions is becoming more and more evident. The influence on cognitive functions from acquired cerebellar lesions during childhood, however, is not well known. We present follow‐up data from 24 patients, who were operated upon during childhood for benign cerebellar tumours. The benign histology of these tumours required neither radiotherapy nor chemotherapy. Post‐operatively, these children were of normal intelligence with a mean IQ of 99.1, performance intelligence quotient (PIQ) of 101.3 and verbal intelligence quotient (VIQ) of 96.8. However, 57% of patients showed abnormalities in subtesting. In addition, more extensive neuropsychological testing revealed significant problems for attention, memory, processing speed and interference. Visuo‐constructive problems were marked for copying the Rey figure, but less pronounced for recall of the figure. Verbal fluency was more affected than design fluency. Behavioural deficits could be detected in 33% of patients. Attention deficit problems were marked in 12.5%, whereas others demonstrated psychiatric symptoms such as mutism, addiction problems, anorexia, uncontrolled temper tantrums and phobia. Age at tumour operation and size of tumour had no influence on outcome. Vermis involvement was related to an increase in neuropsychological and psychiatric problems. The observation that patients with left‐sided cerebellar tumours were more affected than patients with right‐sided tumours is probably also influenced by a more pronounced vermian involvement in the former group. In summary, this study confirms the importance of the cerebellum for cognitive development and points to the necessity of careful follow‐up for these children to provide them with the necessary help to achieve full integration into professional life.

As compreensões do construtivismo de Ernst Von Glasersfeld e John Fossa: intermediando um diálogo em busca de novas significações

The present thesis, orientated by a letter sent by Ernst von Glasersfeld to John Fossa, is the product of a theoretical investigation of radical constructivism. In this letter, von Glasersfeld made three observations about Fossa’s understanding of radical constructivism. However, we limited our study to the second of these considerations since it de als with some of the core issues of constructivism. Consequently, we investigated what issues are raised by von Glasersfeld’s observation and whether these issues are relevant to a better understanding of constructivism and its implications for the mathema tics classroom . In order to realize the investigation, it was necessary to characterize von Glasersfeld’s epistemological approach to constructivism, to identify which questions about radical constructivism are raised by von Glasersfeld’s observation, to i nvestigate whether these issues are relevant to a better understanding of constructivism and to analyze the implications of these issues for the mathematics classroom. Upon making a hermeneutic study of radical constructivism, we found that what is central to it is its radicalism, in the sense that it breaks with tradition by its absence of an ontology. Thus, we defend the thesis that the absence of an ontology, although it has advantages for radical constructivism, incurs serious problems not only for the theory itself, but also for its implications for the mathematics classroom. The advantages that we were able to identify include a change from the usual philosophical paths to a very different rational view of the world, an overcoming of a naive way of thi nking, an understanding of the subject as active in the construction of his/her experiential reality, an interpretation of cognition as an instrument of adaptation, a new concept of knowledge and a vision of knowledge as fallible (or provisional). The prob lems are associated with the impossibility of radical constructivism to explain adequately why the reality that we build up is regular, stable, non - arbitrary and publicly shared. With regard to the educational implications of radical constructivism, the ab sence of an ontology brings to the mathematics classroom not only certain relevant aspects (or favorable points) that make teaching a process of researching student learning, empowering the student to learn and changing the classroom design, but also certa in weaknesses or limitations. These weaknesses or limitations of constructivism in the classroom are due to its conception of knowledge as being essentially subjective. This requires it to work with one - on - one situations and, likewise, makes the success of teaching dependent on the teacher’s individual skills. Perhaps the most important weakness or limitation, in this sense, is that it makes teaching orientated by constructivist principles unable to reach the goal of the formation of a community. We conclud e that issues raised by von Glasersfeld’s observation are absolutely relevant to the context of a better understanding of radical constructivism and its implications for education, especially for Mathematics Education.

Arterial entrapment syndrome in the cubital fossa: a rare cause of acute stress-related arterial thrombosis in a patient with brachial artery duplication

Arterial entrapment syndrome (AES) at elbow level is very rare and to our knowledge no case of AES by lacertus fibrosus in the cubital fossa in presence of brachial artery duplication has been described to date. We describe a rare case of acute arterial thrombosis of one of two brachial arteries highlighted in the cubital fossa which developed after strenuous right elbow flexor muscle activity and hyper-extensions presumably related to AES by lacertus fibrosus at elbow level. A 43-year-old right-handed woman, experienced paleness, coldness and numbness of the right hand, after 8 consecutive hours of gardening. As she worked, her ipsilateral flexor elbow muscles remained in prolonged and inappropriate tension. Clinical examination evidenced the absence of radial artery pulse in the wrist and mild hypothermia in the second and third finger. During surgical exploration two anastomosed brachial arteries were detected in the cubital fossa under the lacertus fibrosus. The lateral superficial brachial artery was occluded. Intraoperative arteriography evidenced brachial artery duplication at the third superior of the arm and normal vascular pattern at the forearm level. In cases of unexplained atypical intermittent upper extremity claudication or acute ischemic symptoms an AES should always be ruled out, particularly when symptoms are exacerbated by strenuous upper extremity activity or when upper limb muscular hypertrophy is evident. In these cases a thorough dynamic clinical and instrumental examination is mandatory to confirm a diagnosis of AES and to avoid possible future ischemic complications.

Prevalencia de artritis séptica neonatal en un hospital universitario

Introducción: La artritis séptica neonatal es un padecimiento poco común que se ha relacionado con recién nacidos internados en la unidad de cuidados intensivos neonatal, cuyo principal factor de riesgo es el uso previo de catéter central. Objetivo: establecer la prevalencia de la artritis séptica neonatal en nuestro Hospital. Material y método: estudio observacional descriptivo de prevalencia. Se incluyeron todos los recién nacidos con diagnostico de artritis séptica neonatal internados un la unidad de cuidados intermedios e intensivos neonatal del Hospital Universitario Dr. José Eleuterio González del año 2003 al 2007. Se revisaron los expedientes y se registraron variables generales, factores de riesgo, bacteriología y mortalidad. Resultados: Se diagnosticaron 26 casos de artritis séptica neonatal durante el periodo de tiempo estudiado, solo 20 casos lograron criterios de inclusión: la prevalencia fue de 1.2 casos por cada 1,000 nacidos. La edad gestacional fue 39.2 ± 1.3 semanas, con peso 3193 ± 709 g. El factor de riesgo que se presento con mas frecuencia fue el antecedente de uso previo de catéter en 75% de los casos. Se aisló microorganismo en 80% de los casos, los bacterias grampositivas se aislaron en 80% de los casos; el Staphylococcus aureus fue el microorganismo aislado predominantemente en 75% de los casos. La presentación poliarticular fue en 40% de los casos. La mortalidad fue de 0%. Conclusiones: La prevalencia fue menor a lo reportado en la literatura. Los microorganismos grampositivos continúan siendo los microorganismos predominantes en la artritis séptica neonatal. La mortalidad es baja.

Embolia pulmonar séptica

Paciente de 70 años con embolia pulmonar séptica asociada a artritis séptica de cadera derecha por Staphylococcus aureus.

Artritis séptica de hombro

Hombre de 66 años de edad, con dolor en hombro derecho, malestar general y fiebre de una semana de evolución. Al exámen físico presenta edema, rubor y calor del hombro derecho. Los paraclínicos evidenciaron leucocitosis con neutrofilia. La resonancia magnética y el aislamiento de Staphylococcus aureus en sangre confirmaron la sospecha de artritis séptica de hombro. El paciente requirió manejo en unidad de cuidado intensivo, antibioticoterapia y drenaje quirúrgico.

Lavage treatment of distal intestinal obstruction syndrome in children with cystic fibrosis

The efficacy, adverse reactions, and long-term effects of intestinal lavage treatment with a balanced electrolyte solution (Golytely) was evaluated in patients with cystic fibrosis and distal intestinal obstruction syndrome. Twenty-two patients with cystic fibrosis (mean age 21.8 years, range 14 to 34 years, 15 boys or men) who sough medical attention because of abdominal pain and a mass in the right iliac fossa received Golytely, 5.6 ± 1.9 L (mean ± 1 SD), either orally (n = 14) or via nasogastric tube (n = 8) during 5.6 ± 2.4 hours. No serious side effects occurred. Serum electrolyte values remained within normal limits. Body weight did not change significantly. Minor adverse reactions included bloating (n = 12), nausea (n = 8), vomiting (n = 1), and chills (n = 3). All but one patient reported impressive relief of symptoms and remained pain free for an average of 3 months (range 1 to 19 months). Symptoms of abdominal pain and radiologic signs of fecal impaction assessed before and after lavage both decreased significantly (P < .0001). During follow-up (mean 15.2 months, range 4 to 26 months), 11 patients required a total of 38 (range one to nine) additional doses of Golytely. Seven patients drank the solution at home (21 treatments); only two patients chose a nasogastric tube. In ten patients with symptoms of recurrent distal intestinal obstruction syndrome prior to institution of therapy, duration of hospitalization was significantly reduced by this treatment (5.1 ± 7.6 v 2.3 ± 6.3 hospital days per annum, P < .02). It is concluded that intestinal lavage is a well-accepted, safe, and effective therapy for distal intestinal obstruction syndrome in patients with cystic fibrosis.

Atrial Electric Signal During Sinus Rhythm in Lone Paroxysmal Atrial Fibrillation

Atrial fibrillation (AF) is the most common tachyarrhythmia and is associated with substantial morbidity, increased mortality and cost. The treatment modalities of AF have increased, but results are still far from optimal. More individualized therapy may be beneficial. Aiming for this calls improved diagnostics. Aim of this study was to find non-invasive parameters obtained during sinus rhythm reflecting electrophysiological patterns related to propensity to AF and particularly to AF occurring without any associated heart disease, lone AF. Overall 240 subjects were enrolled, 136 patients with paroxysmal lone AF and 104 controls (mean age 45 years, 75% males). Signal measurements were performed by non-invasive magnetocardiography (MCG) and by invasive electroanatomic mapping (EAM). High-pass filtering techniques and a new method based on a surface gradient technique were adapted to analyze atrial MCG signal. The EAM was used to elucidate atrial activation in patients and as a reference for MCG. The results showed that MCG mapping is an accurate method to detect atrial electrophysiologic properties. In lone paroxysmal AF, duration of the atrial depolarization complex was marginally prolonged. The difference was more obvious in women and was also related to interatrial conduction patterns. In the focal type of AF (75%), the root mean square (RMS) amplitudes of the atrial signal were normal, but in AF without demonstrable triggers the late atrial RMS amplitudes were reduced. In addition, the atrial characteristics tended to remain similar even when examined several years after the first AF episodes. The intra-atrial recordings confirmed the occurrence of three distinct sites of electrical connection from right to left atrium (LA): the Bachmann bundle (BB), the margin of the fossa ovalis (FO), and the coronary sinus ostial area (CS). The propagation of atrial signal could also be evaluated non-invasively. Three MCG atrial wave types were identified, each of which represented a distinct interatrial activation pattern. In conclusion, in paroxysmal lone AF, active focal triggers are common, atrial depolarization is slightly prolonged, but with a normal amplitude, and the arrhythmia does not necessarily lead to electrical or mechanical dysfunction of the atria. In women the prolongation of atrial depolarization is more obvious. This may be related to gender differences in presentation of AF. A significant minority of patients with lone AF lack frequent focal triggers, and in them, the late atrial signal amplitude is reduced, possibly signifying a wider degenerative process in the LA. In lone AF, natural impulse propagation to LA during sinus rhythm goes through one or more of the principal pathways described. The BB is the most common route, but in one-third, the earliest LA activation occurs outside the BB. Susceptibility to paroxysmal lone AF is associated with propagation of the atrial signal via the margin of the FO or via multiple pathways. When conduction occurs via the BB, it is related with prolonged atrial activation. Thus, altered and alternative conduction pathways may contribute to pathogenesis of lone AF. There is growing evidence of variability in genesis of AF also within lone paroxysmal AF. Present study suggests that this variation may be reflected in cardiac signal pattern. Recognizing the distinct signal profiles may assist in understanding the pathogenesis of AF and identifying subgroups for patient-tailored therapy.