Secondary amyloidosis: a severe complication of ankylosing spondylitis. Two case-reports.

STUDY OBJECTIVE: To report two cases of amyloidosis secondary to ankylosing spondylitis. PATIENTS AND RESULTS: Of the 47 ankylosing spondylitis patients who have received follow-up at our department over the last few years, two have developed AA amyloidosis. Both have extremely severe, long-standing joint disease, with virtually complete spinal ankylosis and destructive peripheral arthritis of the hips and wrists; one also has tarsal joint destruction. Renal dysfunction was the first manifestation of amyloidosis in both cases. One patient required chronic hemodialysis and developed peritonitis due to colonic perforation, probably at a site of amyloid deposition. CONCLUSIONS: Secondary amyloidosis is a rare complication of ankylosing spondylitis that can cause severe renal and gastrointestinal complications. No treatment capable of clearing established amyloid deposits is available to date.

Lumbar-sacral pedicle screw insertion with preoperative CT-based navigation

Objectif: Nous avons effectué une étude chez 135 patients ayant subis une chirurgie lombo-sacrée avec vissage pédiculaire sous navigation par tomographie axiale. Nous avons évalué la précision des vis pédiculaires et les résultats cliniques. Méthodes: Cette étude comporte 44 hommes et 91 femmes (âge moyen=61, intervalle 24-90 ans). Les diamètres, longueurs et trajectoires des 836 vis ont été planifiés en préopératoire avec un système de navigation (SNN, Surgical Navigation Network, Mississauga). Les patients ont subi une fusion lombaire (55), lombo-sacrée (73) et thoraco-lombo-sacrée (7). La perforation pédiculaire, la longueur des vis et les spondylolisthesis sont évalués par tomographies axiales postopératoires. Le niveau de douleur est mesuré par autoévaluations, échelles visuelles analogues et questionnaires (Oswestry et SF-36). La fusion osseuse a été évaluée par l’examen des radiographies postopératoires. Résultats: Une perforation des pédicules est présente pour 49/836 (5.9%) des vis (2.4% latéral, 1.7% inférieur, 1.1% supérieur, 0.7% médial). Les erreurs ont été mineures (0.1-2mm, 46/49) ou intermédiaires (2.1 - 4mm, 3/49 en latéral). Il y a aucune erreur majeure (≥ 4.1mm). Certaines vis ont été jugées trop longues (66/836, 8%). Le temps moyen pour insérer une vis en navigation a été de 19.1 minutes de l΄application au retrait du cadre de référence. Un an postopératoire on note une amélioration de la douleur des jambes et lombaire de 72% et 48% en moyenne respectivement. L’amélioration reste stable après 2 ans. La dégénérescence radiologique au dessus et sous la fusion a été retrouvée chez 44 patients (33%) and 3 patients respectivement (2%). Elle est survenue en moyenne 22.2 ± 2.6 mois après la chirurgie. Les fusions se terminant à L2 ont été associées à plus de dégénération (14/25, 56%). Conclusion: La navigation spinale basée sur des images tomographiques préopératoires est une technique sécuritaire et précise. Elle donne de bons résultats à court terme justifiant l’investissement de temps chirurgical. La dégénérescence segmentaire peut avoir un impact négatif sur les résultats radiologique et cliniques.

The effect of Nystatin on the inner ear : an experimental guinea pig study

Objectifs: Le Nystatin est un antibiotique efficace pour le traitement d’otomycose. Bien que sa sécurité au niveau de l’oreille externe soit bien établie, son utilisation n’est pas recommandée lorsqu’il y a une perforation tympanique. L’objectif de cette étude est d’évaluer le potentiel ototoxique du Nystatin lorsque celui-ci est appliqué directement au niveau de l’oreille moyenne. Méthodes: Nous avons fait une étude expérimentale avec 18 cochons d’Indes de souche Hartley que nous avons divisés en deux groupes. En exposant l’oreille moyenne de chaque animal au Nystatin (groupe I) ou à la néomycine (groupe II) et chaque oreille controlatérale à une solution physiologique (NaCl), la fonction auditive a été évaluée avec un test de potentiels évoqués auditif du tronc cérébral avant et après les injections. Une étude par microscopie électronique a permis une comparaison histologique de l’état des cellules ciliées cochléaires entre les 2 groupes. Résultats: Les pertes auditives moyennes du groupe « Nystatin » étaient de 13.0 dB et comparables aux pertes moyennes observées dans les oreilles ayant été injectées avec du NaCl (4.0 dB dans le groupe I et 15.1 dB dans le groupe II). Le groupe de contrôle « néomycine » a subi une perte auditive moyenne de 39.3 dB, ce qui représente une différence cliniquement et statistiquement significative (p<0.001). L’étude histologique avec une microscopie à balayage électronique a démontré une conservation de l’architecture des cellules ciliées cochléaires dans les groupe Nystatin et NaCl. La néomycine a causé une destruction marquée de ces structures. Conclusions: Le Nystatin ne provoque pas d’atteinte auditive ni de destruction des cellules ciliées externes après injection directe dans l’oreille moyenne chez le cochon d’Inde.

Investigations on Structural response of Water Backed Perforated plates

The study envisaged herein contains the numerical investigations on Perforated Plate (PP) as well as numerical and experimental investigations on Perforated Plate with Lining (PPL) which has a variety of applications in underwater engineering especially related to defence applications. Finite element method has been adopted as the tool for analysis of PP and PPL. The commercial software ANSYS has been used for static and free vibration response evaluation, whereas ANSYS LS-DYNA has been used for shock analysis. SHELL63, SHELL93, SOLID45, SOLSH190, BEAM188 and FLUID30 finite elements available in the ANSYS library as well as SHELL193 and SOLID194 available in the ANSYS LS-DYNA library have been made use of. Unit cell of the PP and PPL which is a miniature of the original plate with 16 perforations have been used. Based upon the convergence characteristics, the utility of SHELL63 element for the analysis of PP and PPL, and the required mesh density are brought out. The effect of perforation, geometry and orientation of perforation, boundary conditions and lining plate are investigated for various configurations. Stress concentration and deflection factor are also studied. Based on these investigations, stadium geometry perforation with horizontal orientation is recommended for further analysis.Linear and nonlinear static analysis of PP and PPL subjected to unit normal pressure has been carried out besides the free vibration analysis. Shock analysis has also been carried out on these structural components. The analytical model measures 0.9m x 0.9m with stiffener of 0.3m interval. The influence of finite element, boundary conditions, and lining plate on linear static response has been estimated and presented. Comparison of behavior of PP and PPL in the nonlinear strain regime has been made using geometric nonlinear analysis. Free vibration analysis of the PP and PPL has been carried out ‘in vacuum’ condition and in water backed condition, and the influence of water backed condition and effect of perforation on natural frequency have been investigated.Based upon the studies on the vibration characteristics of NPP, PP and PPL in water backed condition and ‘in vacuum’ condition, the reduction in the natural frequency of the plate in immersed condition has been rightly brought out. The necessity to introduce the effect of water medium in the analysis of water backed underwater structure has been highlighted.Shock analysis of PP and PPL for three explosives viz., PEK, TNT and C4 has been carried out and deflection and stresses on plate as well as free field pressure have been estimated using ANSYS LS-DYNA. The effect of perforations and the effect of lining plate have been predicted. Experimental investigations of the measurement of free field pressure using PPL have been conducted in a shock tank. Free field pressure has been measured and has been validated with finite element analysis results. Besides, an experiment has been carried out on PPL, for the comparison of the static deflection predicted by finite element analysis.The distribution of the free field pressure and the estimation of differential pressure from experimentation and the provision for treating the differential pressure as the resistance, as a part of the design load for PPL, has been brought out.

Apendicitis aguda perforada en adultos; aproximación a las inequidades sociales en salud, Bogotá 2012

La perforación del apéndice es una complicación temprana de la apendicitis aguda, demoras en el diagnóstico o tratamiento incrementan la tasa de perforación. Se desconoce si la perforación dl apéndice es un reflejo de inequidades sociales. Se pretendió determinar la asociación de la apendicitis aguda perforada en adultos y la equidad en acceso a salud. Estudio tipo cohorte retrospectivo documental, de historias clínicas de pacientes con apendicitis aguda; el análisis se realizó con Stata 11.1 y Epi-info. Los resultados se presentaron en tablas y figuras. Se incluyeron 540 casos (292 hombre y 248 mujeres), el grupo de edad que aporto más datos fue el de 18 a 49 años (391 pacientes); el tiempo medio de síntomas a consulta fue de 37,45 horas, y de 5,3 horas para el paso a cirugía desde el ingreso, fueron solicitadas 76 ecografías y 53 tomografías, 50 interconsultas a urología y 10 a ginecología hasta el diagnostico. El grupo de mayores de 49 años, el estrato socioeconómico tres y la tomografía fueron factores de riesgo independientes para perforación del apéndice. El análisis multivariado mostró asociación lineal entre el estrato socioeconómico y tiempo de síntomas al ingreso, tiempo para paso a cirugía, solicitud de ayudas diagnósticas e interconsultas, con buena significación estadística. La apendicitis aguda perforada en adultos, podría ser un indicador de inequidad en salud. Se requiere de estudios multi-céntricos, con mayor tiempo de evaluación y muestra para demostrar si el apéndice perforado es un trazador de inequidades en salud en Colombia.

Utilidad de la resonancia magnética en el diagnóstico de apendicitis aguda

Comparar el resultado de la resonancia magnética en el diagnóstico de apendicitis aguda con el patrón de oro (estudio histopatológico o seguimiento clínico del paciente) con el fin de establecer la utilidad de ésta como prueba diagnóstica y poder incluirla dentro del algoritmo de estudio de esta patología cuando hay sospecha clínica y un resultado negativo o dudoso de la ecografía abdominal

Perforaciones duodenales posteriores a colangiopancreatografia retrograda endoscopica (CPRE) en el hospital universitario mayor - MEDERI

Las perforaciones duodenales posteriores a colangiopancreatografía retrógrada endoscópica (POST – CPRE) son un evento raro pero que genera aumento en la morbimortalidad del paciente expuesto a este método diagnóstico y terapéutico. El principal objetivo de este trabajo es describir una serie de casos haciendo énfasis en las características sociodemográficas y las relacionadas con el diagnóstico y el manejo.

Protocolo interno para la oferta de bienes y servicios y contratación de mano de obra de las comunidades

Los actores involucrados dentro de los proyectos de exploración y perforación de pozos petroleros son variados y tienen necesidades diferentes. El éxito y satisfactorio desarrollo de los proyectos va ligado en gran medida a temas de orden social entre los diferentes actores, que están definidos por regulaciones legislativas, de costumbres comerciales y culturales, políticas de responsabilidad social y procedimientos internos de las compañías involucradas (Operadoras, Prestadoras de Servicios Petroleros, Contratistas y Subcontratistas) Después de analizar la situación de la industria, los resultados de Halliburton SRL Sucursal Colombia, los problemas y sobrecostos generados por temas de orden social. Se identificó que la mayoría de ellos eran causados por falta de comunicación, desconocimiento de elementos clave de las políticas de responsabilidad social de los clientes, desconocimiento de la importancia de la responsabilidad social como práctica y desconocimiento de la normatividad legal vigente aplicable a la industria y a la actividad que desarrolla la compañía. De las necesidades y problemáticas descritas anteriormente surge la idea de crear una herramienta que permita llenar los vacíos de información identificados, alinear a las partes involucradas dentro del proceso y ser una guía para el inicio, desarrollo y cierre de proyectos de exploración y perforación de pozos petroleros que desarrolle Halliburton con sus clientes.

Immunohistochemical, tomographic and histological study on onlay iliac grafts remodeling

The information concerning the molecular events taking place in onlay bone grafts are still incipient. The objective of the present study is to correlate the effects of perforation of resident bone bed on (1) the timing of onlay autogenous graft revascularization; (2) the maintenance of volume/density of the graft (assessed through tomography); and (3) the occurrence of bone remodeling proteins (using immunohistochemistry technique) delivered in the graft. Thirty-six New Zealand White rabbits were subjected to iliac crest onlay bone grafting on both sides of the mandible. The bone bed was drill-perforated on one side aiming at accelerating revascularization, whereas on the other side it was kept intact. After grafts fixation and flaps suture all animals were submitted to tomography on both mandible sites. Six animals were sacrificed, respectively, at 3, 5, 7, 10, 20 and 60 days after surgery. A second tomography was taken just before sacrifice. Histological slides were prepared from each grafted site for both immunohistochemistry analysis [osteopontin, osteocalcin, type I collagen and vascular endothelial growth factor (VEGF) anti-bodies] and histometric analysis. The values on bone volume measured on tomography showed no statistic significance (P >= 0.05) between perforated and intact sites. Grafts placed on perforated beds showed higher bone density values compared with non-perforated ones at 3 days (P <= 0.05). This correlation was inverted at 60 days postoperatively. The findings from VEGF labeling revealed a tendency for earlier revascularization in the perforated group. The early revascularization of bone grafts accelerated the bone remodeling process (osteocalcin, type I collagen and osteopontin) that led to an increased bone deposition at 10 days. The extended osteoblast differentiation process at intermediate stages in the perforated group cooperated for a denser bone at 60 days.

Morphometric analysis of tracheary elements in four Portulaca species

This paper deals with the morphological features of the tracheary elements of the vegetative organs in four Portulaca species (Portulaca hirsutissima Camb., P. halimoides L., P. wedermannii Poelln. and P. mucronata Link.) occurring in Southeast and Northeast Brazil. The vessel elements are small (< 25 mu m) and with simple perforation plate. The pattern of wall thickening varied from bordered pitting (in roots) to scalariform and helicoidal (stem and leaves). Statistical methods show variation in vessel-element diameter in different vegetative organs; wider elements were observed in roots. Tracheids occurring in leaves of P. hirsutissima and P. wedermannii, have morphological features that are similar to terminal tracheids or tracheoid idiolasts frequently associated with xerophytes. The paedomorphic features (juvenlism) observed here may be related, in part, to aspects of water transport and storage as described in Cactaceae.

Placement of Kuhlmanniodendron Fiaschi & Groppo in Lindackerieae (Achariaceae, Malpighiales) confirmed by analyses of rbcL sequences, with notes on pollen morphology and wood anatomy

The phylogenetic placement of Kuhlmanniodendron Fiaschi & Groppo (Achariaceae) within Malpighiales was investigated with rbcL sequence data. This genus was recently created to accommodate Carpotroche apterocarpa Kuhlm., a poorly known species from the rainforests of Espirito Santo, Brazil. One rbcL sequence was obtained from Kuhlmanniodendron and analyzed with 73 additional sequences from Malpighiales, and 8 from two closer orders, Oxalidales and Celastrales, all of which were available at Genbank. Phylogenetic analyses were carried out with maximum parsimony and Bayesian inference; bootstrap analyses were used in maximum parsimony to evaluate branch support. The results confirmed the placement of Kuhlmanniodendron together with Camptostylus, Lindackeria, Xylotheca, and Caloncoba in a strongly supported clade (posterior probability = 0.99) that corresponds with the tribe Lindackerieae of Achariaceae (Malpighiales). Kuhlmanniodendron also does not appear to be closely related to Oncoba (Salicaceae), an African genus with similar floral and fruit morphology that has been traditionally placed among cyanogenic Flacourtiaceae (now Achariaceae). A picrosodic paper test was performed in herbarium dry leaves, and the presence of cyanogenic glycosides, a class of compounds usually found in Achariaceae, was detected. Pollen morphology and wood anatomy of Kuhlmanniodendron were also investigated, but both pollen (3-colporate and microreticulate) and wood, with solitary to multiple vessels, scalariform perforation plates and other features, do not seem to be useful to distinguish this genus from other members of the Achariaceae and are rather common among the eudicotyledons as a whole. However, perforated ray cells with scalariform plates, an uncommon wood character, present in Kuhlmanniodendron are similar to those found in Kiggelaria africana (Pangieae, Achariaceae), but the occurrence of such cells is not mapped among the angiosperms, and it is not clear how homoplastic this character could be.

INCREASED WATER STORAGE CAPACITY IN CACTUS WOOD: A STUDY IN THE TRIBE CEREEAE (CACTOIDEAE, CACTACEAE)

Secondary xylem of fibrous cactus wood is characterized by short narrow vessel elements with both simple perforation plates and large intervessel pits, libriform septate fibers, and large rays. These are present in basal cactus taxa, as well as in many other groups of the family. In Cactoideae, the most diversified and most derived subfamily, there are remarkable variations found in the secondary xylem, with the more highly derived taxa containing the greatest water storage capacity. Unlignified parenchyma is one specialization found in the fibrous wood of cacti. We observed this tissue in the secondary xylem at the base of the sterns of several Brazilian endemic species of Arrojadoa, Melocactus, and Stephanocereus, all members of the tribe Cereeae. In Arrojadoa and Melocactus the unlignified parenchyma occurs in lines and bands amongst the axial and radial xylem elements, while in Stephanocereus it is mainly restricted to the rays and does not form bands. We address the adaptive importance of the unlignified parenchyma in the fibrous wood in tribe Cereeae and the family Cactaceae as a whole.

Melting Regime of the Anionic Phospholipid DMPG: New Lamellar Phase and Porous Bilayer Model

Aqueous dispersions of the anionic phospholipid dimyristoyl phosphatidylglycerol (DMPG) at pH above the apparent pK of DMPG and concentrations in the interval 70-300 mM have been investigated by small (SAXS) and wide-angle X-ray scattering, differential scanning calorimetry, and polarized optical microscopy. The order. disorder transition of the hydrocarbon chains occurs along an interval of about 10 degrees C (between T(m)(on) similar to 20 degrees C and T(m)(off) similar to 30 degrees C). Such melting regime was previously characterized at lower concentrations, up to 70 mM DMPG, when sample transparency was correlated with the presence of pores across the bilayer. At higher concentrations considered here, the melting regime persists but is not transparent. Defined SAXS peaks appear and a new lamellar phase L(p) with pores is proposed to exist above 70 mM DMPG, starting at similar to 23 degrees C (similar to 3 degrees C above T(m)(on)) and losing correlation after T(m)(off). A new model for describing the X-ray scattering of bilayers with pores, presented here, is able to explain the broad band attributed to in-plane correlation between pores. The majority of cell membranes have a net negative charge, and the opening of pores across the membrane tuned by ionic strength, temperature, and lipid composition is likely to have biological relevance.

Grafts in myringoplasty : utilizing a silk fibroin scaffold as a novel device

Chronic perforations of the eardrum or tympanic membrane represent a significant source of morbidity worldwide. Myringoplasty is the operative repair of a perforated tympanic membrane and is a procedure commonly performed by otolaryngologists. Its purpose is to close the tympanic membrane, improve hearing and limit patient susceptibility to middle ear infections. The success rates of the different surgical techniques used to perform a myringoplasty, and the optimal graft materials to achieve complete closure and restore hearing, vary significantly in the literature. A number of autologous tissues, homografts and synthetic materials are described as graft options. With the advent and development of tissue engineering in the last decade, a number of biomaterials have been studied and attempts have been made to mimic biological functions with these materials. Fibroin, a core structural protein in silk from silkworms, has been widely studied with biomedical applications in mind. Several cell types, including keratinocytes, have grown on silk biomaterials, and scaffolds manufactured from silk have successfully been used in wound healing and for tissue engineering purposes. This review focuses on the current available grafts for myringoplasty and their limitations, and examines the biomechanical properties of silk, assessing the potential benefits of a silk fibroin scaffold as a novel device for use as a graft in myringoplasty surgery.

Ecologically sustainable noise barrier – further developments

This paper reports on the second phase of a research project aimed at the development of an environmentally friendly noise barrier for urban freeways, also known as KMAK (Krezel and McManus, 2007). The concrete barrier, which has some unique capabilities to mitigate transportation noise, is made from recycled concrete (RC) aggregate and industrial by-products such as fly ash and reclaimed water. The current developmental work expands on a research project that resulted in a two-layer (2L) concrete barrier. Two prototypes of the 2L barrier were produced, followed by extensive acoustic testing and a number of simulations where standard timber and/or concrete barriers were substituted with KMAK barrier (Krezel et al, 2004). Current research investigates a variety of architectural finishes applied to the original KMAK barrier with the aim of improving its visual appearance and also fine-tuning its acoustic performance. The new three-layer (3L) barrier optimises sound absorption in a frequency range characteristic to that of transportation noise, especially road traffic noise. Three major aspects related to the development of architectural finishes were considered; environmentally responsible materials, surface features and production methods. The light-weight material used in the architectural finish is based on ordinary Portland cement (OPC) and uses very fine fraction of RC aggregate. The manufacturing process of the 3L barrier was tested in a commercial setting and two sets of prototype barrier were cast. An innovative, cost effective method of applying pattern and perforation to the surface of architectural finish was also developed and tested. The findings of the current investigation demonstrate that there is a positive correlation between surface features, percentage of perforation as well as depth of the architectural layer and increased potential of the 3L barrier to mitigate transportation noise. On average, the addition of perforated architectural finish contributes to 20% increase in sound absorption. The preliminary results also show that the sound absorbency of the 3L barrier can be better controlled and tuned to specific noise frequency. The visual appearance has been significantly improved with the addition of the architectural finish, which makes the barrier an attractive, feasible and viable alternative to road barriers made from standard concrete or timber.