Somatic pain sensitivity in children with recurrent abdominal pain

OBJECTIVE: Evidence is accumulating that recurrent abdominal pain (RAP) in children is associated with visceral hyperalgesia. However, it is not known whether somatic sensitivity is altered as well. Therefore, the aim of our study was to assess somatic pain sensitivity in children with RAP and healthy controls at the abdomen and a distal site (thenar).
METHODS: We examined 20 children with RAP (age 8–14) and 23 healthy control children (age 9–14). Heat and mechanical pain thresholds as well as measures of perceptual sensitization in response to repetitive mechanical or tonic thermal noxious stimulation were assessed.
RESULTS: At the abdominal site, pain sensitivity in children with RAP did not differ significantly when compared to controls. At the thenar, pain thresholds of children in the RAP group were not significantly different from control children. However, children with RAP showed less perceptual sensitization in response to tonic heat and repetitive mechanical stimuli (ps ≤ 0.05) than controls.
CONCLUSIONS: We found no evidence for somatic hyperalgesia in RAP arguing against generalized hyperalgesia in these children. Somatic hypoalgesia at the thenar might either be related to a dysregulation of sensory processing and/or attentional avoidance of pain-related stimuli.     

Cytomegalovirus in colorectal cancer and idiopathic ulcerative colitis

Cytomegalovirus (CMV) is a genus in the family Herpesviridae that has been associated with gastrointestinal syndromes. In this work we looked for a possible association of CMV infection with colorectal cancer and ulcerative colitis (UC). Blood and enteric tissue samples of 14 patients with colorectal cancer and of 21 with UC were subjected to a nested-PCR that amplifies part of the gB gene of CMV and also to immunohistochemistry using a specific monoclonal antibody to IE 76 kDa protein of CMV. CMV was detected by nested-PCR in the blood and/or the enteric tissue of nine (64.3%) colorectal cancer and 16 (76.2%) ulcerative colitis patients. In the immunohistochemistry it was observed that 12 (12/21, 57.1%) positive enteric tissue samples of patients with UC and none from patients with colorectal cancer (0/14) were positive to CMV. The positivity of CMV infections in the UC patient group (12/21, 57.1%) showed by both techniques, was significantly higher (p = 0.015) than that observed for colorectal cancer patients (2/14, 14.3%). These results suggest an association of ulcerative colitis with CMV infection of the enteric tissue.     

Prevalence of pertussis antibodies in maternal delivery, cord, and infant serum

BACKGROUND: Passively acquired maternal antibodies protect infants from many pathogens. With increasing reports of infant pertussis, we evaluated pertussis antibodies in maternal-infant paired sera from 1999-2000. METHODS: Antibodies to pertussis toxin (PT), filamentous hemagglutinin (FHA), and fimbrial proteins (FIM) were measured by validated IgG-specific enzyme-linked immunosorbant assay (ELISA) in 64 maternal-umbilical cord serum pairs and in 61 of 64 infant sera. Geometric mean concentrations (GMCs) of pertussis antibodies and cord : maternal GMC ratios were calculated. RESULTS: Mean maternal age and gestation were 29.7 years (range, 19-42) and 39.3 weeks (range, 35.6-40.9), and 81% of mothers were white. GMCs of maternal antibodies at delivery (ELISA units/mL) were 2.4 for PT, 6.9 for FHA, and 13 for FIM. Cord GMCs were 169%, 178%, and 157% of maternal delivery values for PT, FHA, and FIM, respectively, demonstrating active placental transfer (P<.001). Pertussis-specific IgG values for each antigen decayed to below the threshold of detection by age 2 months. CONCLUSIONS: Despite efficient placental transfer, low maternal pertussis antibody levels and their rapid decay in infant sera leave infants with little humoral protection against pertussis. These data support the rationale for maternal or neonatal immunization, with acellular pertussis vaccines, to prevent life-threatening pertussis in early infancy.     

Multiple pathways process stalled replication forks

Impairment of replication fork progression is a serious threat to living organisms and a potential source of genome instability. Studies in prokaryotes have provided evidence that inactivated replication forks can restart by the reassembly of the replication machinery. Several strategies for the processing of inactivated replication forks before replisome reassembly have been described. Most of these require the action of recombination proteins, with different proteins being implicated, depending on the cause of fork arrest. The action of recombination proteins at blocked forks is not necessarily accompanied by a strand-exchange reaction and may prevent rather than repair fork breakage. These various restart pathways may reflect different structures at stalled forks. We review here the different strategies of fork processing elicited by different kinds of replication impairments in prokaryotes and the variety of roles played by recombination proteins in these processes.     

Constraint-induced movement therapy for motor recovery in chronic stroke patients.

OBJECTIVE: Assessment of the effectiveness of constraint-induced (CI) movement therapy and quantitative evaluation of the effects of CI therapy. DESIGN: Intervention study; case series; pretreatment to posttreatment measures and follow-up 3 months after intervention. SETTING: An outpatient department. PATIENTS: Five chronic stroke patients with moderate motor deficit; convenience sample. INTERVENTIONS: CI therapy consisting of restraint of the unaffected upper extremity in a sling for 14 days combined with 6 hours of training per weekday of the affected upper extremity. MAIN OUTCOME MEASURES: Actual Amount of Use Test (AAUT), Motor Activity Log (MAL), Wolf Motor Function Test (WMFT), and Arm Motor Ability Test (AMAT) RESULTS: There was a substantial improvement in the performance times of the laboratory tests (AMAT, WMFT, p < or = .039) and in the quality of movement (AMAT, WMFT, p < or = .049; MAL, p = .049), particularly in the use of the extremity in "real world" environments (AAUT, p = .020), supported by results of quantitative evaluation. The effect sizes were large and comparable to those found in previous studies of CI therapy. CONCLUSIONS: CI therapy is an efficacious treatment for chronic stroke patients, especially in terms of real world outcome.     

Alpha1-Antitrypsin Deficiency May Be a Risk Factor for Duodenal Ulcer in Patients with Helicobacter pylori Infection

Background: It is not known whether evaluation of motor and sensory function of the rectum using a barostat may help to distinguish subtypes of constipation. Methods: Motor and sensory function of the rectum have been evaluated using a barostat in 14 patients with slow transit constipation (STC), 12 patients with constipation-predominant irritable bowel syndrome (IBS) and 18 healthy controls. First minimal distending pressure was determined, after which spontaneous adaptive relaxation of the rectum was monitored. Then a step-wise isobaric distension procedure was performed, during which symptom perception was determined. The distension was followed by a 90-min barostat procedure: for 30 min in the basal state followed by ingestion of a semi-liquid meal (postprandial state). Results: Minimal distending pressure was not different between both patient groups and controls, neither was compliance different between constipated patients and controls. The degree of spontaneous adaptive relaxation was in the same range in all groups. During distensions with high pressures, the perception of urge was significantly reduced in STC patients compared to IBS and controls, while the perception of pain was significantly increased in IBS versus STC and controls. Postprandially, a small decrease of rectal volume was only observed in the control group, but not in the patients. Conclusions: Rectal motor characteristics are not different between patients with constipation-predominant IBS, patients with STC and healthy controls while during isobaric distensions, sensations of urge were reduced in STC and sensations of pain were increased in IBS. Rectal visceroperception testing may help distinguish groups of patients with different subtypes of constipation.     

Cordoma condroide de localización atípica

Chondroid chordoma is an extremely rare tumour with an annual incidence of around 0.1 cases per 100,000 population. Involvement of the thoracic vertebrae may be present in 2-5% of cases.     

Relaxant effects of antidepressants on human isolated mesenteric arteries

AIMS: The therapeutic action of tricyclic agents may be accompanied by unwanted effects on the cardiovascular system. The evidence for the effects on vascular and nonvascular smooth muscle comes from animal studies. Whether these studies can be extrapolated to human vessels remains to be determined. Therefore, the present study was designed to investigate the influence of amitriptyline, nortriptyline and sertraline on the contractile responses of human isolated mesenteric arteries to electrical field stimulation, noradrenaline and potassium chloride. METHODS: Arterial segments (lumen diameter 0.8-1.2 mm) were obtained from portions of the human omentum during the course of 41 abdominal operations (22 men and 19 women), and rings 3 mm long were mounted in organ baths for isometric recording of tension. In some artery rings the endothelium was removed mechanically. RESULTS: In precontracted artery rings amitriptyline, nortriptyline and sertraline (3x10(-7)-10(-4) m ) produced concentration-dependent relaxation that was independent of the presence or absence of vascular endothelium. Incubation with indomethacin (3x10(-6) m ) reduced the pD2 values thus indicating the participation of dilating prostanoid substances in this response. Amitriptyline and nortriptyline inhibited both the neurogenic-and noradrenaline-induced contractions. In contrast, only the highest concentration of sertraline reduced the adrenergic responses. Amitriptyline, nortriptyline and sertraline inhibited contractions elicited by KCl and produced rightward shifts of the concentration-response curve to CaCl2 following incubation in calcium-free solution. CONCLUSIONS: These results indicate that amitriptyline and nortriptyline could act as adrenoceptor antagonists and direct inhibitors of smooth muscle contraction of human mesenteric arteries, whereas sertraline might principally exert its action only as direct inhibitor of smooth muscle contraction. This relaxant mechanism involves an interference with the entry of calcium.     

Pharmacokinetics and safety of single rising doses of ofloxacin in healthy volunteers.

The pharmacokinetics, safety, and disposition of the new antimicrobial fluoroquinolone ofloxacin were evaluated after oral administration in 14 healthy, male volunteers in a double-blind, placebo-controlled study. Ofloxacin was administered as 100-, 300-, and 600-mg doses separated by 1 week. Plasma and urine concentrations after each administration were measured using a sensitive and specific high-performance liquid chromatographic procedure. The distribution of ofloxacin was modeled using a two-compartment open-body model with first-order absorption. Maximum plasma concentrations and area under the plasma concentration versus time curve increased in a linear, dose-proportional manner over the range studied. At all levels, within 36 hours after administration, approximately 70% of the dose was recovered in urine as unchanged ofloxacin and only minimal amounts (less than 4%) as metabolites. No significant changes in the distribution or elimination of the compound were found over the 6-fold dose range. No major laboratory toxicities or clinically significant adverse effects were noted in either the ofloxacin or placebo group.     

An expanded view of psychological aspects in head pain: the biopsychosocial model

Neurological Sciences - Traditionally, headache has been viewed from a limited perspective, both medically and psychologically. The authors propose that a more expanded view of headache that...