Abdomen release in prone position does not improve oxygenation in an experimental model of acute lung injury

OBJECTIVE: To analyze the effect of abdomen release in the prone position on oxygenation in an experimental model of acute lung injury. DESIGN: Experimental randomized controlled study. SETTING: Experimental laboratory of a tertiary university hospital. PARTICIPANTS: Mixed-breed adolescent pigs weighing between 25-31 kg. INTERVENTIONS: Thirty minutes after pulmonary edema was produced with oleic acid, the animals were turned prone and randomized into two groups: group I or control (n = 9), lying directly on the operating table; and group II (n = 11) with abdomen release, with positioning rolls under the upper part of the chest wall and the pelvis to allow free movement of the abdomen. MEASUREMENTS AND RESULTS: The gas exchange, respiratory mechanics, hemodynamics, intra-abdominal pressure (IAP) and the extravascular lung water (EVLW), determined by double indicator dilution method (DI), were recorded at baseline (time 0) and at 30, 60, 90, 120 and 150 min. The PaO2/FIO2 increased in both groups at 30 min after the pigs were placed in the prone position (time 60) and then decreased progressively until the end of the experimental period, with no statistical differences between the groups at any time (73.1 +/- 14.5 vs 79.5 +/- 14.9 at 150 min). Abdomen release was not associated with changes in the respiratory mechanics, EVLW or intra-abdominal pressure. CONCLUSIONS: Abdomen release in prone position does not improve oxygenation in an experimental model of acute lung injury.     

Diagnostic reasoning in neurology. An analysis of the more frequent errors

Diagnostic reasoning is a cognitive proccess that has various performance and results. There are several kinds of clinical reasoning, such as model or pattern recognizing, causal or physiopathologic reasoning, deterministic, exhaustive, and hypotetic-deductive ones. Each form of reasoning may be relevant in certain clinical context, and all of the forms are also complementary. The logical consequence of diagnostic reasoning, like every cognitive proccess, is a clinical error. It is necessary that the neurologist knows the principles of diagnostic reasoning and the more frequent errors and biases. These can be summarized as: errors associated with the proccess of taking history and clinical examination, mnesic and semantic components of clinical reasoning, failure of hipotetic- deductive reasoning, and inadequate use of probability theory in Medicine.     

Study of 1,000 patients with disequilibrium

We present a series of one thousand patients tested with electronystagmography (ENG) for evaluation of complaints of unstability. Personal data and electronystagmographic results are analysed.     

Surfing for back pain patients: the nature and quality of back pain information on the Internet

STUDY DESIGN: A prospective, systematic review of web sites related to back pain. OBJECTIVE: To assess the nature and quality of back pain-related information on the World Wide Web during a 2-year period. SUMMARY OF BACKGROUND DATA: The Internet has become a rich source of medical information. Limited knowledge is available, however, about the quality of online resources. Although previous systematic reviews on medical-related web sites found problems in varying degrees with the credibility of information, no such review was conducted to assess the back pain-related sites. METHODS: A search of web sites was conducted in November 1996 using five search engines (AltaVista, Infoseek, Lycos, Yahoo, and Magellan) and two key terms ("back pain" and "back problems"). A sample of sites was evaluated by two independent reviewers. Each site was described by the type and nature of the sponsor, target audience, and content. Overall quality was assessed in terms of evidence-based information available. RESULTS: Seventy-four web sites were reviewed in 1996, and nine of them (12.2%) were identified as high-quality sites. Advertising was the focus of 80.8% of the sites. Eleven sites (14.9%) were found to be discontinued 1 year later, and 20 (27.0%) were not accessible by the reviewers at the 2-year follow-up evaluation. Of the remaining 54 sites, 44.4% were produced by for-profit companies, and most sites targeted people with back pain (63.0%). Only seven out of the nine high-quality sites held their ratings at the 2-year follow-up evaluation. CONCLUSION: Most back pain-related web sites can be classified as advertising. The quality varied considerably, resulting in difficulties for patients to find useful information in this field. The increasing number of people seeking medical information on the Web creates a need for more high quality sites. Further, systematic review of web sites should be encouraged to monitor the accuracy of Internet publication.     

Adamantylamide dipeptide as effective immunoadjuvant in rabbits and mice

In the search for more potent and less toxic immunomodulators, adamantylamide dipeptide (AdDP) was synthesized by the covalent union of amantadine with the L-alanyl-D-isoglutamine residue of muramyldipeptide (MDP). The present experiments demonstrate the ability of AdDP, co-administered with a protein immunogen, to raise or enhance a humoral response in immunized animals. BALB/c mice were immunized either by the intraperitoneal (ip) or oral route with ovalbumin (Ova) alone or combined with either AdDP or CpG oligonucleotide (ODN-CpG), a proved adjuvant. A clear adjuvant dose-response relationship was observed on the increment of Ova-specific serum antibody titers when AdDP was used as adjuvant, irrespectively of the administration route. The IgG isotype analysis showed that AdDP promotes a consistent increment in IgG1 antibodies associated with a dominant Th2 response pattern. When administered by the oral route, AdDP was at least as efficient as ODN-CpG as adjuvant. Similar results were obtained in rabbits immunized by the oral route, suggesting that the adjuvanticity of AdDP is not restricted to the murine system. In conclusion, AdDP was shown to be a powerful and non-toxic adjuvant at both systemic and mucosal levels, which makes it a promising tool for vaccine development.     

Prostate biopsy strategies. A review of the literature

IntroductionIn 1987 transrectal ultrasound was described like the technique for guiding prostate biopsy. Since that time different options of transrectal ultrasound guided prostate biopsy were described.Material and MethodsWe did a reviewed of the different techniques and cores distribution in the prostate biopsy, also we describes the patient preparation and the most important complications.ResultsThe majority of the reviewed showed an increase in the sensibility rates with the extended transrectal ultrasound guided prostate biopsies. These improvements generally are due to the most lateral zones.ConclusionUntil now, due to a great experience and a low complications rate, the transrectal ultrasound guided prostate biopsy strategy should be extended respect the classical sextant biopsy with cores from the most lateral zones of the prostate.     

Antinociceptive effects of ceftriaxone in formalin-induced nociception

Ceftriaxone (CFX) is a β-lactam antibiotic with analgesic properties. However, its role in the formalin-induced nociception remains unknown. The purpose of this study was to investigate the antinociceptive effect of CFX in the 1% formalin test in rats. Formalin induced a typical nociceptive response (flinching behavior) of two phases. Local peripheral pretreatment (20 min) with CFX (400–800 μg/paw) slightly attenuated the flinching behavior in phase 2, but not phase 1. Acute intraperitoneal pretreatment (20 min) also reduced phase 2 of the formalin test. In both cases, CFX induced a dose-dependent antinociception. We also tested the effect of CFX 1 day after its administration and in two schedules of repeated administration. One-day pretreatment with CFX (50–400 mg/kg, ip) induced a dose-dependent antinociceptive effect in formalin-treated rats. Repeated administration (daily during 3 or 7 days) with CFX (50–400 mg/kg, ip) diminished formalin-induced nociception. Results suggest that local or systemic as well as single or repeated administration of CFX reduces formalin-induced nociception.