Usefulness of transrectal ultrasonography in the diagnosis of anomalies of intersexual conditions

Between the external genital exploration and the internal genital direct vision, through laparoscopia, there is a black point which is the pelvic floor; we have to know whether there is a vagina or not, what it is like and where it arrives at. The reason for this research is to present our experience with the transrectal ecography, which allows us a very good exploration of the pelvic floor.     

Augmentation technique for partial ACL ruptures using semitendinosus tendon in the over-the-top position

The aim of this study is to present a surgical augmentation technique for partial ACL ruptures in which an isolated, autologous, double-bundle semitendinosus tendon graft is passed over the top of the femur, thus fully preserving the still-intact fibers of the ligament remnant. Between 1992 and 2006, 24 patients underwent ACL semitendinosus autograft reconstruction and were followed up for at least 2 years. The median follow-up was 6.2 years (2–15.6). At the last follow-up examination, the patients were evaluated using the International Knee Documentation Committee scale. Subjective and functional parameters were assessed using the Tegner activity scale and the Lysholm scale. Instrumental evaluation was carried out using the KT-1000 instrument. Sixteen of the 24 patients achieved an IKDC score of A. Of the remaining eight patients, six achieved an IKDC score of B, one an IKDC score of C, and one an IKDC score of D. According to the Tegner activity scale, the median pre-injury sports activity level was seven (5–9) and the median post-injury level was six (4–9), while the mean Lysholm scale score was 95 (90–100). Clinical and biomechanical studies have shown that reconstruction techniques that address both bundles of the ACL provide better rotational stability than techniques that address only a single bundle. Therefore, it seems logical than in patients with a partial rupture of the ACL, the intact bundle could be preserved and only the torn bundle would need to be reconstructed.     

Percutaneous transluminal angioplasty of the branches of the aortic arch

Percutaneous transluminal angioplasty (PTA) takes its stable position in the therapy of obliterating arterial diseases. Its indication areas considerably extend. The authors present a survey of their experience and the results of PTA of arteries supplying the brain and upper extremities. This surgery was made in 29 patients on 31 arteries. The authors consider PTA on a. subclavia as a method of choice. In the angioplasty on a. vertebralis there is a very low risk in correctly indicated cases. An atherosclerotic stricture of a. carotis interna is not considered suitable for PTA for the risk of embolism from the exulcerated plaques. However, the method may be used with advantage in the stenosis based on fibromuscular dysplasia and in some cases of early restenoses in a. carotis interna after previous endarterectomy. The authors arrive at the conclusion that PTA, if correctly indicated, is a safe method even in arteries supplying the brain and upper extremities. No complication was observed in the reported group.     

Doxycycline restrains glia and confers neuroprotection in a 6‐OHDA Parkinson model

Neuron–glia interactions play a key role in maintaining and regulating the central nervous system. Glial cells are implicated in the function of dopamine neurons and regulate their survival and resistance to injury. Parkinson's disease is characterized by the loss of dopamine neurons in the substantia nigra pars compacta, decreased striatal dopamine levels and consequent onset of extrapyramidal motor dysfunction. Parkinson's disease is a common chronic, neurodegenerative disorder with no effective protective treatment. In the 6‐OHDA mouse model of Parkinson's disease, doxycycline administered at a dose that both induces/represses conditional transgene expression in the tetracycline system, mitigates the loss of dopaminergic neurons in the substantia nigra compacta and nerve terminals in the striatum. This protective effect was associated with: (1) a reduction of microglia in normal mice as a result of doxycycline administration per se; (2) a decrease in the astrocyte and microglia response to the neurotoxin 6‐OHDA in the globus pallidus and substantia nigra compacta, and (3) the astrocyte reaction in the striatum. Our results suggest that doxycycline blocks 6‐OHDA neurotoxicity in vivo by inhibiting microglial and astrocyte expression. This action of doxycycline in nigrostriatal dopaminergic neuron protection is consistent with a role of glial cells in Parkinson's disease neurodegeneration. The neuroprotective effect of doxycycline may be useful in preventing or slowing the progression of Parkinson's disease and other neurodegenerative diseases linked to glia function.     

Long-term results of coronary surgery

Coronary angiography was performed in a total of 3,696 patients at the Institute for Clinical and Experimental Medicine from 1971 to 1980. From this number 720 were in the subsequent period treated surgically for ischaemic heart disease (IHD). In the majority of them myocardial revascularization was performed using saphenous vein aortocoronary bypass graft and in 7% resection of left ventricular aneurysm was carried out, either separately or together with the aortocoronary bypass. The remaining patients with IHD were treated medically. All patients were followed up for a period ranging from 1 to 10 years (mean 50 months). In most of the patients there was symptomatic improvement and increased tolerance of physical exercise. Among patients with double- and triple-vessel disease there was higher survival in those treated surgically. There was no difference in survival between surgically and medically treated patients with single-vessel disease and patients after aneurysmectomy. Neither was there a marked difference in survival symptoms, exercise tolerance and the occurrence of postoperative myocardial infarction between patients with preoperative MI and those without it. No influence was found of surgical treatment of IHD on the occurrence of sudden death.     

Genotypic and phenotypic analysis of S. mutans isolated from dental biofilms formed in vivo under high cariogenic conditions

The oral cavity harbors several Streptococcus mutans genotypes, which could present distinct virulence properties. However, little is known about the diversity and virulence traits of S. mutans genotypes isolated in vivo under controlled conditions of high cariogenic challenge. This study evaluated the genotypic diversity of S. mutans isolated from dental biofilms formed in vivo under sucrose exposure, as well as their acidogenicity and aciduricity. To form biofilms, subjects rinsed their mouths with distilled water or sucrose solution 8 times/day for 3 days. S. mutans collected from saliva and biofilms were genotyped by arbitrarily-primed PCR. Genotypes identified in the biofilms were evaluated regarding their ability to lower the suspension pH through glycolysis and their acid susceptibility and F-ATPase activity. Most subjects harbored only one genotype in saliva, which was detected in almost all biofilm samples at high proportions. Genotypes isolated only in the presence of sucrose had higher acidogenicity than those isolated only in the presence of water. Genotypes from biofilms formed with sucrose were more aciduric after 30 and 60 min of incubation at pH 2.8 and 5.0, respectively. The present results suggest that biofilms formed under high cariogenic conditions may harbor more aciduric and acidogenic S. mutans genotypes.     

Suspected ureteral colic: plain film and sonography vs unenhanced helical CT. A prospective study in 66 patients

The aim of this study was to compare the sensitivity and specificity of plain abdominal films plus ultrasound, vs nonenhanced CT for the diagnosis of ureteral colic in patients with acute flank pain. During a 4-month period, 66 patients (mean age 48 years) with acute flank pain were prospectively studied by means of plain abdominal film, US, and unenhanced CT. The presence of lithiasis and of obstructive uropathy signs were determined. The plain film was only used as a guide for the US exam. Clinical follow-up of all patients was obtained. Ureteral lithiasis was confirmed in 56 patients. The CT had a greater sensitivity (93 vs 79%) and negative predictive value (71 vs 46%) for the detection of lithiasis. The combination of lithiasis plus obstructive signs showed a sensitivity and a specificity of 100% for CT and of 100 and 90%, respectively, for US. The 11 lithiasis not detected by US were passed spontaneously (10 were <5 mm). Both techniques showed similar extraurinary pathology. Computed tomography is the most accurate technique for the detection of ureteral lithiasis; however, the combination of plain film and US is an alternative to nonenhanced CT with a lower sensitivity and radiation dose that has a good practical value.     

Effect of Ki‐67 on Immunohistochemical Classification of Luminal A to Luminal B Subtypes of Breast Carcinoma

It has recently been proposed to include an immunohistochemical marker of cell proliferation, Ki‐67, as an element with which to classify the molecular subtypes of breast cancer. The objective of this study was to evaluate the effect of the introduction of the Ki‐67 marker on the molecular classification of breast cancer by immunohistochemistry. This study was performed on 234 cases of invasive ductal carcinoma of the breast submitted to two immunohistochemical classification panels, one including Ki‐67 and the other not. The data obtained with the two classifications were correlated with well‐established prognostic factors such as histologic grade, the number of lymph nodes affected and tumor size. The molecular classification without Ki‐67 identified: 136 cases of luminal A (58.1%), 19 cases of luminal B (8.1%), 27 cases of human epidermal growth‐factor receptor 2 overexpressing (11.5%), 27 cases of basal‐like (11.5%), and 25 cases of nonbasal‐like triple‐negative tumors (10.7%). When Ki‐67 was included, this situation changed significantly, with the following cases being identified: 72 cases of luminal A (30.8%) and 83 cases of luminal B tumors (35.5%), resulting in a Kappa score of 0.216. Evaluation of correlations between the luminal A and luminal B tumor subtypes and the selected prognostic factors showed a statistically significant difference only when Ki‐67 was included and only with respect to histologic grade (p < 0.001). The new classification with Ki‐67 significantly altered the prevalence of the luminal A and luminal B subtypes and improved correlation with the histologic grade.     

Strength of Denture Base Resins Repaired with Auto- and Visible Light-Polymerized Materials

Purpose: Clinicians are still confused about the choice of repair method, which depends on factors such as the length of time required for processing, the mechanical strength of the repaired material, and the effect of stress concentration in the acrylic resins before the repair. The aim was to determine the impact and flexural strength characteristics, such as stress at yield, Young's modulus, and displacement at yield of denture base resins fractured and repaired by three methods using heat‐, auto‐, and visible light‐polymerized acrylic resins. Material and Methods: For impact and flexural strength tests, 18 rectangular specimens measuring 50 × 6 × 4 mm³ and 64 × 10 × 3.3 mm³, respectively, were processed using Impact 2000, Lucitone 550, Impact 1500, and QC‐20 acrylic resins. Fracture tests were performed according to ISO1567:1999. Afterward, all fractured specimens were stored in distilled water at 37°C for 7 days, and then repaired with (1) the same acrylic resin used for specimen fabrication (n = 6), (2) an autopolymerized acrylic resin (TruRepair, n = 6), and (3) a visible light acrylic resin (Versyo.com, n = 6). The repaired specimens were again submitted to the same fracture tests, and the failures were classified as adhesive or cohesive. Data from all mechanical tests after repair by the different methods were submitted to two‐way ANOVA, and mean values were compared by the Tukey test. Results: All acrylic resins showed adhesive fractures after impact and flexural strength tests. Differences (p < 0.05) were found among repair methods for all acrylic resins studied, with the exception of displacement at yield, which showed similar values for repairs with auto‐ and visible light‐polymerized acrylic resins. The highest values for impact strength, stress, and displacement at yield were obtained when the repair was made with the same resin the specimen was made of. Conclusion: Denture base acrylic resins repaired with the same resin they were made of showed greater fracture strength.     

Does caffeine affect cerebral blood flow in the preterm infant?

Caffeine, used for treatment of idiopathic apnea in preterm infants, may have a vasoconstrictive effect on cerebral vessels. The ensuing reduction in cerebral blood flow may play a role in the pathogenesis of ischemic brain damage. In 25 preterm infants possible changes in cerebral blood flow due to caffeine administration were assessed using Doppler ultrasound. During caffeine treatment PaCO2 was reduced. However, no changes were found in cerebral blood flow velocity suggesting absence of major changes in cerebrovascular resistance and actual cerebral blood flow following caffeine medication.