Painful Intervertebral Dysfunction: Robert Maigne's Original Contribution to Headache of Cervical Origin

SYNOPSIS
Professor Robert Maigne, a French Orthopedic Medicine and Functional Rehabilitation specialist, hasput forward new concepts leading to a better understanding of common pain of spinal origin. Maigneexplains that pain in the spine is due to an intervertebral dysfunction of the mobile segment which consistsof the intervertebral disc, ligaments and the facet joints. Any benign mechanical dysfunction of the mobilesegment can induce a pain radiating in the dermatome at the same level as the vertebral problem. Maignealso described signs found in the skin (cellulalgia), in the muscles (myalgic bands) and in the bonyinsertions of tendons (tenalgia). These signs are to be found in the same dermatome, myotome andsclerotome as the spinal dysfunction. For headache of cervical origin due to painful intervertebraldysfunction, the most frequent dysfunctional mobile segment is located at the C2-C3 level. This inducespain mostly in the posterior parts of the head and cellulalgia in the C2 and C3 dermatomes. Painfultumefaction is also found over the posterior aspects of the facet joints on palpation at this level. Thesefindings are key elements for the diagnosis of painful intervertebral dysfunction. The recognition of thesesigns is changing our understanding of the role of the cervical spine in headaches. Painful intervertebraldysfunction is very frequently found in chronic daily headaches.     

牡丹江市正常成人尿液红、白细胞定量分析参考值调查

目的尿液沉渣分析红、白细胞由传统的定性报告方式改为定量分析(××/μl).由于使用的检查方法不同,其参考值也不一样,国内目前尚未有统一的参考值,为使牡丹江市有一个统一的判断标准.方法我们对1109名健康成人其中男性591人,女性518人进行尿中红细胞及白细胞的参考值调查.方法采用国内的专用尿沉渣计数板,显微镜下计数.对体检者在统一时间清晨7点钟留取尿液20～30毫升,按统一操作规程进行操作,对不同性别的人群进行参考值的调查.结果男性红细胞x是1.12,S是1.42,95%可信界限0～3.96,参考值范围0～4/μl;男性白细胞x是1.84,是S 2.05,95%可信界限0～5.94,参考值范围0～6/μl.女性红细胞x是2.46,S是3.26,95%可信界限0～8.98,参考值范围0～9/μl;女性白细胞x是2.25,S是3.82,95%可信界限0～9.89,参考值范围0～10/μl.结论通过1109名正常成人尿液红细胞及白细胞含量的调查,建立了牡丹江市的参考值.     

Hemodynamic effects of prolonged enoximone infusion (7 days) in patients with severe chronic heart failure

Summary This study investigated the hemodynamic effects and tolerance of infusion of 10 µg/kg/min enoximone over 7 days in 12 patients (mean age 64.3 years) with severe chronic heart failure (10 NYHA Class III and 2 Class IV) with idiopathic dilated cardiomyopathy. Hemodynamic parameters were measured 10 minutes, 3 hours, 6 hours, 18 hours, 24 hours, and 7 days after the start of infusion. Catecholamines were assayed before the start of the infusion and on day 7. The heart rate increased on an average from 90.8±13.7 before infusion to 108.5±8.2 beats/min (p<0.05) on day 7 (+20%). The mean arterial pressure decreased by approximately 10% (p<0.05) between the start and end of the infusion. The pulmonary artery diastolic pressure dropped by a maximum of 30% at the 24th hour (23.1±5.1 to 16±5.4 mm Hg; p<0.01). This decrease remained significant on day 7; the index cardiac was increased a maximum of 40% between the 18th and the 24th hour; p<0.01). This increase was still significant on day 7 (2.35±0.44; p<0.05; +22%). Finally, the decrease in systemic arterial resistance, which reached a maximum of 30% of the 24th hour, persisted on day 7 (–22%); 2076±451 to 1612±283 dynes/sec/cm⁵; p<0.05). The norepinephrine level did not change significantly (4.5±1.2 nmol/l before infusion vs. 4.2±1.1 nmol/l on day 7). Infusion had to be stopped in one patient after 30 minutes because of prolonged severe hypotension. Frequent supraventricular extrasystoles were observed in another patient during the entire period of infusion. In conclusion, a beneficial hemodynamic effect persisted on day 7 of enoximone infusion in patients with chronic heart failure, and clinical and biologic tolerance were good despite moderate tachycardia.     

Monitoring rotavirus environmental contamination in a pediatric unit using polymerase chain reaction.

Rotavirus environmental contamination in a pediatric unit was investigated. Surfaces were swabbed, then viruses eluted, ultracentrifuged, and detected by polymerase chain reaction (PCR) amplification. Of 55 samples, 25 (46%) tested positive. Rotavirus RNA was more prevalent on surfaces in direct contact with children (thermometers and play mats) than on other environmental surfaces (washbasins, door handles, etc). PCR has proved useful for monitoring rotavirus environmental contamination.     

Infected pancreatic fluid collections: percutaneous catheter drainage

Thirty-eight infected pancreatic fluid collections in 23 patients with acute or chronic pancreatitis were drained percutaneously following initial diagnosis with computed tomography and fine-needle aspiration. Fifteen (65.2%) patients were cured completely without surgery. Eight (34.8%) patients required some type of surgery despite successful treatment of the fluid collection, and in two (6.5%) the collection recurred after catheter removal. Complications occurred in three (13%) patients, but only one complication (4%), empyema, was a direct result of catheter drainage. Catheter drainage time averaged 29 days for 16 patients with isolated collections and 96 days and 104 days for patients with collections with pancreatic duct fistulas (nine patients) or gastrointestinal fistulas (14 patients), respectively. This study confirms that infected pancreatic fluid collections can be safely and effectively treated with percutaneous catheter techniques in most patients.     

Kinetic properties of two plasmid-mediated beta-lactamases from Klebsiella pneumoniae with strong activity against third-generation cephalosporins

We determined the kinetic constants for two plasmid-mediated beta-lactamases with strong activity against third-generation cephalosporins: CTX-1 and SHV-2. The enzymes had many similar properties: their synthesis was constitutive and they were significantly active against penicillins as well as cephalosporins. The two enzymes thus differed considerably from the chromosomal cephalosporinases, but bore some resemblance to the commonly-encountered plasmid-coded penicillinases, such as TEM beta-lactamases. Moreover, like the TEM enzymes, the plasmid-mediated CTX-1 and SHV-2 enzymes were highly sensitive to the action of the inhibitors clavulanic acid and sulbactam. These inhibitors protected cefotaxime from hydrolysis by these enzymes. Both CTX-1 and SHV-2 lacked activity against the cephamycins, cefoxitin, latamoxef (moxalactam) and cefotetan. The CTX-1 and SHV-2 enzymes had a low activity against oxacillin and were not sensitive to chloride ions. Thus, they were not related to the OXA type beta-lactamases. For the third-generation cephalosporins the rates of hydrolysis were high and thus bore no relation with those observed for the other presently-known beta-lactamases, with perhaps the exceptions of those produced by K. oxytoca. Imipenem was very resistant to the action of these CTX-1 and SHV-2 beta-lactamases.     

Life table analysis of 879 treatment episodes with slow acting antirheumatic drugs in community rheumatology practice.

In 596 patients with RA managed over a decade in a community practice setting, 879 slow acting antirheumatic drug (SAARD) treatment episodes were analyzed using 5-year life tables. The probability of continuation of therapy was 50% by 9-24 months for all drugs except for methotrexate (MTX), which was 62% by 5 years [corrected]. MTX treatments were of significantly longer duration than those of all other SAARD (p less than 0.001); terminations for both inefficacy (p less than 0.001) and toxicity (NS) were less likely. These findings concur with recent evidence suggesting that MTX is a superior SAARD in this setting.