Clinical significance of abdominal scintigraphy using 99mTc-HMPAO-labelled leucocytes in patients with seronegative spondyloarthropathies

Abdominal scintigraphy shows silent gut inflammation in patients with spondyloarthropathies (Sp) without clinical evidence of gut inflammation. Abdominal scintigraphy images are different than those obtained in patients with ulcerative colitis or Crohn's disease and are not related to the anti-inflammatory drugs administered. The aim of this study was to examine the clinical associations of findings on abdominal scintigraphy in patients with Sp. A total of 204 Sp patients (European Spondylarthropathy Study Group 1991 criteria) and 54 non-Sp controls receiving non-steroidal anti-inflammatory drugs were studied. Abdominal scintigraphy images were obtained at 30 and 120 min after injection of technetium-99m hexamethylpropylene amine oxime (^99mTc-HMPAO)-labelled leucocytes. ^99mTc-HMPAO-labelled leucocyte scans were positive in 104 Sp patients (50.9%) and in six non-Sp controls (2.9%) (P<0.001; OR=8.32; 95% CI=3.23-22.67). Silent gut inflammation was not associated with any of the following: age of onset, duration of evolution, sex, family history of Sp or psoriasis, articular manifestations, extra-articular manifestations, radiological findings or HLA-B27 positivity. Positive abdominal scintigraphy was associated with active disease (P<0.0001; OR=52.7; 95% CI=19-145.6) and an increase in the C-reactive protein (P<0.005; OR=3.4; 95% CI=1.5-7.4). It is concluded that (a) abdominal scintigraphy using ^99mTc-HMPAO-labelled leucocytes is of value in detecting the silent gut inflammation in Sp patients, and (b) silent gut inflammation is related to the clinical activity, but is not associated with any particular type of illness or with HLA-B27.     

Treatment of osteoarthritis of the knee with valgus deformity by means of varus osteotomy

Nineteen cases of osteoarthritis of the knee with valgus deformity in 17 patients were treated by femoral supracondylar varus osteotomy (17 cases) or by high tibial varus osteotomy (2 cases) over the last 15 years. Fixation was performed using a 95 degrees AO blade-plate in 13 of the femoral osteotomies and a straight plate in the other four. The mean follow-up time was 6.5 years. The valgus deformity was idiopathic in 14 cases, secondary to rheumatoid arthritis in 2 cases and to tibial valgus in one case. The Hospital for Special Surgery (HSS) score was used to evaluate the clinical results: nearly 75% were excellent or good. The causes related to poor results are analyzed regarding indication and surgical technique. It appears that varus osteotomy is an effective procedure for the treatment of osteoarthritis of the knee with valgus deformity, above all in order to alleviate pain, although the operation requires precision, and correct selection of patients is of prime importance.     

Spontaneous rib fracture during pregnancy. A case report and review of the literature

No studies have demonstrated a direct relationship between pregnancy and rib fracture. A case of spontaneous rib fracture in the third trimester presents the opportunity to examine factors unique to pregnancy that may predispose the patient to stress fractures of the lower ribs. A 28-year old woman in week 31 of her pregnancy presented with the chief complaint of acute onset of right upper quadrant pain. A chest radiograph demonstrated a minimally displaced fracture of the right 10th rib. During pregnancy, the enlarging uterus causes certain opposing muscular forces to act on the ribs, making them more susceptible to fracture after minimal trauma or after repeated stresses such as a chronic cough.     

Information processing in the spinocerebellar system

The purpose of this study was to determine whether sensory information about limb kinematics relayed to the cerebellum over spinocerebellar pathways may be modified at the cerebellar level. We tested this by recording from dorsal spinocerebellar tract (DSCT) and Purkinje cells under the same experimental conditions in which the hindlimbs of anesthetized cats were passively moved through a series of step-like movement cycles. A population analysis of the response behavior showed that DSCT neurons encode a combination of limb axis position and movement velocity, whereas the Purkinje cells located in the DSCT cerebellar target areas encode limb axis velocity and position independently. We conclude from this that the cerebellum may somehow extract a velocity component from the afferent input signal.     

Emphysema induced by elastase enhances acute inflammatory pulmonary response to intraperitoneal LPS in rats

Abnormalities in lungs caused by emphysema might alter their response to sepsis and the occurrence of acute lung injury (ALI). This study compared the extension of ALI in response to intraperitoneal lipopolysaccharide (LPS) injection in Wistar rats with and without emphysema induced by elastase. Adult male Wistar rats were randomized into four groups: control, emphysema without sepsis, normal lung with sepsis and emphysema with sepsis. Sepsis was induced, and 24 h later the rats were euthanised. The following analysis was performed: blood gas measurements, bronchoalveolar lavage (BAL), lung permeability and histology. Animals that received LPS showed significant increase in a lung injury scoring system, inflammatory cells in bronchoalveolar lavage (BAL) and IL‐6, TNF‐α and CXCL2 mRNA expression in lung tissue. Animals with emphysema and sepsis showed increased alveolocapillary membrane permeability, demonstrated by higher BAL/serum albumin ratio. In conclusion, the presence of emphysema induced by elastase increases the inflammatory response in the lungs to a systemic stimulus, represented in this model by the intraperitoneal injection of LPS.     

Experiencia y tratamiento anestésico en el implante transcatéter de la prótesis valvular aórtica autoexpandible CoreValve®

ObjectiveTo analyze the experience and anesthetic management in the transcatheter implantation of the CoreValve^® self-expanding aortic valve, in a university tertiary hospital.Material and methodsObservational analytical review of data incorporated into a prospectively maintained database of 142 patients diagnosed with severe aortic stenosis who underwent implantation of a CoreValve^® aortic self-expanding aortic valve between December 2007 and December 2012.ResultsThe mean age of patients was 82.5 ± 6.1 years and the logistic EuroSCORE was 14.9 ± 11.2. General anesthesia was used in 107 patients (75.3%), with local anesthesia with sedation in 35 (24.6%). Local anesthesia and sedation was associated with a lower requirement of vasoactive drugs (P = .003) during implantation. No statistically significant differences were found between the 2 anesthetic techniques in the duration of the procedure, hospital stay, or morbimortality. The success rate was 97.1%. The most common complication was conduction disorders that required implantation of a permanent pacemaker in 46 patients (32.3%). There was no intraoperative mortality, and all-cause mortality at 30 days was 6.3%, with a one-year survival estimated by the Kaplan-Meier of 83.1%.ConclusionsThis study confirms that in patients with severe aortic stenosis and high surgical risk, transcatheter implantation of aortic valve is a safe and effective alternative. Both, general anesthesia and local anesthesia with sedation are valid options, depending on the experience of the team.     

Swimming-induced pulmonary oedema an uncommon condition diagnosed with POCUS ultrasound

Swimming Induced Pulmonary Edema, or SIPE, is an emerging condition occurring in otherwise healthy individuals during surface swimming or diving that is characterized by cough, dyspnea, hemoptysis, and hypoxemia. It is typically found in those who spend time in cold water exercise with heavy swimming and surface swimming, such as civilian training for iron Man, triathalon, and military training. We report the case of a highly trained young female swimmer in excellent cardiopulmonary health, who developed acute alveolar pulmonary oedema in an open water swimming training diagnosed in the emergency department using POCUS ultrasound.     

P300 latency and amplitude in Alzheimer's disease: a systematic review

The P300 plays a key role as a method for monitoring and evaluating dementia, including Alzheimer's disease.Objective: The goal of this study was to search for articles which analyzed P300 latency and amplitude values in Alzheimer's disease.Methods: We searched in the following databases: Web of Science, Pub Med, Psyc Info, Medline, Biological Abstracts and Scielo using the following keywords: speed of information processing, processing speed, information processing, aged, older, elderly, older people, alzheimer dementia, alzheimer disease, Alzheimer and cross-references of selected articles.Results: We found eight studies matching the inclusion criteria. These studies showed that there is a consensus on a P300 latency increase of elderly patients with Alzheimer's disease compared with subjects without the disease. However, it appears that, with respect to the P300 amplitude, there is still no consensus; however, it may be related to different methodological variables adopted in the reviewed studies.Conclusion: There is a need to standardize the variables involved in P300 measurement for senior citizens with Alzheimer's disease in order to be able to compare P300 latency and amplitude values for this population.