The digastric muscle's anterior accessory belly: case report

Digastric muscle is characterized by presenting occasional variations. The suprahyoid region of an 83 year-old male cadaver was dissected and an anatomic variation of the digastric muscle was observed in its anterior belly. It consisted of an accessory bilateral anterior belly originating in the intermediate tendon and inserted into the mylohyoid raphe. The implications of this variation are discussed from a diagnostic and functional perspective.     

One-Stage Revision Arthroplasty Using Cementless Stem for Infected Hip Arthroplasties

The objective of this retrospective study was to evaluate our results with one-stage revision using cementless femoral stem for infected hip arthroplasties. Twenty-four patients were included in the study. The acetabular component was cemented in 9 cases. In 2 patients a structured bone allograft was necessary to fill an acetabular defect. After a mean follow-up of 44.6 months, 23 patients showed no signs of infection (95.8%), the mean functional response according to the Merle d’Aubigné scale was 13.8 and the mean Harris Hip Score was 65.4. One-stage revision hip arthroplasty using cementless femoral stem was associated with a high success rate.     

Melatonin and viral infections

The therapeutic effects of melatonin against viral infections, with emphasis on the Venezuelan equine encephalomyelitis (VEE), are reviewed. Melatonin has been shown to prevent paralysis and death in mice infected with the encephalomyocarditis virus and to decrease viremia. Melatonin also postpones the onset of the disease produced by Semliki Forest virus inoculation and reduces the mortality of West Nile virus-infected mice stressed by either isolation or dexamethasone injection. An increase in the host resistance to the virus via a peripheral immunostimulatory activity is considered responsible for these effects. It has also been demonstrated that melatonin protects some strains of mink against Aleutian disease, and prevents the reduction of B- and T-cells as well as Th1 cytokine secretion in mice infected with leukemia retrovirus. In VEE-infected mice, melatonin postpones the onset of the disease and death for several days and reduces the mortality rate. This protective effect seems to be due to the increase in the production of interleukin-1beta (IL-1beta), as 100% of the infected mice treated with melatonin die when IL-1beta is blocked with antimurine IL-1beta antibodies. Although melatonin administration raises serum levels of tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma), the mortality observed in neutralization experiments with the corresponding anticytokine antibodies, suggests that neither TNF-alpha nor IFN-gamma are essential for the protective effect of melatonin on murine VEE virus infection. Melatonin treatment also enhances the efficiency of immunization against the VEE virus. Reactive oxygen species have been implicated in the dissemination of this virus, and their deleterious effects may be diminished by melatonin. This indole inhibits nitric oxide synthetase activity and it is a potent scavenger of nitric oxide, which also plays an important role in the spread of the VEE virus. In conclusion, the immunomodulatory, antioxidant, and neuroprotective effects of melatonin suggest that this indole must be considered as an additional therapeutic alternative to fight viral diseases.     

Neither too much,nor too little. The dilemma of identifying personality disorders in adolescents patients with self-reports

The study aimed to compare methods of identification of Personality Disorders (PD) in adolescent patients with psychiatric disorders. A sample of 120 Spanish adolescents with clinical disorders was assessed using the International Personality Disorder Examination (IPDE) interview, its Screening Questionnaires (IPDE-SQ) comprising the ICD-10 and DSM-IV modules, and also the Temperament Character Inventory (TCI) to identify risk of PD. The IPDE-SQ identified a risk of PD around 92–97% of the sample; 61.7% when adjusting the stricter cut-off points. The TCI showed a PD risk of 20%, whereas the prevalence of PD identified by the IPDE clinical interview was around 36–38%. The differences between the IPDE, IPDE-SQ and TCI were significant, and a low agreement among instruments was obtained. Large discrepancy between self-report instruments in identifying PD with regard to the clinical interview raises several questions concerning the use of these instruments in clinical settings on adolescents with psychiatric disorders.     

Type of delivery and reading,writing, and arithmetic learning in twin births

This study analyses, in children born in twin births, the relationship between reading, writing and arithmetic learning, on the one hand, and type of delivery, on the other, controlling for the effect of interaction and/or confusion of third variables (maternal age at delivery, gestational age, fetal position, birthweight, 1-min Apgar score). In the planned retrospective cohort design, the exposed cohort consisted of children born by caesarean section, and the non-exposed cohort was comprised of children born vaginally. One hundred and twenty-four children born of twin births were evaluated during their first year of primary school: K-BIT tests were used to measure intelligence; the Evalúa-1 battery was used to assess reading, writing, and arithmetic ability; and the children's clinical histories were analysed for obstetric and neonatal variables. After applying binary logistic regressions for each dependent variable, it was found that caesarean delivery in twin births appeared as a possible independent risk factor for specific learning disabilities (LDs) in reading, writing, and arithmetic. Based on these results, further research using larger samples and at more advanced ages is required in order to analyse the influence of obstetric and neonatal variables on the processes underlying specific LDs.     

Marcadores pronósticos en pacientes con gammapatía monoclonal de significado incierto

Objective

The assessment of prognostic biomarkers in monoclonal gammopathies of uncertain significance (MGUS) requires using large cohorts and long follow-ups, due to the low rate of conversion to multiple myeloma (MM). The aim of this article is to develop a model that allows smaller cohorts and shorter follow-ups to be used with high reliability.

Patients and methods

A total of 64 MGUS patients were studied and followed-up prospectively for 6 ± 0.24 years. Patients were classified as evolving or non-evolving, depending on whether the monoclonal protein levels increased or not over time. The risk of conversion to MM was tested based on these phenotypes, and whether the factors that predict conversion to MM are also associated with the appearance of an evolving phenotype.

Results

Eleven patients showed an evolving phenotype, and 53 a non-evolving one. All patients who converted to MM previously showed evolving phenotype (P = .003). At diagnosis, evolving phenotype associated with monoclonal gammopathies of IgA isotype (27 vs. 9%), monoclonal IgG levels above 1,500 mg/dl (P = .007, OR 9.8) and altered kappa/lambda ratios (P = .001, OR 11.7).

Conclusions

Risk factors for developing an evolving phenotype in MGUS patients are the same as those already described for the development of MM. These data show the validity of the evolving/non-evolving model to study markers to predict the outcome of MGUS patients, and confirm the role of the levels of monoclonal IgG and the light chains ratio in the prognosis of this disease.