Gel tópico de amitriptilina al 2% y ketamina al 0,5% para el tratamiento de la eritromelalgia: reporte de un caso con respuesta positiva al dolor

Erythromelalgia (EM) is a rare autosomal dominant neuropathy characterized by the combination of severe burning pain and erythematous warm extremities. Chronic pain control is most often unsuccessful and a completely effective therapy is yet to be identified. Recent studies have reported significant improvements in pain management using a combination of amitriptyline and ketamine in a topical formulation. We describe a 1-year follow-up pain control success case of a male patient with EM, proposed for topical use of a 2% Amitriptyline and 0.5% Ketamine gel.     

Vascular anatomy of the first metatarsal bone and surgical implications according to the severity of hallux valgus deformity: A cadaveric study

BackgroundVascular injury after hallux valgus surgery is a rare condition but serious complications can ensue.MethodsWe performed an anatomical study using 26 cadaveric lower extremities. We enhanced first metatarsal bone’s (FMB) vascularization by injecting latex. Each specimen was classified according to the severity of hallux valgus deformity (HVD). Then we measured two distances: one between the first tarsometatarsal joint (FTMJ) to the first dorsal branch’s origin, the other between the first metatarsophalangeal joint (MTP) to the dorsal plexus’s origin.ResultsThe distance between the FTMJ and the first dorsal branch to the FMB ranges from 10 mm in normal feet to 15 mm in severe deformed feet. The distance between the MTP and the dorsal plexus’ origin ranges from 20 mm in normal feet to 25 mm in severe deformed feet.ConclusionsUnderstanding the foot’s vascular anatomy has allowed us to adapt surgical landmarks to the severity of the HVD and to avoid post-operative complications.     

Auditory extinction and dichotic listening CV task in cerebral infarction: preliminary report

Six stroke patients were studied using a dichotic listening CV task, 4 with left hemisphere infarction, 2 with right hemisphere infarction. It was observed a "lesion-effect", a shift of hemisphere prevalence to the side opposite a brain lesion. The authors suggest that the lesion-effect can be explained by the auditory extinction phenomenon at the linguistic level.     

Low flow veno-venous ECMO: an experimental study

Clinical use of extracorporeal membrane oxygenation (ECMO) and carbon dioxide removal (ECCO 2R) have become well established techniques for the treatment of severe respiratory failure; however they require full cardiopulmonary bypass, representing major procedures with high morbidity. We theorized the possibility of an efficient low flow veno-venous extracorporeal membrane gas exchange method. Four mongrel 12 kg dogs were submitted to veno-venous extracorporeal membrane gas exchange via a jugular dialysis catheter using a low flow (10 ml/min) roller pump and a membrane oxygenator for a period of four hours. Respiratory rate was set at 4 breaths/min with a FiO 2 of 21% and ventilatory dead space was increased. Adequate gas exchange was obtained (pO 2139, pCO 224, Sat 99.4%), without major hemodynamic changes or hematuria. Our results demonstrate the feasibility of a low flow, less aggressive system. Further research should be considered.     

Validation of therapeutic test in the diagnosis and treatment of Kala-Azar in children

The author studied the value of therapeutic test for the diagnosis and treatment of kala-azar in children by comparing two groups of patients. The identification of Leishmania donovani in smears of bone marrow confirmed the diagnosis in all fifty seven patients of the control group. In another group with sixteen children, the diagnosis was based on the successful response to the treatment with meglumine antimonate. In none of the patients of the second group the protozoa was identified and the decision to give the specific treatment was based on epidemiological, clinical, biochemical and hematological criteria for the disease. Statistical analysis was performed by Student t test to compare clinical, biochemical and hematological variables between the groups. None of the differences between the groups was statistically significant, suggesting that the therapeutic test was valid, and all patients who received treatment had kala-azar.     

The extent of Barrett's esophagus depends on the status of the lower esophageal sphincter and the degree of esophageal acid exposure

OBJECTIVE: The purpose of this study was to assess whether the extent of intestinal metaplasia is related to the severity of the gastroesophageal reflux disease. METHODS: A total of 556 consecutive patients with symptoms suggestive of foregut disease had upper gastrointestinal endoscopy with extensive biopsies from the gastroesophageal junction and the esophagus. All patients had esophageal motility and 24-hour pH monitoring. In 411 patients, cardiac-type mucosa was identified; in 147 patients, the cardiac-type mucosa showed intestinal metaplasia. They were divided into 3 groups based on the extent of intestinal metaplasia commonly seen clinically: long segments (>3 cm), short segments (<3 cm), and limited to the gastroesophageal junction. The duration of symptoms, the status of the lower esophageal sphincter, the degree of esophageal acid exposure, and the time to clear a reflux episode were assessed in each group. RESULTS: The presence of intestinal metaplasia in cardiac-type mucosa was associated with the hallmarks of gastroesophageal reflux disease. The extent of intestinal metaplasia correlated strongly with the degree of esophageal acid exposure (r = 0.711; P <.001) and inversely with the lower esophageal sphincter pressure (r = 0.351; P <.001) and length (r = 0. 259; P =.002). Patients with a long segment of intestinal metaplasia (>3 cm) had longer duration of symptoms (16 years) than those patients with a segment of intestinal metaplasia less than 3 cm (10 years; P =.048) or those patients with intestinal metaplasia limited to the gastroesophageal junction (10 years; P =.01). CONCLUSION: The extent of intestinal metaplasia, that is, Barrett's esophagus, is related to the status of the lower esophageal sphincter and the degree of esophageal acid exposure.     

Eryngium spp. (Umbelliferae) as phytotelmata and their Culex (Culex) inhabitants in temperate Argentina

The host-plant fidelity, seasonality, and population dynamics of 3 species of Culex (Culex) were examined from monthly samples of mosquito immatures extracted from the leaf axils of Eryngium pandanifolium and Eryngium cabrerae growing sympatrically in the Punta Lara region of Buenos Aires Province, Argentina. Culex hepperi was collected only from E. pandanifolium, and abundance peaks of its larvae and pupae were asynchronous in forest and field habitats. However, the proportion of plants positive for Cx. hepperi, as well as larval densities and developmental success, did not differ between forest and field. Culex renatoi was collected only from E. cabrerae in the field habitat. The monthly numbers of Cx. hepperi and Cx. renatoi were not significantly correlated with the proportion of their host plants that held water. The stage-specific distributions of Cx. hepperi and C. renatoi numbers were highly skewed towards 1st instars and did not differ between species or, for Cx. hepperi, between forest and field habitats. Culex castroi was collected regularly from the axils of both species of Eryngium, but usually in lesser numbers than either Cx. hepperi or Cx. renatoi. Association analyses indicated significant positive associations between Cx. castroi and the other 2 culicine species in host plants. Culex renatoi occurred preferentially in small E. cabrerae, but Cx. castroi did not discriminate plants based on their size. These 3 species of Culex are known only from Eryngium spp. phytotelmata. We suggest that their host-plant specificity is maintained by oviposition preferences, which are more highly selective for Cx. hepperi or Cx. renatoi than for Cx. castroi.     

Attempts to culturing triatominae in the laboratory using "in vitro" feeding]

In order to simplify breeding of triatominae in the laboratory, for performing xenodiagnosis and other biologic studies, we tried to feed the insects "in vitro" with citrated or defibrinated blood from commercially abated chicken. Two types of efficacy observations were carried out with Triatoma infestans: a) analysis of the chaining of successive nymphal stages, viability of satisfactory matching, fertile oviposition and adequate reproduction; b) assessment of viability and infectivity of Trypanosoma cruzi in the insects. As a conclusion, it became evident that, despite operational easiness, the objectives were not achieved, since the classical procedure used as the control, was always superior.     

Veratridine modifies the TTX-resistant Na channels in rat vagal afferent neurons

A number of neurotoxins from venoms of invertebrates and plants are ligands for voltage-gated Na⁺ channels and are useful tools for studying Na⁺ channel function and structure. Using whole-cell recordings from vagal afferent nodose neurons, we studied neurotoxins that target Na⁺ channels. We asked whether Ts3 (an α-scorpion toxin) and/or veratridine (a lipid-soluble toxin), could modify the TTX-resistant Na⁺ current generated by vagal afferent nodose neurons. Nodose TTX-resistant current was not affected by Ts3, whereas Ts3 slowed inactivation of the current generated by TTX-sensitive current component. We found that veratridine inhibited the TTX-resistant Na⁺ currents on rat nodose neurons. Interestingly, veratridine-modified Na⁺ channels developed a persistent current that accounted for the large tail current observed. We propose that veratridine modifies TTX-resistant Na⁺ channels through a mechanism distinct from its actions on other voltage-gated Na⁺ channels.