Sarcoidosis and brucellosis: a strange and infrequent association

A cattlewoman, a 63-year-old patient with sarcoidosis associated to mellitensis brucellosis, was studied. Clinical manifestations of both multisystemic diseases were compared, as well as diagnostic and therapeutic aspects; we concluded that coexistence of both entities is infrequent but may occur due to increased presentation of the diseases.     

Total skin electron therapy treatment verification: Monte Carlo simulation and beam characteristics of large non-standard electron fields

Total skin electron therapy (TSET) is a complex technique which requires non-standard measurements and dosimetric procedures. This paper investigates an essential first step towards TSET Monte Carlo (MC) verification. The non-standard 6 MeV 40 x 40 cm2 electron beam at a source to surface distance (SSD) of 100 cm as well as its horizontal projection behind a polymethylmethacrylate (PMMA) screen to SSD = 380 cm were evaluated. The EGS4 OMEGA-BEAM code package running on a Linux home made 47 PCs cluster was used for the MC simulations. Percentage depth-dose curves and profiles were calculated and measured experimentally for the 40 x 40 cm2 field at both SSD = 100 cm and patient surface SSD = 380 cm. The output factor (OF) between the reference 40 x 40 cm2 open field and its horizontal projection as TSET beam at SSD = 380 cm was also measured for comparison with MC results. The accuracy of the simulated beam was validated by the good agreement to within 2% between measured relative dose distributions, including the beam characteristic parameters (R50, R80, R100, Rp, E0) and the MC calculated results. The energy spectrum, fluence and angular distribution at different stages of the beam (at SSD = 100 cm, at SSD = 364.2 cm, behind the PMMA beam spoiler screen and at treatment surface SSD = 380 cm) were derived from MC simulations. Results showed a final decrease in mean energy of almost 56% from the exit window to the treatment surface. A broader angular distribution (FWHM of the angular distribution increased from 13 degrees at SSD = 100 cm to more than 30 degrees at the treatment surface) was fully attributable to the PMMA beam spoiler screen. OF calculations and measurements agreed to less than 1%. The effect of changing the electron energy cut-off from 0.7 MeV to 0.521 MeV and air density fluctuations in the bunker which could affect the MC results were shown to have a negligible impact on the beam fluence distributions. Results proved the applicability of using MC as a treatment verification tool for complex radiotherapy techniques.     

Insulin,insulin-like growth factor-1, and insulin resistance in women with pregnancy-induced hypertension

OBJECTIVE: The purpose of this study was to assess insulin, insulin sensitivity, and insulin-like growth factor-I in women with preeclampsia and gestational hypertension. STUDY DESIGN: Insulin resistance was measured with the short insulin-tolerance test in 20 women with preeclampsia, in 18 women with gestational hypertension, and in 20 normotensive control subjects. Sex hormone binding globulin, insulin-like growth factor-I, glucose, fructosamine, glycosylated hemoglobin, insulin, C-peptide, and lipids were measured in the fasting state. RESULTS: Women with gestational hypertension had a significant lower insulin sensitivity index (0.13 +/- 0.1) and a higher level of insulin-like growth factor-I (333.71 +/- 107.6 ng/mL) than women in the control group (0.21 +/- 0.1 [P <.05]; 218.11 +/- 82.3 ng/mL [P <.01]) and women with preeclampsia (0.21 +/- 0.12 [P <.05]; 234.78 +/- 92.76 ng/mL [P <.01]). There were no significant correlations between insulin sensitivity index and insulin-like growth factor-I. CONCLUSION: Insulin resistance is present in women with gestational hypertension but not in women with preeclampsia and did not correlate with insulin-like growth factor-I.     

Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects

There are many potential mechanisms of action for the intrauterine device (IUD), which vary by type of IUD (inert, copper, or hormonal). This paper reviews the evidence for each potential mechanism of action. On the basis of available data for fertilization rates and clinical pregnancy rates, the relative contribution of mechanisms acting before or after fertilization were quantitatively estimated. These estimates indicate that, although prefertilization effects are more prominent for the copper IUD, both prefertilization and postfertilization mechanisms of action contribute significantly to the effectiveness of all types of intrauterine devices.     

Risk of injury to the external branch of the superior laryngeal nerve in thyroidectomy

OBJECTIVE: To establish in the Mexican population with thyroid disease the risk of injury to the external branch of the superior laryngeal nerve (EBSLN) based on its anatomical position. STUDY DESIGN: Non-randomized comparative clinical trial. METHODS: Seventy-three patients subjected to thyroidectomy because of thyroid nodule in which the EBSLN was identified and classified. The dependent variable was Cernea's classification of the EBSLN, and the independent variables were weight (in grams) of the nodule, side studied, gender, and age. For statistical analysis, chi2 test, Fisher's Exact test, and analysis of multiple variables (analysis of variance) were used. RESULTS: We studied 73 patients; 64 (87.62%) were women and 9 (12.38%) were men (average age, 39.3 years [age range, 17-73 y]; median age, 40 y; mode, 40 y; SD +/- 23.4 y). Regarding location of the EBSLN, for pathological lobes, 78.1% were located in a high-risk position and for nonpathological lobes, 72.7%. Comparative analysis between sides and relation between weight and classification revealed no statistical significance. CONCLUSION: The frequency of high-risk position for EBSLN lesion in our milieu was higher than that reported in series from other countries and races.     

Ventilation tubes after surgery for otitis media with effusion or acute otitis media and swimming. Systematic review and meta-analysis

OBJECTIVE: To determine if the use of ear protection when swimming of children with ventilation tubes modifies the risk of acute otitis media (AOM) compared to not swimming. METHODS: Systematic review. DATA SOURCES: Search conducted in MEDLINE, EMBASE and The Cochrane Library databases. STUDY SELECTION: Prospective cohort studies and controlled clinical trials of children with ventilation tubes, with a minimum follow-up of 2 months. Data extraction: Two reviewers independently assessed trial quality and extracted data. RESULTS: 11 studies were selected. No difference was found in risk of AOM in children who swim without ear protection compared with those who do not swim: Odds ratio=0.78, 95% confidence interval 0.42-1.44; nor compared with those who use earplugs and swimming caps, odds ratio=0.75, 95% confidence interval 0.38-1.48; nor in those who use ear drops after swimming compared with those who used earplugs or swimming caps, odds ratio=0.76, 95% confidence interval 0.56 to 1.02. The use of ear drops after swimming increases the risk of AOM in children with ventilation tubes as compared with those who do not swim, odds ratio=3.14, 95% confidence interval 1.40 to 7.05. CONCLUSIONS: There is no evidence to suggest that protection when swimming with earplugs, swimming caps or ear drops in children with ventilation tubes reduces the risk of AOM. Ear drops may even increase this risk.     

Efficacy of latex avoidance for primary prevention of latex sensitization in children with spina bifida

Over 6 years, the prevalence of latex sensitization fell from 4/15 (26.7%) to 1/22 (4.5%) in children with spina bifida treated in a latex-free environment from birth compared with historic controls. These precautions appear to be efficacious for the primary prevention of latex sensitization.