In vivo performance of a sol-gel glass-coated collagen

Synthetic bioactive materials offer possibilities to repair large tissue defects. It is well known that bioactivity, angiogenesis, and inflammation are key events in implant incorporation. Using glass-coated and glass-free collagen as potential bone graft substitutes, we carried out in vitro bioactivity and an in vivo angiogenesis and inflammation studies. The in vitro study showed bioactivity when the glass-coated samples were left in SBF for 5 days. This was confirmed by FTIR results, which presented P--O vibration bands characteristic of hydroxyapatite close to 1060 cm(-1) and 600 cm(-1). The in vivo response was evaluated following subcutaneous implantation of the biomaterial in the mouse dorsa. Angiogenesis, as determined by hemoglobin content extracted from implants 7 and 14 days after implantation, increased progressively in both glass-coated and glass-free collagen implants. However, vascularization was higher in the glass-coated collagen implants 14 days after implantation (mug Hb per mg wet tissue 6.0 +/- 0.3) compared with the glass-free group (1.6 +/- 0.1). The inflammatory process, determined by the levels of myeloperoxidase and N-acetylglucosaminidase, was similar for both implants. This study shows that glass-coated collagen implants hold osteogenic and angiogenic potential and may be used in clinical conditions requiring improvement of these biological processes.     

Histological evaluation of an alternative method of neophalloplasty based on two lower abdominal skin flaps and simultaneous buccal mucosa graft in the ventral surface of the neophallus (two-stage urethroplasty): Experimental study in rabbits

ObjectiveTo evaluate, in an experimental study in rabbits, a new model of neophalloplasty based on two lower abdominal skin flaps and ventral buccal mucosa graft for planned two-stage urethroplasty procedure.Material and methodsSixteen rabbits were operated and divided into four equal groups which were sacrificed at 2, 4, 8 and 12 weeks. The inflammatory pattern, presence of sub-epithelial fibrosis and epithelial changes in the grafted area were evaluated histologically.ResultsThere were no deaths and no dehiscence of the wound was seen. One animal in the 2-week group developed an ulcer in the grafted area. We found minimal contracture of the neophallus, but this was not statistically significant between groups. Buccal mucosa graft showed good uptake in all groups, with vascular support from subcutaneous tissue of the flaps. The grafted area developed epithelial metaplasia, showing a decrease in cell layers with time, with disappearance of the sub-epithelial papillae and appearance of stratum granulosum and keratinization of the epithelial graft surface. A decrease in sub-epithelial fibrosis with replacement of immature by mature (eosinophilic) collagen was found. In the later groups was also observed an important decrease in inflammatory response, and the chorion of the grafted area presented a dilated capillary network, indicating that the process of neoangiogenesis was effective.ConclusionBuccal mucosa displayed histological integration in the abdominal flaps with epithelial metaplasia in all groups. The surgical aspect of the neophallus was cosmetically acceptable, with minimal contracture.     

Cost-effectiveness analysis of a state funded programme for control of severe asthma

Background  

Asthma is one of the most common chronic diseases and a major economical burden to families and health systems. Whereas efficacy of current therapeutical options has been clearly established, cost-effectiveness analysis of public health interventions for asthma control are scarce.     

Advances of the investigation of "Ambulatory Care Sensitive Conditions" in primary care in Spain

Hospitalization due to ambulatory care sensitive conditions (ACSC) is an indicator of hospital activity that has demonstrated its usefulness as an indirect measurement of primary care effectiveness. Since this indicator was recently introduced in Spain, a collaborative effort between the different research groups could facilitate and promote its development and progress. The objective of this paper is to propose a working agenda that, starting from the most recent information, enhances the advance in this research field. The agenda includes the following sections: 1) To draw up specific ACSC lists for adult and pediatric population, as well as to look in greater depth into the concepts of, and differences in avoidable hospitalization and ACSC. 2) To complete the indicator validation process by assessing the external validity. 3) To propose, for future studies, the municipality as the unit of analysis, as well as to individualize the analysis of health conditions allowing for the differences between acute and chronic ones. 4) To adjust the indicators of hospital activity by hospital use index, when data from some hospitals are lacking and comparisons are wanted 5) To include a new variable, provider of primary health care services, in the Minimum Basic Data Set of Hospital Discharges. 6) To use this indicator as a measure of both the distribution of functions between levels of care and the coordination among them.     

Distal myasthenia gravis: case report

We report the case of a 30-year-old woman with a 7-year history of distal lower limbs weakness that evolved to upper limbs weakness. On neurological examination, she presented normal cranial nerves, bilateral quadriceps and feet interosseous atrophy, normal muscular tonus, muscular weakness more severe in dorsal feet interosseous and anterior tibial, and decreased deep tendon reflexes. Repetitive nerve stimulation of the ulnar and fibular nerves showed a decrement greater than 10% of the compound muscle action potential. Antibody against acetylcholine receptor titer was positive. Computed tomography scan of the thorax was normal. Thyroid function tests showed evidence of hyperthyroidism. Distal muscular weakness is a rare onset presentation of myasthenia gravis. However, myasthenia gravis must be considered in the differential diagnosis of distal limb weakness.     

Hemimasticatory spasm treated with botulinum toxin: case report

We describe a female patient with hemimasticatory spasm, a rare movement disorder due to dysfunction of the motor trigeminal nerve of unknown origin. This patient had an excellent response to botulinum toxin therapy.     

TSH pituitary adenoma: case report

We describe a rare case of thyroid-stimulating hormone-secreting pituitary adenoma in a patient with a clinical picture of hyperthyroidism, that developed bitemporal hemianopsia after four years of a known thyroid dysfunction. CT scan showed a pituitary tumor considered grade 2 and stage C according to Hardy-Vezina and Wilson. Treatment was surgical, initially by a transsphenoidal approach, in which only a biopsy was possible. The patient was then submitted to an orbital-pterional craniotomy with sub-total resection of the tumor. Complementary treatment was indicated with radiotherapy.     

Glioma and multiple sclerosis: case report

We report a case of a 44-years-old woman with relapsing-remitting and secondarily progressive form of multiple sclerosis (MS) since aged 24 years, who developed an anaplastic astrocytoma. The neurological manifestations of the tumor were misinterpreted as resulting from MS. Sequential MRI examination and seizures raised the possibility of another nature of her symptoms, besides MS. Her initial good response to high doses corticosteroids led to the initial assumption her symptoms were only exclusively due to the demyelinating process. She underwent craniotomy with radical excision of the lesion. Pathological examination disclosed anaplastic astrocytoma. Other cases of coincidental MS and primary CNS tumors are reviewed, as well as their possible relation.