Rheumatic carditis in the adult. Anatomoclinical correlation

The histologic findings of 325 necropsies of rheumatic patients at the National Institute of Cardiology in Mexico, between 1980-1985 were studied forty five of them had Aschoff nodules plus valvular inflammation-Out of these 45 cases two groups were formed: children-adolescent group (24 cases) and an adult group (21 cases). The clinical, histologic and laboratory findings were compared. Clinical records were reviewed searching for history of rheumatic fever. Active rheumatic fever was suspected in 16 patients in the younger group (67%) and only in 3 adults (14.2%). As far as Jones' criteria is concerned, the most common finding was carditis, principally in the younger group (83%). In the adult group, it appeared in 50% of the patients. All other criteria were only occasionally seen or could not be identified during the patients lifetime. The most common laboratory finding which could suggest active rheumatic fever were: a high levels of anti-streptolysin in younger patients (95%) and elevation of erythro-sedimentation in adults (83%). We conclude that in active rheumatic fever of the adult; Jones criteria are not met, so the illness is difficult to recognize, and there is clinical-histologic discrepancy. In this context the disease has a "silent" evolution.     

Distal radius epiphysiolysis associated with scaphoid fractures in immature patients: report of two cases and review of the literature

Two cases of carpal scaphoid fractures associated with distal radius epiphysiolysis are presented. Only three cases of this unlikely combination were found in the English literature. One of the scaphoid fractures had to be confirmed by bone scan. Conservative treatment after gentle reduction of the radius fracture gave excellent results.     

Nonspinal orthopaedic problems in familial dysautonomia (Riley-Day syndrome)

Familial dysautonomia (FD) is a rare autosomal recessive disease occurring in Ashkenazi Jews. It affects the autonomic, central, and peripheral nervous systems. The purpose of this study was to assess the prevalence and characteristics of orthopedic deformities, other than spinal deformities, in this population. A retrospective review of the medical records and radiographs of 182 patients was made. Three main groups of orthopaedic conditions were evaluated: (a) Fractures: 60% of the patients had one or more fractures; the average fracture rate was 1.4/patient. (b) Neuropathic joints: 11% of the cases had one or more neuropathic joints, the knee being the most common. (c) Other musculoskeletal deformities: 26% of the patients had one or more deformities. Lower extremity rotational problems and foot anomalies accounted for most of these deformities. Patients with FD have a higher prevalence of fractures and neuropathic joints than do their peers. The fracture pattern also is different, with a higher incidence of proximal femoral fractures.     

Pancreatitis after surgery in adolescent idiopathic scoliosis: incidence and risk factors.

Acute pancreatitis has been documented as a postoperative complication in both the general surgery and orthopaedic literature. The etiology of pancreatitis in the postoperative orthopaedic population is not clear. The purpose of this study was to determine the incidence and possible predisposing factors for acute pancreatitis after scoliosis surgery in adolescent patients. This is a retrospective review of records and radiographs of patients undergoing surgery for adolescent idiopathic scoliosis during a 3-year period from 1995 to 1997. Twelve of 80 patients reviewed had amylase and lipase blood levels analyzed because of abdominal symptoms. Twenty-two clinical and radiologic parameters were assessed in each patient. Seven patients (9%) had elevated serum lipase or amylase levels consistent with pancreatitis. The only statistically different parameters were age, height, body mass index, days of postoperative fasting, and hospital stay (pancreatitis patients were older and taller and had a lower body mass index, and their hospital stay was longer). Older age and lower body index mass were the only factors relating to postoperative pancreatitis.     

Quality of life in osteogenesis imperfecta

The purpose of this study was to quantify the physical and mental health of a diverse adult cohort of patients with osteogenesis imperfecta (OI) utilizing a validated health self-assessment questionnaire (SF-36). In addition, a specific demographic questionnaire and a functional questionnaire were utilized to assess more specifically the physical limitations imposed by osteogenesis imperfecta in adulthood. The results of the SF-36 revealed significantly lower physical function scores compared to the U.S. adult norms. However, the SF-36 mental component scores were equal to the U.S. adult norms. The demographic questionnaire revealed high levels of educational achievement, as well as employment, despite significant physical impairments. The functional questionnaire clearly demonstrated limitations mostly related to ambulation.     

Modification of yeast Cdc53p by the ubiquitin-related protein Rub1p affects function of the SCFCdc4 complex

The RUB1/NEDD-8 family of ubiquitin-related genes is widely represented among eukaryotes. Here we report that Cdc53p in Saccharomyces cerevisiae, a member of the Cullin family of proteins, is stably modified by the covalent attachment of a single Rub1p molecule. Two genes have been identified that are required for Rub1p conjugation to Cdc53p. The first gene, designated ENR2, encodes a protein with sequence similarity to the amino-terminal half of the ubiquitin-activating enzyme. By analogy with Aos1p, we infer that Enr2p functions in a bipartite Rub1p-activating enzyme. The second gene is SKP1, shown previously to be required for some ubiquitin–conjugation events. A deletion allele of ENR2 is lethal with temperature-sensitive alleles of cdc34 and enhances the phenotypes of cdc4, cdc53, and skp1, strongly implying that Rub1p conjugation to Cdc53p is required for optimal assembly or function of the E3 complex SCF^Cdc4. Consistent with this model, both enr2Δ and an allele of Cdc53p that is not Rub1p modified, render cells sensitive to alterations in the levels of Cdc4p, Cdc34p, and Cdc53p.     

Infiltration de ropivacaïne en chirurgie carcinologique du sein : effet sur la douleur postopératoire aiguë et chronique

Objectives

Decrease acute pain after breast cancer surgery by an infiltration of ropivacaine. Analyse effect on chronic pain.

Study design

Prospective randomised double blind versus placebo study.

Patients and methods

Eighty-one patients randomised between two groups received wound infiltration with 40 ml of ropivacaine 4.75 mg/ml or placebo. Acute pain was assessed during 24 h with analogical visual scale and antalgic consumption. One year later, telephonic interviews looked for chronic pain and evaluate it with McGill Pain Questionnaire.

Results

Analogical visual scale pain score, antalgic consumption and chronic pain incidence were similar between groups.

Conclusion

Ropivacaine scar infiltration provided no acute or chronic pain relief after breast cancer surgery.     

Transport of Ionic Species in Skin: Contribution of Pores to the Overall Skin Conductance

Two methods are reported that allow visualization of high conductance paths in skin at current densities typically used during clinical iontophoretic drug delivery (10–200 µA/cm²). In the first method, the counter-directional iontophoretic transport of Fe(CN)₆ ^4– and Fe³⁺ across skin results in the precipitation of colloidal prussian blue, Fe₄[Fe(CN)₆]₃, at sites of high iontophoretic flux. The appearance of localized deposits of Fe₄[Fe(CN)₆]₃ is recorded by video microscopy and used to document the activation of low-resistance paths. In the second method, the ionic flux of Fe(CN)₆ ^4– through pores is directly imaged by scanning electrochemical microscopy (SECM). Both methods demonstrate that the iontophoretic flux across skin is highly localized. Activation of low-resistance pores in hairless mouse skin is shown to occur during iontophoresis. The spatial density of current carrying pores increases from 0 to 100–600 pores/cm² during the first 30–60 min of iontophoresis. At longer times, the active pore density approaches a quasi-steady-state value that is proportional to the applied current density. The total conductance of the skin is proportional to the number of pores, consistent with a model of conduction in skin that is comprised of low-resistivity pores in parallel with a high-resistivity bulk phase. The contribution of pores to the total skin conductance during iontophoresis increases from an initial value of 0–5% to a quasi-steady-state value of 50–95%.