RESUMEN
OBJECTIVE: An expert working group was set up at the initiative of the French Ministry of Sports with the objective of harmonising the management of sport related concussion (SRC) in France, starting with its definition and diagnosis criteria. RESULTS: Definition: A clinical definition in 4 points have been established as follows: Concussion is a brain injury: 1) caused by a direct or indirect transmission of kinetic energy to the head; 2) resulting in an immediate and transient dysfunction of the brain characterised by at least one of the following disorders: a) Loss of consciousness, b) loss of memory, c) altered mental status, d) neurological signs; 3) possibly followed by one or more functional complaints (concussion syndrome); 4) the signs and symptoms are not explained by another cause. Diagnosis criteria: In the context of the direct or indirect transmission of kinetic energy to the head, the diagnosis of concussion may be asserted if at least one of the following signs or symptoms, observed or reported, is present within the first 24hours and not explained by another cause: 1) loss of consciousness; 2) convulsions, tonic posturing; 3) ataxia; 4) visual trouble; 5) neurological deficit; 6) confusion; 7) disorientation; 8) unusual behaviour; 9) amnesia; 10) headaches; 11) dizziness; 12) fatigue, low energy; 13) feeling slowed down, drowsiness; 14) nausea; 15) sensitivity to light/noise; 16) not feeling right, in a fog; 17) difficulty concentrating. CONCLUSION: Sharing the same definition and the same clinical diagnostic criteria for concussion is the prerequisite for common rules of management for all sports and should allow the pooling of results to improve our knowledge of this pathology.
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Traumatismos en Atletas/diagnóstico , Conmoción Encefálica/diagnóstico , Fenómenos Biomecánicos , Conmoción Encefálica/complicaciones , Conmoción Encefálica/psicología , Diagnóstico Diferencial , Servicios Médicos de Urgencia , Francia , Humanos , Trastornos de la Memoria/etiología , Trastornos de la Memoria/psicología , Escala del Estado Mental , Terminología como Asunto , Inconsciencia/etiología , Inconsciencia/psicologíaRESUMEN
Symptomatic accessory soleus muscle (ASM) can cause exercise-induced leg pain due to local nerve/vascular compression, muscle spasm, or local compartment syndrome. As intramuscular injections of botulinum toxin type A (BTX-A) can reduce muscle tone and mass, we investigated whether local BTX-A injections relieve the pain associated with symptomatic ASM. We describe five patients presenting peri/retromalleolar exertional pain and a contractile muscle mass in the painful region. Com-pression neuropathy was ruled out by electromyo-graphic analysis of the lower limb muscles. Doppler ultrasonography was normal, excluding a local vascular compression. ASM was confirmed by magnetic resonance imaging. After a treadmill stress test, abnormal intramuscular pressure values in the ASM, confirmed the diagnosis of compartment syndrome only in one patient. All five patients received BTX-A injections in two points of the ASM. The treatment efficacy was evaluated based on the disappearance of exercise-induced pain and the resumption of normal physical and sports activities. After BTX-A injection, exertional pain disappeared and all five patients resumed their normal level of physical and sports performances. Neither side effects nor motor deficits were observed. BTX-A is well tolerated in patients with ASM and could be used as a new conservative therapeutic strategy for the treatment of symptomatic ASM before surgery.
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Toxinas Botulínicas Tipo A/uso terapéutico , Músculo Esquelético/anomalías , Anomalías Musculoesqueléticas/tratamiento farmacológico , Fármacos Neuromusculares/uso terapéutico , Dolor/tratamiento farmacológico , Adolescente , Adulto , Femenino , Humanos , Inyecciones Intramusculares , Imagen por Resonancia Magnética , Masculino , Músculo Esquelético/diagnóstico por imagen , Anomalías Musculoesqueléticas/complicaciones , Anomalías Musculoesqueléticas/diagnóstico por imagen , Dolor/etiología , Dimensión del Dolor , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVES: Complex regional pain syndrome type 1 (CRPS-1) can progress to joint stiffness, which may be related to pain and/or capsule-ligament contracture. In this context, it is difficult to distinguish the respective causative roles of pain and contractures. Nerve blocks (NBs) can be used to determine the aetiology of joint stiffness. Subsequent treatment will depend on whether contractures are present or not. The objective of the present study was to evaluate the diagnostic and therapeutic value of the nerve blocks in the management of joint stiffness caused by CRPS-1. DESIGN OF THE STUDY: A retrospective case series. METHODS: Implementation of NBs in subjects with joint stiffness caused by CRPS-1. Primary efficacy criterion: an increase in the range of joint movement. Secondary criteria: pain level, treatment decision, duration of therapeutic NBs, return to work. RESULTS: Fourteen patients with joint stiffness underwent 17 NBs. Ten NBs (59%) were associated with the normalization of the range of joint movement (i.e. the absence of contractures and the presence of an isolated pain component), prompting the implementation of physical therapy during NBs ("therapeutic NBs") in 90% of these cases. Three NBs (18%) were associated with a partial increase in the range of joint movement (i.e. a background of joint stiffness due to a combination of pain and contracture), prompting the implementation of a therapeutic NB in all of these cases. Four NBs (23%) were not associated with any increase in the range of joint movement (i.e. pure contractures), prompting consultation with a surgeon in all of these cases. Forty-three percent of the patients have since returned to work. CONCLUSIONS: Nerve block is a valuable diagnostic and therapeutic option in the management of joint stiffness caused by CRPS-1.
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Artralgia/terapia , Artropatías/etiología , Bloqueo Nervioso/métodos , Modalidades de Fisioterapia/estadística & datos numéricos , Distrofia Simpática Refleja/diagnóstico , Distrofia Simpática Refleja/terapia , Adulto , Anciano , Anciano de 80 o más Años , Artralgia/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Rango del Movimiento Articular , Distrofia Simpática Refleja/complicaciones , Estudios Retrospectivos , Reinserción al Trabajo , Resultado del TratamientoRESUMEN
INTRODUCTION: Women run a 4-8-fold greater risk of anterior cruciate ligament (ACL) tear than men, and especially during the pre-ovulation stage of their cycle. The main study objective was to describe the distribution of ACL lesions according to menstrual cycle in a large population of female recreational skiers. MATERIALS AND METHODS: A prospective study was conducted during the 2010-11 ski season on women sustaining ACL tear during skiing. Patients filled out a questionnaire during consultation with the mountain physician, including date of last menstrual period (LMP) and contraceptive method. Fifty-seven of the 229 patients with diagnosed ACL tear were excluded from analysis, 41 being post-menopausal (mean age, 47 ± 9 years), and 16 having irregular cycles or LMP>30 days. One hundred and seventy-two patients (mean age, 34 ± 8.7 years) were thus included. RESULTS: Fifty-eight women (33.72%) were in follicular phase, 63 (36.63%) in ovulatory phase and 51 (29.65%) in luteal phase; difference with respect to the theoretic distribution regardless of menstrual phase was highly significant: χ(2)=48.32; P=0.00001. Fifty-three of the 172 women (30.8%) were taking oral contraceptives. ACL tear was 2.4-fold more frequent in pre-ovulatory than post-ovulatory phase, whether in women using oral or other contraceptives: 85/119 (71.4%) vs. 36/53 (67.9%); P=0.64. CONCLUSION: ACL tear risk in skiing in women is not constant over the menstrual cycle, being 2.4-fold more frequent in pre-ovulatory (follicular and ovulatory) than post-ovulatory phase (luteal). Oral contraception seems not to exert any protective effect. LEVEL OF EVIDENCE: Level IV. Retrospective cohort study.
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Lesiones del Ligamento Cruzado Anterior , Traumatismos de la Rodilla/epidemiología , Ciclo Menstrual , Esquí/lesiones , Adulto , Traumatismos en Atletas/epidemiología , Traumatismos en Atletas/etiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Traumatismos de la Rodilla/etiología , Traumatismos de la Rodilla/fisiopatología , Estudios Prospectivos , Recreación , Medición de RiesgoRESUMEN
PURPOSE: Haemophilic arthropathy is painful, invalidating and destructive. Authors report a prospective study of total knee arthroplasties in patients with severe haemophilia under continuous infusion of clotting factors. The purpose is to evaluate the benefits of continuous infusion of clotting factors regarding long-term functional improvement and radio-clinical results. METHODS: From 1998 to 2009, 20 total knee arthroplasties were implanted in 14 patients with a mean age of 36.5 years (24-56). A continuous infusion of anti-haemophilic factors was used and supervised by the physician of the Regional Haemophilia Treatment Centre (CRTH). Evaluation was clinical using the HSS and Oxford scores and radiological. RESULTS: One patient was lost to follow-up. Median follow-up is 66.5 months (6-134). Oxford score at latest follow-up is 42 (37-46). On revision, HSS score is 91 (84-96). Median flexion gain is 32.5° (-20; 75°). There is a median flexion contracture of 5° (0-15°) and a median extension improvement of 22.5°. We report 2 secondary infectious complications, concerning the same operated knee of a single patient. No post-operative haematoma was reported in our study. CONCLUSION: Total knee arthroplasty in haemophilic arthropathy improves both the function and quality of life of this group of patients. Continuous infusion of clotting factors contributes significantly to these results, by allowing early and intensive rehabilitation, and offers security regarding haemorrhagic complications commonly described in the literature and that we have not encountered in our study. LEVEL OF EVIDENCE: Therapeutic study, Level IV.
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Artroplastia de Reemplazo de Rodilla , Factores de Coagulación Sanguínea/uso terapéutico , Coagulantes/uso terapéutico , Hemartrosis/tratamiento farmacológico , Hemartrosis/cirugía , Articulación de la Rodilla/cirugía , Adulto , Factores de Coagulación Sanguínea/administración & dosificación , Coagulantes/administración & dosificación , Estudios de Seguimiento , Hemartrosis/etiología , Hemofilia A/complicaciones , Humanos , Persona de Mediana Edad , Adulto JovenRESUMEN
GOALS: To determine prevalence, risk factors and treatment of osteoporosis in patients with hip fracture observed in a rehabilitation ward. BACKGROUND: Hip fractures are associated with up to 20% excess mortality in the first year after fracture and cause functional disability in most survivors. Despite available risk indices and physician information, osteoporosis is still underdiagnosed and undertreated. METHOD: We obtained history, clinical and biological data, and bone density (BD) data in 41 patients admitted with hip fracture to a rehabilitation care centre. RESULTS: Only 3 patients had known osteoporosis. Although 50% had at least 1 clinical risk factor, all patients showed osteopenic BD scores and 68% had osteoporotic scores; only one was correctly treated. DISCUSSION: As with international studies, our study shows that osteoporosis is underdiagnosed. Risk assessment tools allow for routine screening and preventive measures incorporated into standard care practice. The prevention of osteoporotic fracture can be promoted in rehabilitation centres.
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Fracturas de Cadera/epidemiología , Osteoporosis/diagnóstico , Centros de Rehabilitación , Factores de Edad , Anciano , Anciano de 80 o más Años , Densidad Ósea , Enfermedades Óseas Metabólicas/diagnóstico , Densitometría , Femenino , Encuestas Epidemiológicas , Fracturas de Cadera/prevención & control , Fracturas de Cadera/rehabilitación , Humanos , Masculino , Persona de Mediana Edad , Osteoporosis/complicaciones , Osteoporosis/epidemiología , Prevalencia , Medición de Riesgo , Factores de Riesgo , Factores SexualesRESUMEN
PURPOSE OF THE STUDY: Well known to anatomy specialists, the accessory soleus muscle was first demonstrated to be involved in painful syndromes in 1965 (Dunn). This supranumerary muscle situated in front of the calcaneum can be taken for a soft tissue tumor. The purpose of this work was to report a series of 21 patients with an accessory soleus muscle and to present the characteristic features, diagnostic methods, and treatment indications and modalities. MATERIAL AND METHODS: This series included 20 patients (one symptomatic bilateral case), fourteen men and six women, mean age 25 years. Seventeen patients practiced sports and ten had had a prior operation. All patients complained of exercise-related pain. The physical examination was normal with the exception of a tumefaction, which was soft at rest and hard at triceps contraction against resistance, lying laterally to the Achilles tendon. We studied plain x-rays, ultrasound studies, computed tomographies, and electromyograms and later MRI which became the reference method to demonstrate the details of normal muscle structure. Ten patients (one bilateral case) were not particularly bothered by the supernumerary muscle. Functional treatment was given and provided patient satisfaction. For the other ten patients, who wished to continue their physical activities, two underwent fasciotomy (including our first case where fasciotomy was undertaken because a tumor was suspected) and eight underwent resection of the supranumerary muscle. RESULTS: The patients were followed for 6 to 19 years. Outcome was very good in all patients who were free of pain and had complete joint movement with symmetrical muscle force. Normal sports activities were resumed. DISCUSSION: The accessory soleus muscle is found in 10% of individuals. It is often asymptomatic. The muscle inserts on the anterior aspect of the soleus muscle or on the posterior aspect of the tibia or the muscles of the deep posterior compartment. It lies anterior to the calcaneal tendon and terminates on the calcaneal tendon or the superior or medial aspect of the calcaneus via fleshy fibers or a distinct tendon. Frequent in primates, this anatomic variant is present during embryological development. Its persistence depends on phylogenetic evolution. Among other hypotheses (exercise-induced intermittent claudication, compression of the tibial nerve, excessive tension on the nerve innervating the accessory soleus muscle), this supranumerary muscle is generally considered to be the cause of a localized compartment syndrome. Pain experienced during exercise is the only symptom regularly reported by patients. A careful examination is required to rule out another local cause. Besides tumefaction lateral to the Achilles tendon, often found bilaterally, there is no other clinical sign. Plain x-rays, ultrasound and computed tomography simply demonstrate a "mass" in front of the Achilles tendon. MRI is the examination of choice enabling confirmation of the muscle nature of the mass and ruling out the possible diagnosis of tumor. Since there is no risk of aggravation, surgical treatment can be avoided if there is no complaint. If the patient is seriously impaired, surgery can be proposed. In our opinion, complete resection of the supernumerary muscle is the safest solution and should be preferred over simple fasciotomy.
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Fasciotomía , Músculo Esquelético/anomalías , Tendón Calcáneo/anatomía & histología , Adulto , Traumatismos en Atletas , Electromiografía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Músculo Esquelético/patología , Músculo Esquelético/cirugía , Dolor/etiología , Modalidades de Fisioterapia , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To review the literature on well-documented cases of neurogenic muscle hypertrophy in order to define significant features of this disease. PATIENTS AND METHODS: The PUBMED and SCIENCE DIRECT web-sites were used to conduct an inventory of all reported cases of this disease. We entered the key-words "hypertrophy", "muscle" and "neurogenic", and found 48 articles, describing 129 cases. Our criteria of inclusion included hypertrophy of one or several muscles of a lower limb, previous realization of at least one imaging study (CT or MRI) and electromyography of lower limbs; criterion of exclusion was hypertrophy related to hereditary or acquired polyneuropathies. Twenty-five cases were retained for investigation along with 3 recent cases observed in our department. RESULTS: Results show that neurogenic muscle hypertrophy is usually presents with painful enlargement of a calf in a male, aged 32 to 60 years, with previous history of low back pain and sciatica, 68% of the time due to disk herniation or lumbar stenosis. Other clinical findings may include radiation therapy or trauma. CONCLUSION: The symptoms of neurogenic muscle hypertrophy may lead to MRI examination before electromyography. This disease should be included in the differential diagnosis.
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Síndromes Compartimentales/diagnóstico , Pierna , Imagen por Resonancia Magnética , Adulto , Síndromes Compartimentales/etiología , Electromiografía , Femenino , Humanos , Hipertrofia , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: To review the literature on chronic exertional compartment syndrome. METHODS: We searched the Medline database with use of the keys words compartment syndrome, exertional, chronic, pressure, and fasciotomy. RESULTS: Exertional compartment syndrome is characterized by pain on exertion, which recedes at rest, and by excessive increase in compartment intramuscular pressure. Intramuscular pressure measurement is the reference diagnostic tool, but it has not been standardized or evaluated. Pressure observed during the first 5 min after exertion stops is more often used in diagnosis. The first studies of noninvasive investigations (magnetic resonance imaging, thallium single-photon emission tomographic imaging, near infrared spectroscopy) revealed their inadequate diagnostic value. The pathophysiological features of exertional compartment syndrome remain unclear: increased muscle bulk, fascia thickness and stiffness, stimulation of fascial sensory stretch-receptors, poor venous return, micromuscular injuries, and small clinical myopathic abnormalities. Treatment includes decreased sport activity or fasciotomy with partial fasciectomy. Several authors have used endoscopically assisted fasciotomy, which retrospective studies have shown to be successful. Long-term outcome studies could investigate the persistence of exertional minor pain and recurrence of the compartment syndrome with this treatment. CONCLUSION: Further studies are required to understand the physiopathology, standardize the intramuscular pressure test and evaluate the pressure threshold values, evaluate noninvasive investigations and specify the long-term outcome of fasciotomy.
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Síndromes Compartimentales/fisiopatología , Ejercicio Físico , Procedimientos Quirúrgicos Operativos/métodos , Enfermedad Crónica , Síndromes Compartimentales/cirugía , Fasciotomía , Humanos , Manometría , Músculo Esquelético/patología , Músculo Esquelético/cirugía , Presión , Resultado del TratamientoRESUMEN
INTRODUCTION: Recent studies have emphasized the incidence and the general underestimation in literature of spinal manipulation (SM) linked accident. The aim of this study was to estimate the frequency and the incidence of strokes, myelopathies, radiculopathies or osteoarticular accidents in a major French area. MATERIAL AND METHOD: We made a survey among 240 neurologists, neurosurgeons, rhumatologists and physicians concerning the number of accidents observed during the preceding two years. RESULTS: We obtained a response from 133 physicians and 93 cases of complication were reported. Most of these complications were radiculopathies (69%). Approximatively 50% occurred at the cervical level, less than 24 hours after SM with or without sligth aftereffects in 68%. The incidence of vertebro-basilar accidents was 30 times higher than in published series. CONCLUSION: Spinal manipulations should remain under very strict medical control. Physicians who practice SM should be able to choose the manual treatment and perform it themselves in order to minimize risks of complications, especially at the cervical level.
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Neuritis del Plexo Braquial/etiología , Manipulación Quiropráctica/efectos adversos , Manipulación Espinal/efectos adversos , Medicina Osteopática , Polirradiculopatía/etiología , Radiculopatía/etiología , Enfermedades de la Médula Espinal/etiología , Traumatismos Vertebrales/etiología , Accidente Cerebrovascular/etiología , Adulto , Factores de Edad , Anciano , Enfermedades de las Arterias Carótidas/etiología , Niño , Recolección de Datos , Francia , Humanos , Luxaciones Articulares/etiología , Fracturas de las Costillas/etiología , Factores de Riesgo , Fracturas de la Columna Vertebral/etiología , Encuestas y Cuestionarios , Factores de Tiempo , Insuficiencia Vertebrobasilar/etiologíaRESUMEN
Many causes of saphenous nerve lesions at the knee or leg level have been reported. Proximal nerve lesions, especially after varicose vein stripping, are uncommon. We report a case of saphenous nerve lesion following catheterization of the femoral artery complicated with arterial spasm. The patient experienced pain for 10 years and only transdermal electroneural stimulation provided sedation. To our knowledge, this is the first published case of such an unusual complication after coronarography, despite the frequency of this procedure. We suggest nerve ischemia could explain the definitive neuralgia.
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Angiografía Coronaria/efectos adversos , Neuralgia/etiología , Traumatismos de los Nervios Periféricos , Adulto , Cateterismo Periférico/efectos adversos , Arteria Femoral/lesiones , Humanos , Masculino , Neuralgia/patología , Neuralgia/terapia , Nervios Periféricos/patología , Estimulación Eléctrica Transcutánea del NervioRESUMEN
Elective orthopaedic surgery is regularly withheld from patients with haemophilia and high inhibitor titre despite the presence of severe arthropathy and urgent medical need. A knee joint arthroplasty was performed in a patient with severe haemophilia A and a high inhibitor titre using recombinant factor VIIa (rFVIIa) as the sole coagulation factor. There was no abnormal bleeding during surgery although an increased blood loss through surgical drains did occur during the first 6 h postoperatively. Rehabilitation was started on day 1 and continued for 3 months. Walking commenced on day 4. After 1 year of follow-up, the clinical outcome of surgery was considered excellent with no pain, knee mobility at 0-5-90 degrees, and an International Knee Society score of 95/100. No rFVIIa-associated side-effects or thrombotic complications were reported. In conclusion, knee joint arthroplasty is now an option for haemophilia patients with a high inhibitor titre. An international review of all available data on elective orthopaedic surgery in inhibitor patients is required so that the optimal treatment regime can be defined and the short- and long-term risk-benefit ratio of surgery compared to that of noninhibitor patients.
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Artroplastia de Reemplazo de Rodilla/rehabilitación , Factor VIIa/administración & dosificación , Hemofilia A/cirugía , Adulto , Pérdida de Sangre Quirúrgica/prevención & control , Hemofilia A/tratamiento farmacológico , Hemofilia A/inmunología , Humanos , Isoanticuerpos/sangre , Masculino , Proteínas Recombinantes/administración & dosificaciónRESUMEN
The authors present a case of pseudotumoral osteochondromatosis of the hip, interesting for its clinical and radiological features. They discuss the incidence of the sport in the pathogenesis of the loose bodies and the magnetic resonance findings.
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Condromatosis Sinovial/etiología , Lesiones de la Cadera , Fútbol/lesiones , Adulto , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/patología , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/patología , Humanos , Cuerpos Libres Articulares/diagnóstico por imagen , Cuerpos Libres Articulares/patología , Imagen por Resonancia Magnética , Masculino , RadiografíaAsunto(s)
Anquilosis/inducido químicamente , Anquilosis/patología , Antiinfecciosos/efectos adversos , Articulación del Hombro/efectos de los fármacos , Articulación del Hombro/patología , Anquilosis/diagnóstico por imagen , Femenino , Fluoroquinolonas , Humanos , Masculino , Radiografía , Articulación del Hombro/diagnóstico por imagenRESUMEN
Neuromuscular complications acquired in the intensive care unit form a new clinical entity. Three neuromuscular deficits are described: so-called critical illness polyneuropathy where neuromyopathic changes are associated with corticosteroid and/or neuromuscular blocking agents, and catabolic myopathy. We report four new cases: three of them concerning polyneuropathy and one neuromyopathic change.
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Cuidados Críticos , Enfermedades Desmielinizantes/etiología , Enfermedades Neuromusculares/etiología , Polineuropatías/etiología , Corticoesteroides/efectos adversos , Adulto , Anciano , Biomarcadores , Creatina Quinasa/sangre , Curare/efectos adversos , Enfermedades Desmielinizantes/inducido químicamente , Diabetes Mellitus Tipo 2/complicaciones , Electromiografía , Femenino , Paro Cardíaco/complicaciones , Humanos , Isquemia/etiología , Isoenzimas , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/complicaciones , Conducción Nerviosa , Enfermedades Neuromusculares/inducido químicamente , Fármacos Neuromusculares no Despolarizantes/efectos adversos , Parálisis/etiología , Parálisis/fisiopatología , Nervios Periféricos/irrigación sanguínea , Polineuropatías/inducido químicamente , Reflejo Anormal , Músculos Respiratorios/fisiopatologíaRESUMEN
alpha 1-Antitrypsin (alpha AT) deficiency, a hereditary cause of progressive emphysema, can potentially be treated by transfer of a functional human alpha 1AT gene to the respiratory epithelium. For such an approach to be successful, alpha 1AT must be provided to both the interstitium and the epithelial surface--that is, the alpha 1AT directed by the transferred gene must be secreted to both the apical and basolateral surfaces of the epithelial cells. To evaluate this concept, a recombinant, replication-deficient adenoviral vector (Ad-alpha 1AT) containing a human alpha 1AT cDNA driven by an adenovirus major late promoter was used to infect Bet-1A human respiratory epithelial cells. The infected cells expressed Ad-alpha 1AT-directed mRNA transcripts and synthesized and secreted functional human alpha 1AT as shown by [35S]methionine labeling and immunoprecipitation of a 52-kD glycosylated human alpha 1AT molecule capable of interacting with neutrophil elastase, its natural substrate. Bet-1A cells grown on microporous polycarbonate membranes formed tight junctions (resistance > 150 omega x cm2). After infection with Ad-alpha 1AT, [35S]methionine labeling and enzyme-linked immunoassay demonstrated that alpha 1AT was secreted into both the apical and basolateral compartments, with an average apical to basolateral ratio of 1.9 +/- 0.2. Thus, human respiratory epithelial cells infected with a recombinant adenoviral vector containing a human alpha 1AT cDNA secrete alpha 1AT across both the apical and basolateral cell membranes, suggesting that the respiratory epithelium could serve as a target for in vivo gene therapy of alpha 1AT deficiency.
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Epitelio/metabolismo , alfa 1-Antitripsina/metabolismo , Adenoviridae/genética , Polaridad Celular , Células Cultivadas , ADN Complementario/administración & dosificación , Células Epiteliales , Expresión Génica , Técnicas de Transferencia de Gen , Vectores Genéticos , Glicosilación , Humanos , Técnicas In Vitro , Riñón , Procesamiento Proteico-Postraduccional , ARN Mensajero/genética , Proteínas Recombinantes/metabolismo , alfa 1-Antitripsina/administración & dosificaciónRESUMEN
We assayed the vaccine potentialities of a recombinant S. bovis-derived glutathione S-transferase (rSb28GST), member of a molecular family already shown to have protective capacities in the S. mansoni and S. japonicum models. Injection of the rSb28GST in Freund's Complete Adjuvant resulted in good specific IgG responses allowing all the animals to display high antibody titres on the day of experimental challenge with S. bovis cercariae. No statistically significant differences were observed in the faecal egg output. Although tissue egg counts in vaccinated animals were lower than in controls, the difference was not statistically significant, apart from the number of eggs trapped in the liver (P < 0.05). Likewise, PCV values remained parallel between the two groups. However, immunized goats gained 1.4 kg of body weight throughout the experiment whereas controls lost 1.2 kg (P < 0.05). In addition, the mean worm burden, assessed by perfusion 20 weeks after infection, was significantly reduced by 48% in the vaccinated group, the sex ratio being unaffected. It appears that a recombinant homologous protein can affect, in a natural host, the course of an experimental infection with a local strain of S. bovis, by affecting worm viability but not fecundity. These results also point to the striking differences in the effect of vaccination according to animal species. Because it has the capacity to prevent growth impairment due to schistosome pathogenicity, the molecule can be proposed as a valuable tool in the development of vaccine-based control programs in endemic areas.
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Glutatión Transferasa/inmunología , Enfermedades de las Cabras/prevención & control , Schistosoma/inmunología , Esquistosomiasis/veterinaria , Vacunación/veterinaria , Vacunas Sintéticas/administración & dosificación , Animales , Anticuerpos Antihelmínticos/biosíntesis , Femenino , Enfermedades de las Cabras/inmunología , Cabras , Inmunoglobulina G/biosíntesis , Masculino , Schistosoma/enzimología , Esquistosomiasis/inmunología , Esquistosomiasis/prevención & controlRESUMEN
Published data on the efficacy and presumptive modes of action of spinal manipulations are reviewed, as well as current problems with the technique. Although the best-designed studies have shown promising results, the efficacy of spinal manipulations has not as yet been firmly proven. The mode of action may involve mechanical changes in the disk and facet joints, but neurological mechanisms probably play the key role. Complications of cervical spinal manipulations are rare. To protect patients, French law requires that spinal manipulations be performed only by licensed physicians, who are the only professionals capable of establishing the accurate diagnosis before undertaking manipulations.
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Dolor de la Región Lumbar/terapia , Manipulación Ortopédica , Ensayos Clínicos como Asunto , Francia , Humanos , Legislación Médica , Vértebras Lumbares , Manipulación Ortopédica/efectos adversos , Manipulación Ortopédica/métodos , Efecto Placebo , Resultado del TratamientoRESUMEN
The properties of the cystic fibrosis gene product (CFTR) were studied by expression of cloned cDNA in different cell systems. Infection of both simian fibroblast (Vero) cells and immortalized CF nasal polyp cells (NCF3A) with a vaccinia virus encoding CFTR induced forskolin-induced Cl- permeability and low-conductance (8 pS) Cl- channels. By stable transfection of the rat intestinal crypt-derived cell line IEC-6 we have isolated a clone, IEC-CF7, which expresses CFTR mRNA and antigen. IEC-CF7 cells, but not IEC-6, display forskolin-induced Cl- permeability and multiple linear low-conductance (+/- 8 pS) Cl- channels in cell-attached membrane patches. In excised patches of IEC-CF7 cells, low-conductance Cl- channels could be activated by addition of the catalytic subunit of the adenosine 3',5'-cyclic monophosphate-dependent protein kinase A (PKA) plus ATP. During bath fluid replacement studies, the activated low-conductance channel remained active in the absence of ATP at room temperature and showed saturation kinetics. Rectifying (32 pS) Cl- channels were not observed in either IEC-6 cells or IEC-CF7 cells, indicating that there is no relation between CFTR expression and the incidence of this channel. Our data strongly support the conclusion that CFTR can act as a low-conductance Cl- channel, gated by PKA. The IEC-6-derived cell line IEC-CF7 may prove to be a useful model in the study of CFTR function because of the absence of 32-pS Cl- channel activity and its potential for differentiation.