RESUMEN
AIM: The aim of our study is to introduce a new objective method of perioperative evaluation of the size of diaphragmatic defect to enable comparison of results among various centres and methods used for diaphragmatic reconstruction. MATERIALS AND METHODS: Prospective observational study of neonates with congenital diaphragmatic hernia (CDH) and respiratory distress within 24 h of birth operated on from January 2009 to December 2011. Weight, length, thoracic shape and the diameters of diaphragmatic defect were measured. To determine the relative size of the defect, a defect-diaphragmatic ratio (DDR = defect area:diaphragm area × 100) was calculated. The measured and calculated data were subsequently compared between Gore-Tex patch group (GT) and primary repair group (PR). Mann-Whitney U test was used for statistical analysis. RESULTS: Forty-seven patients with CDH were admitted during study period. The overall survival rate was 79 % (37/47). Preoperative stabilization was achieved in 85 % (40/47). Survival of operated neonates was 93 % (37/40). Diaphragmatic reconstruction with Gore-Tex patch was used in 7 neonates (17 %), and primary repair in 33 (83 %). Mortality in Gore-Tex group was 29 %; mortality in primary repair group was 3 %. Data of anthropometric measurement were complete in 34 children (5 GT and 29 PR). Significant differences were found between GT group and PR group in the size of diaphragmatic defect with the transverse and sagittal diameters of defect (48.0 ± 5.7 vs. 30.1 ± 5.9, P < 0.00061; 34.0 ± 12.5 vs. 16.0 ± 7.3, P < 0.0022) and DDR (18.29 ± 4.60 vs. 5.77 ± 3.28, P < 0.0005), respectively. CONCLUSION: The value of DDR as an objective criterion of the extent of diaphragmatic defect was confirmed by the close correlation between DDR and feasibility of primary repair in the study group. This objective assessment of defect size may improve comparing various surgical techniques and results of different centres, and thus facilitates sharing experience with management of neonates with CDH.
Asunto(s)
Diafragma/cirugía , Hernias Diafragmáticas Congénitas , Procedimientos de Cirugía Plástica/métodos , Mallas Quirúrgicas , República Checa/epidemiología , Estudios de Seguimiento , Hernia Diafragmática/diagnóstico , Hernia Diafragmática/mortalidad , Hernia Diafragmática/cirugía , Humanos , Recién Nacido , Masculino , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Tasa de Supervivencia/tendencias , Resultado del TratamientoRESUMEN
Generalized Anxiety Disorder (GAD) may involve hypo-responsiveness of noradrenaline a2 receptors. To test this hypothesis, we used (99m)Tc-hexa-methyl-propylene-amine-oxime (HMPAO) Single Photon Emission Computed Tomography to measure regional cerebral perfusion in patients with untreated GAD, venlafaxine-treated patients and healthy controls during word generation before and after clonidine. Concurrent psychological and physiological measures supported noradrenergic hypofunction in GAD in some cases. A single-day split-dose technique was used. Images were processed using SPM5 (Institute of Neurology). Factorial analysis revealed no significant results. Exploratory analyses were done. Regional perfusion during verbal fluency differed by group pre-clonidine. Compared with healthy controls, patients with untreated GAD displayed increased perfusion in the left Broca's area and left occipitotemporal region. Treated GAD patients displayed increased cerebellar perfusion bilaterally. Clonidine was associated with different changes in cerebral perfusion in each group. Increases were seen in the right supra-marginal gyrus in healthy subjects, in the left pre-central gyrus in treated GAD patients and in the right cerebellum and middle frontal gyrus in untreated GAD patients. Despite these differences, the findings were not consistent with a noradrenergic hypo-responsiveness hypothesis, as the treated group showed a different pattern of response rather than a normalization of response.
Asunto(s)
Trastornos de Ansiedad/tratamiento farmacológico , Encéfalo/efectos de los fármacos , Clonidina/farmacología , Receptores Adrenérgicos alfa 2/fisiología , Tomografía Computarizada de Emisión de Fotón Único/métodos , Adulto , Anciano , Trastornos de Ansiedad/diagnóstico por imagen , Trastornos de Ansiedad/fisiopatología , Trastornos de Ansiedad/psicología , Circulación Cerebrovascular/efectos de los fármacos , Humanos , Memoria a Corto Plazo/efectos de los fármacos , Persona de Mediana EdadRESUMEN
PURPOSE: The aim of study was to compare growth, nutritional status and incidence of chest wall deformities and scoliosis in survivors of large congenital diaphragmatic hernia (CDH) defect (Gore-Tex patch reconstruction) with survivors with smaller defects and primary reconstruction. MATERIALS AND METHODS: An anthropometric study of 53 children who underwent CDH repair in neonatal period was carried out. Weight, height, and skin-fold thickness were measured, scoliosis and chest wall deformity were evaluated. Body mass index (BMI) and thoracic index (TI) were calculated using standard rules. The measured data were compared with national population standard with the use of standard deviation score (SDS). According to the type of diaphragmatic reconstruction, the patients were divided into two groups [Gore-Tex patch (10) versus primary repair (43)]. Student t test and Fisher exact tests were used for statistical analysis. RESULTS: Pectus excavatum was found in 25 (47%) patients, poor posture in 33% and significant scoliosis in 5%. Compared with the population norm, CDH children had a significantly lower body height SDS (mean -0.39, p < 0.05), weight SDS (mean -0.75, p < 0.001), BMI (mean SDS -0.68, p < 0.001) and lower TI (mean SDS -0.62, p < 0.01). Gore-Tex versus primary repair group significantly differed in incidence of pectus excavatum and BMI (PE: p = 0.027, BMI SDS: p = 0.016). A majority of anthropometric parameters (weight, height, thoracic index, and thorax circumference) and incidence of scoliosis and poor posture in children after Gore-Tex patch reconstruction did not significantly differ from children after primary repair. CONCLUSION: The differences in some anthropometric parameters (weight, BMI, and TI) and in the skeletal deformity suggest that the CDH not only disturbs normal lung growth, but also seems to have implications on some other aspects of somatic development. Whether these changes could be related to the type of diaphragmatic reconstruction or rather to the size of the defect remains uncertain.
Asunto(s)
Tórax en Embudo/prevención & control , Hernias Diafragmáticas Congénitas , Procedimientos de Cirugía Plástica/métodos , Escoliosis/prevención & control , Mallas Quirúrgicas , Materiales Biocompatibles , Índice de Masa Corporal , Niño , República Checa/epidemiología , Femenino , Tórax en Embudo/epidemiología , Tórax en Embudo/etiología , Hernia Diafragmática/complicaciones , Hernia Diafragmática/diagnóstico , Hernia Diafragmática/cirugía , Humanos , Incidencia , Masculino , Politetrafluoroetileno , Pronóstico , Radiografía Torácica , Estudios Retrospectivos , Escoliosis/epidemiología , Escoliosis/etiologíaRESUMEN
Serotonin and noradrenaline reuptake inhibitor (SNRI) antidepressants have evidence of efficacy in the treatment of generalized anxiety disorder (GAD); however, it is not clear whether there is an advantage over selective serotonin reuptake inhibitor (SSRI) medicines and there is limited evidence for noradrenergic dysfunction in GAD. We tested whether a dysfunctional alpha-2 adrenoceptor system is present in patients with GAD and the effects of SNRI treatment on this system. The method used was an infusion of clonidine (a selective alpha-2 adrenergic receptor agonist) on psychological and physiological outcomes in three subject groups: 10 untreated GAD patients, five SNRI-treated GAD patients and seven normal controls. The clonidine challenge elicited sedation, a rise in growth hormone, decrease in blood pressure, decline in saccadic eye movement (SEM) variables, and improvement in verbal fluency as anticipated in the 22 subjects examined. Lower cortisol levels were found in controls and higher blood pressure readings in GAD-treated subjects, as well as evidence that GAD-treated subjects had SEMs that were intermediate between control and GAD subjects' scores and have less clonidine-induced sedation. The implications of these findings with reference to the study hypothesis in this small study are discussed.
Asunto(s)
Agonistas de Receptores Adrenérgicos alfa 2/farmacología , Trastornos de Ansiedad , Clonidina/farmacología , Ciclohexanoles/farmacología , Receptores Adrenérgicos/fisiología , Inhibidores Selectivos de la Recaptación de Serotonina/farmacología , Adulto , Trastornos de Ansiedad/tratamiento farmacológico , Trastornos de Ansiedad/fisiopatología , Trastornos de Ansiedad/psicología , Presión Sanguínea/efectos de los fármacos , Movimientos Oculares/efectos de los fármacos , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Hormona de Crecimiento Humana/sangre , Humanos , Hidrocortisona/sangre , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Norepinefrina/farmacología , Clorhidrato de VenlafaxinaRESUMEN
We investigated the effects of short-term abstinence from smoking and acute nicotine administration on taste perception in smokers. We assessed sensitivity for salt and sucrose solutions and the self-reported intensity and pleasantness of these tastes, using a previously validated model of taste perception. This was in order to investigate mechanisms by which cigarette smoking and smoking cessation may modulate dietary behaviour. Male and female daily smokers attended a single testing session. Participants were randomised to either abstain for smoking for 12 h or smoke as usual on the morning of testing. At the testing session, participants completed subjective ratings of mood and ratings of intensity and pleasantness of salt and sucrose solutions, followed by measurement of the threshold at which these solutions could be detected on the tongue. Participants were then randomised to smoking either a nicotine-containing or denicotinised cigarette, after which they completed the same measures as previously. Our data suggest that following cigarette smoking, lower taste thresholds are obtained after smoking a denicotinised cigarette compared with a nicotinised cigarette, but among females only. This effect was not observed among males and did not differ as a function of abstinence condition. In addition, among non-abstinent smokers, females demonstrated higher taste thresholds (i.e. reduced sensitivity) for salt than males, but this sex difference was not observed among abstinent smokers.
Asunto(s)
Nicotina/administración & dosificación , Cese del Hábito de Fumar , Fumar , Percepción del Gusto/efectos de los fármacos , Adulto , Afecto/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nicotina/farmacología , Cloruro de Sodio Dietético/administración & dosificación , Sacarosa/administración & dosificación , Umbral Gustativo/efectos de los fármacos , Adulto JovenRESUMEN
Yellow rust (causal agent: Puccinia striiformis f.sp. tritici) resistance in the UK wheat cultivar Guardian is developmentally regulated, resistance increasing as the plant matures. Yellow rust resistance was assessed under field conditions on plants after ear emergence to ensure maximum expression of resistance. Three quantitative trait loci (QTL) for yellow rust resistance were identified, being located on chromosomes 1B (QPst.jic-1B), 2D (QPst.jic-2D) and 4B (QPst.jic-4B). The largest resistance effect, QPst.jic-1B located to the same position on the long arm of chromosome 1B as the known durable source of yellow rust resistance, Yr29. Microscopic studies were carried out to determine what effect the resistance in Guardian had on the development of P. striiformis f.sp. tritici. While the adult plant resistance in Guardian did not prevent germinated urediniospores from establishing an effective infection site, the growth of hyphae within flag leaf tissue was significantly inhibited, slowing the development of microcolonies. 3,3-diaminabenzadine (DAB) and trypan blue staining indicated that this inhibition of hyphal growth was not associated with hydrogen peroxide accumulation or extensive plant cell death.
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Inmunidad Innata/genética , Enfermedades de las Plantas/genética , Enfermedades de las Plantas/inmunología , Sitios de Carácter Cuantitativo/genética , Triticum/crecimiento & desarrollo , Triticum/microbiología , Análisis de Varianza , Basidiomycota/citología , Basidiomycota/crecimiento & desarrollo , Mapeo Cromosómico , Segregación Cromosómica , Cruzamientos Genéticos , Germinación , Escala de Lod , Fenotipo , Enfermedades de las Plantas/microbiología , Carácter Cuantitativo Heredable , Esporas Fúngicas/citología , Esporas Fúngicas/fisiología , Triticum/genética , Triticum/inmunología , Reino UnidoRESUMEN
The purpose of this study was to evaluate the outcome in neonates with congenital diaphragmatic hernia (CDH) either presenting within the first 24 h of life or diagnosed prenatally. The study was particularly focused on the time of onset of respiratory distress and on the use of the Gore-Tex (GT) patch for diaphragmatic reconstruction. Records of 104 neonates with CDH were retrospectively reviewed. The data were analyzed by ANOVA, Kruskal-Wallis test or chi (2) test as appropriate. The result showed that the overall survival rate was 73.1% (76/104). Survival of operated neonates was 91.6% (76/83). Postnatally diagnosed neonates with the onset of respiratory distress within the first minute of life survived in 67%, with the onset between 2 and 10 min survived in 89%, whilst neonates with the onset of respiratory distress after l0 min survived in 100% (P = 0.007). Birth weight, gestational age, time of onset of respiratory distress and Apgar score significantly differed between survivors and nonsurvivors. Primary closure of the diaphragmatic defect was performed in 62 patients while the GT patch was used in 21 patients. The survival of patients with a large defect treated with a GT patch was lower (76.2 vs. 96.8%, P = 0.003). There was only one case of recurrence in our series with the GT patch. Survival depends on the time of onset of respiratory distress and size of the defect, both of which correlate with the degree of pulmonary hypoplasia. The term high-risk CDH is appropriate only for children with respiratory distress within the first 10 min of life and those diagnosed prenatally. The GT patch is a suitable material for the diaphragmatic reconstruction; we suppose that the recurrence is caused by incorrect attachment of the patch to the thoracic wall.
Asunto(s)
Hernia Diafragmática/cirugía , Hernias Diafragmáticas Congénitas , Insuficiencia Respiratoria/etiología , Materiales Biocompatibles , Femenino , Hernia Diafragmática/complicaciones , Humanos , Recién Nacido , Masculino , Politetrafluoroetileno , Estudios Retrospectivos , Análisis de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
The occurrence of coexisting congenital diaphragmatic hernia (CDH) and esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) is extremely rare and is considered highly lethal. The combination of CDH with EA/TEF and truncus arteriosus communis (TAC) has not been reported in the literature to date. The authors describe a premature neonate with this association.
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Atresia Esofágica/cirugía , Hernia Diafragmática/cirugía , Enfermedades del Prematuro/cirugía , Fístula Traqueoesofágica/cirugía , Tronco Arterial/cirugía , Resultado Fatal , Hernias Diafragmáticas Congénitas , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Fístula Traqueoesofágica/congénitoRESUMEN
BACKGROUND: Treatment of the Congenital Diaphragmatic Hernia in neonates with early manifestations has been accompanied with significant mortality. Authors present the treatment protocol employed in such children and results from the period January 1994 to December 2003. METHODS AND RESULTS: Since January 1994 to December 2003 96 children were cured for the Congenital Diaphragmatic Hernia. Ratio F:M was 36:60. 29 children (30%) were diagnosed prenatally, the remaining newborns were diagnosed on the basis of thoracic X-ray, which was required for the early signs of respiratory insufficiency. The postnatal treatment protocol included circulation-ventilation stabilisation, operation, early extubation and initiation of the peroral nourishment. Altogether 78 (81%) of children were operated after the stabilization using the standard laparotomy method, 5 children (6%) were operated with extra corporal membrane oxygenation, in 20 children (26%) a Goretex patch was used to cover an extensi e defect in the diaphragm. Overall survival was 74%, survival of operated children was 91%, 75% of children with a patch survived, survival of children operated with ECMO was 40%. Relapse occurred in one child (1%) with a patch. CONCLUSIONS: Specification of the prenatal diagnosis and collection of patients with CDH into tertiary centres with ECMO possibility can improve prognosis of neonates with the malformation.
Asunto(s)
Hernia Diafragmática/cirugía , Hernias Diafragmáticas Congénitas , Femenino , Hernia Diafragmática/diagnóstico , Hernia Diafragmática/mortalidad , Humanos , Recién Nacido , Masculino , Diagnóstico Prenatal , Tasa de SupervivenciaRESUMEN
In this study the authors present a method of conversion of external fixations to closed intramedullary ones in the treatment of complicated diaphyseal fractures of the calf and femur. According to the conditions, the fixation is secured by a pin. The above mentioned procedure is advantageous especially in cases of patients with open fractures, in patients with polytraumas as well as in patients with a threatening or with a present compartment syndrome. Treatment of the above fractures is not always simple and represents a serious problem in everyday traumatological practice. Treatment of fractures using the above procedure has very good results with a minimum of complications. Although, nowadays, the skeletal defect can be solved and therefore the bearing capacity of the extremity be renewed, damages to the muscles are often irreparable and cause a permanent invalidity.
Asunto(s)
Fijadores Externos , Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas , Fijación de Fractura/instrumentación , Fracturas Abiertas/cirugía , Fracturas de la Tibia/cirugía , Adulto , Clavos Ortopédicos , Diáfisis/lesiones , Humanos , Masculino , Persona de Mediana EdadRESUMEN
AIM: The aim of this study is to assess a contemporary treatment potential for necrotizing enterocolitis in newborns with birth weights under 1000 g. METHODOLOGY AND SUBJECTS: This is a retrospective study of clinical and pathological data in a group of 19 newborns with birth weights under 1000 g treated for necrotizing colitis (NEC) by the authors' team from 1999 to 2003. Only newborns with the second and third grade NEC according to Bell were included in the trial group. RESULTS: The trial group included 19 newborns born in the 26th gestation week, on average (ranging from 23- to 31) with a mean birth weight of 711 grams (the range between 460-980 g). Their NEC appeared on the 18th postnatal day, on average (the range between 6-59). Ten newborns were operated in the acute stage of their NEC, nine were treated conservatively. Five infants operated in the acute stage had separational ileostomy conducted, four had a T-drain introduced and one had an abdominal drain introduced. In the conservatively managed group, three infants were consequently operated for intestinal strictures following their NEC, two recovered during the conservative treatment and four exited due to a fast progress of their NEC without surgery. The total mortality rate of the trial group was 42% (8 infants exited). CONCLUSION: The NEC treatment in the extremely immature newborns with birth weigts under 1000 g requires complex cooperation of a neonatologist and a paediatric surgeon. The necrotic intestine resections followed by stomic procedures remain standard procedures in unstable newborns with a localised form of the disease.
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Enterocolitis Necrotizante/cirugía , Enfermedades del Prematuro/cirugía , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Enterocolitis Necrotizante/diagnóstico , Humanos , Recién Nacido , Enfermedades del Prematuro/diagnósticoRESUMEN
OBJECTIVE: To assess the risk and the degree of possible unfavourable development in neonates with bronchopulmonal dysplasia and with congenital diaphragmatic hernia. DESIGN: Longitudinal monitoring of the mental, motoric and neurological development until the age of 2 years. Comparison of the findings with the result of polygraphic examination carried out at the expected time of birth. METHODS: The following children were monitored: a) 38 children with bronchopulmonal dysplasia born between the 24th and 33rd post-conception weeks; b) 18 children with congenital diaphragmatic hernia, of whom 3 children were born between the 34th and 36th post-conception weeks, while the remaining 15 children were born on the expected date. All children underwent polygraphic examinations (EEG - 8 channels, respiration, EKG, EOG and EMG) between the 38th and 42nd post-conception weeks. During the 1st and the 2nd years, their psychomotoric development and neurological status were repeatedly evaluated according to Bayley and Vlach, respectively. RESULTS: Up until the 2nd year of life, approximately 2/3 of the children in both monitored groups were developing favourably or satisfactorily. However, the development of the remaining 1/3 was not favourable: The children were mentally or motorically retarded and/or cerebral palsy developed in them. The polygraphic examination in the neonatal period predicted the favourable or unfavourable development of the monitored children with high probability. CONCLUSION: The study showed that in accordance with the data stated in the literature, the development of neural functions is seriously affected in a relatively high percentage of neonates with severe pneumopathy. Neonatal polygraphy can contribute to timely determination of the prognosis for these children. Children with serious neonatal pneumopathies need to be provided with dispensary care on a long-term basis, and professional consultancy and intervention programmes need to be ensured for them.
Asunto(s)
Displasia Broncopulmonar/complicaciones , Desarrollo Infantil , Hernia Diafragmática/complicaciones , Hernias Diafragmáticas Congénitas , Enfermedades del Prematuro , Discapacidades del Desarrollo/diagnóstico , Discapacidades del Desarrollo/etiología , Electroencefalografía , Estudios de Seguimiento , Humanos , Recién Nacido , Examen Neurológico , Factores de RiesgoRESUMEN
OBJECTIVE: Nosocomial infections caused by the coagulase-negative staphylococci are among the most frequent complications in an intensive care unit for neonates. The authors describe three cases of successful treatment of this complication in which the new antibiotic Linezolide was used. DESIGN: Analysis of three clinical cases. SETTING: Mother and Child Care Institute, Prague. METHODS: Description of cases of nosocomial sepsis in 3 immature neonates where the usual treatment of multiresistant strains of coagulase-negative staphylococci, based on the use of Vankomycin, was not successful. CONCLUSION: Administration of Linezolide proved to be very effective in all of the described cases. In spite of the high effectiveness and relative safety of this preparation, its precise role in the treatment of infection-related complications caused by coagulase-negative staphylococci has not yet been established. For the time being, we recommend administering this preparation only in strictly indicated cases after the usual therapy fails.
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Acetamidas/uso terapéutico , Antibacterianos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Enfermedades del Prematuro/tratamiento farmacológico , Oxazolidinonas/uso terapéutico , Sepsis/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Coagulasa/metabolismo , Infección Hospitalaria/microbiología , Humanos , Recién Nacido , Linezolid , Sepsis/microbiología , Infecciones Estafilocócicas/microbiología , Staphylococcus/enzimologíaRESUMEN
OBJECTIVE: To evaluate some perinatal and neonatal risk factors of occurrence of necrotising enterocolitis (NEC) and the current possibilities of treatment. DESIGN: A retrospective data analysis. SETTING: Mother and Child Care Institute, Prague. METHODS: The clinical course in 28 neonates treated for NEC on the worksite of the authors in the period 1999-2003. Only neonates with NEC in the second and third Bell's stages were included in the group. RESULTS: From a group of 14,275 neonates born during the reference period, NEC was diagnosed in 28 neonates. In all cases, they were neonates with very low birth weight (VLBW). The average gestation age was 26.6 weeks (the range was 23-35; the median was 25.5); the average birth weight was 822 grams (the range was 340-1,490g; the median was 735). Incidence was between 1.08 and 2.37/1,000 live births (the average was 1.94). On the average, NEC occurred on the 17th day after birth (the range was 5-59; the median was 14). 14 neonates (50%) in the acute stage of NEC were operated on; 9 children (32%) were only treated conservatively. In eight children at the acute stage, who were operated on, divided ileostomy was created; in four children, a T-drain was used for removal of the intestinal content and an abdominal drain was used for this purpose in one child. Repeated surgery was necessary in five children. Of the conservatively treated ones, five children recovered as a result of conservative treatment and four children died as a result of fast progression of NEC without surgical treatment. All the children treated for patent ductus arteriosus (PDA) with Indometacin died. The overall mortality in the group was 39.3% (11 children died). CONCLUSION: Prematurity seems to be the common denominator of the occurrence of NEC. Treatment of NEC in highly immature neonates with birth weight below 1,500g requires comprehensive cooperation of a neonatologist and a children's surgeon. Resection of a necrotic intestine with creation of a stomy remains a standard procedure, which is followed in unstable neonates with a localised form of the illness. Prevention of premature birth, antenatal steroids, frequent feeding (trophic feeding) and the corresponding correction of water management seem to be a reasonable strategy to reduce the incidence of NEC. The resulting incidence, mortality, the time of the occurrence of NEC and the therapeutic procedures are within the limits stated in the international literature.
Asunto(s)
Enterocolitis Necrotizante/cirugía , Enfermedades del Prematuro/cirugía , Recién Nacido de muy Bajo Peso , Enterocolitis Necrotizante/diagnóstico , Humanos , Recién Nacido , Enfermedades del Prematuro/diagnósticoRESUMEN
The authors describe the group of 23 patients (16 women, 7 men), who were operated during 2000-2003 on ulna-carpal impingement or the syndrome of ulna impact on the basis of "plus variant" of ulna or also "long ulna". There was a fracture of distal radius in anamnesis of all these patients. The condition was solved in 18 patients (mean age 51 years) by reducing the ulna by 4.5 cm on the average (range 2-10 mm). In five patients (mean age 49 years), the radius-ulna desis sec. Sauvé-Kapandij was performed. The results are evaluated with the time lapse of 6 months on the average (range 3-26). The resulting evaluation indicates that in all patients, who were not affected by radius-ulna arthrosis, a simple reduction of ulna resulted in an improvement of the extent of movements and improved subjective complaints. Patients with radius-ulna arthrosis, where the ulna-carpal impingement was solved by radius-ulna desis, suffer from worse long-term functional results. The authors also analyze complications of the interventions. Posttraumatic deformations in the area of distal forearm should be solved early before degenerative changes develop. The is the only way how to expect good results of the operation and favorable effect for the patient.
Asunto(s)
Artropatías/etiología , Fracturas del Radio/complicaciones , Articulación de la Muñeca , Adulto , Anciano , Huesos del Carpo/diagnóstico por imagen , Femenino , Humanos , Artropatías/diagnóstico por imagen , Artropatías/cirugía , Masculino , Persona de Mediana Edad , Radiografía , Fracturas del Radio/diagnóstico por imagen , Cúbito/diagnóstico por imagen , Cúbito/cirugía , Articulación de la Muñeca/diagnóstico por imagenRESUMEN
Substitute methadone prescribing is one of the main modes of treatment for opiate dependence. This study examined the relationship between methadone dose (measured by daily dose and methadone's active (R)-enantiomer blood levels) and opiate receptor function. Nine subjects on substitute methadone (30 - 90 mg daily) received three subcutaneous injections 1.5 hours apart (saline, 5 mg and 10 mg hydromorphone, a short-acting opiate agonist) followed by measures of functional response in particular saccadic eye movements (SEMs), as well as self-report measures. Ten mg of hydromorphone significantly slowed SEM parameters (peak velocity by 15%, p < 0.005; peak acceleration by 20%, p < 0.025; peak deceleration by 26%, p < 0.025) and the SEM velocity changes correlated significantly with (R)-methadone levels (r = 0.844, p < 0.005) and with the oral dose of methadone being taken (r = 0.829, p < 0.005). Although a similar trend was observed for 5 mg, this was not significant. These finding suggest that, at higher methadone doses (resulting in higher plasma concentrations), there is significant tolerance to the action of agonists. Such studies may help in refining our understanding of the actions of methadone and the SEM measure could help in defining the degree of tolerance in individuals using street heroin.
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Hidromorfona , Metadona/administración & dosificación , Narcóticos/administración & dosificación , Trastornos Relacionados con Opioides/rehabilitación , Movimientos Sacádicos/efectos de los fármacos , Adulto , Tolerancia a Medicamentos , Femenino , Humanos , Masculino , Metadona/sangre , Persona de Mediana Edad , Trastornos Relacionados con Opioides/sangreRESUMEN
When formulating indications for surgery of the thoracic outlet syndrome (TOS) the authors use as a basis their own experience with treatment of 42 patients and data from the literature. The basis is the fact that to the great majority of patients at the time after establishment of the diagnosis comprehensive and systematic rehabilitation care was not available either because lack of time or due to the absence of a department within their reach which could ensure adequate care. The authors discuss the reasons why they prefer after accurate establishment of the diagnosis a primary surgical approach and elimination of the cause of further mechanical damage of the neurovascular bundle with necessary and obvious continuation with long-term intensive rehabilitation. This is a reverse procedure than that recommended by some others concerned with this problem.
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Síndrome del Desfiladero Torácico/cirugía , Adolescente , Adulto , Femenino , Humanos , Masculino , Complicaciones Posoperatorias , Síndrome del Desfiladero Torácico/diagnósticoRESUMEN
The authors describe very rare complication (pseudopleural effusion) after peripheral venous cannulation (Introcan-W 24G3/4 through v. axilaris) in extremely premature newborn with birth weight 600 grams, which lead to worsening of patient's respiratory insufficiency. Ultrasonographic examination confirmed extrapleural process without necessity of surgical intervention. Cannula extraction and infusion interruption were followed by spontaneous regression of the complication, thereafter artificial ventilation was discontinued and baby was discharged.
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Cateterismo Periférico/efectos adversos , Hidrotórax/etiología , Enfermedades del Prematuro/etiología , Recién Nacido de muy Bajo Peso , Vena Axilar , Displasia Broncopulmonar/terapia , Diagnóstico Diferencial , Femenino , Humanos , Hidrotórax/diagnóstico , Hidrotórax/terapia , Recién Nacido , Enfermedades del Prematuro/diagnósticoRESUMEN
The final common pathway of addiction (the dopamine hypothesis of reward) has recently been evolving, with the mesocorticolimbic dopaminergic system now seen as key to natural rewards and drug-seeking behaviour, though perhaps having less of a role in the maintenance of such behaviour. The perception of a common pathway has meant that treatments for one drug of addiction have 'crossed-over' and become possible treatments for other addictive drugs.
Asunto(s)
Síndrome de Abstinencia a Sustancias/fisiopatología , Trastornos Relacionados con Sustancias/fisiopatología , Alcoholismo/fisiopatología , Trastornos Relacionados con Anfetaminas/fisiopatología , Animales , Benzodiazepinas , Cannabis , Trastornos Relacionados con Cocaína/fisiopatología , Dopamina/fisiología , Humanos , Narcóticos/farmacología , Síndrome de Abstinencia a Sustancias/tratamiento farmacológico , Tabaquismo/fisiopatologíaRESUMEN
OBJECTIVE: The brain circuitry of opiate craving was investigated with positron emission tomography (PET) imaging of regional cerebral blood flow (rCBF). METHOD: Twelve abstinent opiate-dependent subjects listened to audiotaped autobiographical scripts of an episode of craving and a neutral episode while undergoing a PET scan with the tracer [(15)O]H(2)O. Statistical parametric mapping was used to analyze the PET images of rCBF changes. RESULTS: Comparison of the drug-related and neutral stimulus conditions revealed activation of rCBF in the left medial prefrontal and left anterior cingulate cortices and deactivation in the occipital cortex in response to the drug-related stimulus. A further statistical parametric mapping analysis with a subjective rating of craving as a covariate showed a positive association of between craving and rCBF in the left orbitofrontal cortex. CONCLUSIONS: The patterns of cerebral activation reflect the different brain regions mediating the salience of opiate-related stimuli and the subjective experience of craving for opiates.