RESUMEN
Sixteen sites in the watershed of the South Fork of the Broad River (SFBR) in Northeastern Georgia, USA, were sampled in two seasons to detect Campylobacter. Sites were classified as mostly influenced by forest, pasture, wastewater pollution control plants (WPC) or mixed use. Sampling was repeated in the late spring and late fall for 2 years for a total of 126 samples. Free-catch water and sediment grab samples were taken at each site; Moore's swabs were placed for up to 3 days at most sites. A total of 56 isolates of thermophilic Campylobacter were recovered. Thirteen samplings were positive by two or three methods, and 26 samplings were positive by only one method; once by Moore's swab only and 25 times by free-catch water only. Campylobacter was detected at 58% of cattle pasture sites, 30% of forested sites and 81% of WPC sites. Twenty-one of the isolates carried antimicrobial resistance genes, mostly blaOXA-61. Free-catch water samples were more efficient than Moore's swabs or sediment samples for recovery of Campylobacter, which was more likely to be detected in streams near cattle pastures and human communities than in forested land. SIGNIFICANCE AND IMPACT OF THE STUDY: The role of environmental water in transmitting Campylobacter was investigated, and methods for recovery of the organism were compared. The sequence types of recovered Campylobacter correlated with adjacent land use without regard to the method used to isolate the organisms. Sequence types and antimicrobial resistance genes associated with cattle were most prevalent near pastures. Even though types were recurrent at a given site, types appeared to be lost or replaced as the water flowed downstream.
Asunto(s)
Antibacterianos/farmacología , Campylobacter/genética , Sedimentos Geológicos/microbiología , Ríos/microbiología , Resistencia betalactámica/genética , Animales , Campylobacter/efectos de los fármacos , Campylobacter/aislamiento & purificación , Infecciones por Campylobacter/tratamiento farmacológico , Infecciones por Campylobacter/transmisión , Bovinos , Georgia , Humanos , Estaciones del Año , Aguas Residuales/microbiologíaRESUMEN
Deep brain stimulation (DBS) at the globus pallidus pars internus (GPi) is an effective treatment for some patients with medically refractory torsion dystonia. In this chapter we review the classification and treatment of torsion dystonia including the current indications for DBS surgery. Details of the DBS procedure and programming of the DBS devices are discussed. Pallidal DBS is most effective in patients with primary generalized dystonia. Children and adolescents possessing the DYT1 gene mutation may respond best of all. Patients with cervical dystonia may also improve with pallidal DBS but definitive clinical evidence is lacking. As a group, patients with secondary dystonias respond less well to DBS than do patients with primary dystonia; however, patients with dystonia secondary to anoxic brain injury who have grossly intact basal ganglia anatomy, and patients with tardive dystonia may represent secondary dystonia subtypes for whom pallidal DBS is a viable option.
Asunto(s)
Estimulación Encefálica Profunda/métodos , Distonía Muscular Deformante/cirugía , Estimulación Encefálica Profunda/instrumentación , Distonía Muscular Deformante/patología , Globo Pálido/fisiopatología , Globo Pálido/efectos de la radiación , Humanos , Imagen por Resonancia Magnética/métodos , Microelectrodos , Literatura de Revisión como AsuntoRESUMEN
We performed a prospective study of 100 consecutive patients presenting to our unit with complex maxillary fractures. Fracture severity was assessed according to the alpha-numeric scoring system of Cooter and David and correlated with outcome. Regional maxillary and total fracture scores demonstrated a positive correlation with complication rates, with correlation coefficients of 0.89 and 0.98 respectively. Ocular and orbital complications were most commonly seen with these complex injuries, but occlusal problems were much less common. Despite close consultant-led supervision in a specialised centre, these injuries frequently result in long term problems.
Asunto(s)
Fijación de Fractura/métodos , Curación de Fractura , Maxilar/cirugía , Fracturas Maxilares/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Placas Óseas , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Maxilar/diagnóstico por imagen , Fracturas Maxilares/diagnóstico por imagen , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico por imagen , Traumatismo Múltiple/cirugía , Fracturas Orbitales/diagnóstico por imagen , Fracturas Orbitales/cirugía , Estudios Prospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Neurofibromatosis is a systemic disease that often produces striking disfigurement. Orbital manifestations are common and include sphenoid dysplasia with or without infiltration of the periorbital soft tissues. The resultant deficiency of the posterolateral orbital wall may lead to protrusion of the temporal lobe into the orbit, displacement of the globe, and pulsatile exophthalmos. Treatment at our unit has consisted of transcranial orbital reconstruction with bone grafts and periorbital soft-tissue correction. Observation of complete bone graft resorption in one patient prompted an assessment of the Australian Craniofacial Unit's experience with particular attention paid to the stability of operative correction. Of 36 patients with head and neck neurofibromatosis treated during the period from 1981 to 1995, 14 patients underwent transcranial correction of orbital deformities secondary to sphenoid dysplasia. The treatment and outcomes of this transcranial group are reviewed. The most notable finding was that of recurrent globe pulsation in four patients following initial resolution. Computed tomography scans have documented partial to complete bone graft resorption in three of these patients. Titanium mesh is now being utilized to provide a more durable reconstruction.
Asunto(s)
Neurofibromatosis 1/cirugía , Neoplasias Orbitales/cirugía , Adolescente , Adulto , Trasplante Óseo/métodos , Niño , Preescolar , Craneotomía/métodos , Enoftalmia/diagnóstico por imagen , Enoftalmia/cirugía , Exoftalmia/diagnóstico por imagen , Exoftalmia/cirugía , Femenino , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador , Lactante , Masculino , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/cirugía , Neurofibromatosis 1/diagnóstico por imagen , Neoplasias Orbitales/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Prótesis e Implantes , Reoperación , Estudios Retrospectivos , Mallas Quirúrgicas , Titanio , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Leiomiomatosis/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Diagnóstico Diferencial , Femenino , Humanos , Leiomiomatosis/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Persona de Mediana Edad , Toracotomía , Tomografía Computarizada por Rayos X , Neoplasias Uterinas/patologíaRESUMEN
The radiographic appearance of metastatic disease is classic, but nonspecific. The differentiating characteristics of radiographic patterns of metastatic disease are discussed in this article, as well as the relative advantages of different imaging modalities. Recommendations for radiologic evaluation are also presented.
Asunto(s)
Neoplasias Pulmonares/secundario , Sangre , Neoplasias de los Bronquios/secundario , Calcinosis/diagnóstico por imagen , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Metástasis Linfática/diagnóstico por imagen , Sistema Linfático , Neoplasias del Mediastino/secundario , Células Neoplásicas Circulantes , Tomografía Computarizada por Rayos XRESUMEN
Nucleus accumbens (DA) has been implicated in a number of different behavioral functions, but most commonly it is said to be involved in "reward" or "reinforcement". In the present article, the putative reinforcement functions of accumbens DA are summarized in a manner described as the "General Anhedonia Model". According to this model, the DA innervation of the nucleus accumbens is conceived of as a crucial link in the "reward system", which evolved to mediate the reinforcing effects of natural stimuli such as food. The reward system is said to be activated by natural reinforcing stimuli, and this activation mediates the reinforcing effects of these natural stimuli. According to this view, other stimuli such as brain stimulation and drugs can activate this system, which leads to these stimuli being reinforcing as well. Interference with DA systems is said to blunt the reinforcing effects of these rewarding stimuli, leading to "extinction". This general model of the behavioral functions of accumbens DA is utilized widely as a theoretical framework for integrating research findings. Nevertheless, there are several difficulties with the General Anhedonia Model. Several studies have observed substantial differences between the effects of extinction and the effects of DA antagonism or accumbens DA depletions. Studies involving aversive conditions indicate that DA antagonists and accumbens DA depletions can interfere with avoidance behavior, and also have demonstrated that accumbens DA release is increased by stressful or aversive stimuli. Although accumbens DA is important for drug abuse phenomena, particularly stimulant self-administration, studies that involve other reinforcers are more problematic. A large body of evidence indicates that low doses of dopamine antagonists, or depletions of accumbens DA, do not impair fundamental aspects of food motivation such as chow consumption and simple instrumental responses for food. This is particularly important, in view of the fact that many behavioral researchers consider the regulation of food motivation to be a fundamental aspect of food reinforcement. Finally, studies employing cost/benefit analyses are reviewed, and in these studies considerable evidence indicates that accumbens DA is involved in the allocation of responses in relation to various reinforcers. Nucleus accumbens DA participates in the function of enabling organisms to overcome response costs, or obstacles, in order to obtain access to stimuli such as food. In summary, nucleus accumbens DA is not seen as directly mediating food reinforcement, but instead is seen as a higher order sensorimotor integrator that is involved in modulating response output in relation to motivational factors and response constraints. Interfering with accumbens DA appears to partially dissociate the process of primary reinforcement from processes regulating instrumental response initiation, maintenance and selection.
Asunto(s)
Conducta Animal/fisiología , Dopamina/farmacología , Núcleo Accumbens/fisiología , Animales , Modelos NeurológicosRESUMEN
We report the successful coverage of a complete sternal cleft with exposed pericardium using bilateral pectoralis major muscle flaps in a newborn. The patient was transferred to our institution with nearly complete sternal aplasia, rectus diastasis, and only dessicated pericardium covering the visible heart. Complete closure without compromise of cardiac function was achieved at 2 days of age with bilateral pectoralis major muscle flaps and fasciocutaneous advancement flaps.
Asunto(s)
Esternón/anomalías , Esternón/cirugía , Colgajos Quirúrgicos , Femenino , Humanos , Recién Nacido , Músculo Esquelético , Resultado del TratamientoRESUMEN
Calcific myonecrosis of lower extremity muscles has been identified as an uncommon late sequela of posttraumatic compartment syndromes or ischemic myonecrosis. Previous reports have detailed a small number of cases with similar clinical and radiographic features. Two cases of calcific myonecrosis diagnosed more than 30 years following trauma to an extremity are presented. Treatment consisted of serial debridement of all infected and necrotic tissue followed by wound closure using a rectus abdominis muscle microvascular transplant in one patient and delayed primary closure in the other. Both patients have resumed active lifestyles with no recurrence of drainage or infection. Aggressive debridement and definitive soft tissue coverage are the mainstay of effective treatment for this entity.
Asunto(s)
Calcinosis/etiología , Síndromes Compartimentales/complicaciones , Traumatismos de la Pierna/complicaciones , Enfermedades Musculares/etiología , Antibacterianos/uso terapéutico , Calcinosis/cirugía , Terapia Combinada , Desbridamiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Musculares/cirugía , NecrosisRESUMEN
The literature demonstrates inconsistent results amongst investigators who have used pentoxifylline in an effort to enhance skin flap survival. This study employed a standardized skin flap model in the rat and a standard intraperitoneal dose of pentoxifylline (10 mg/kg) delivered in four different temporal regimens. Fluorescein staining and length of flap survival were measured. The only regimen that demonstrated increased flap survival over saline controls included administration of the drug immediately upon raising the flap and every 12 hours for the next 7 days. Three different regimens that included preoperative administration of the drug failed to demonstrate a beneficial effect on skin flap survival. Slight improvement in flap survival was seen in animals receiving fluorescein. These results suggest an inconsistent pentoxifylline effect even within a single controlled study.