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INTRODUCTION: Classically the results of any joint replacement surgery are evaluated at a minimum of 5 years. This period could be considered excessive to evaluate the functional results of this procedure. The objective of this study is to compare functional and quality of life results to 1 and five years of follow-up following a total knee replacement (TKR). MATERIAL AND METHODS: Prospective observational study. All patients visited one year after the implantation of TKR were included. All of these filled out the SF-36 questionnaire and the KSS valuation scale. Both were administered again at age five after surgery. RESULTS: 689 patients were initially included in the study (163 men [23.7%] and 526 women [76.3%]) with an average age of 72.2 years. At age 5,585 (84.9%) of these patients were re-analyzed. While the knee section of the KSS scale remained similar in these two periods, the function section of the KSS titration scale showed a slight worsening over time (p = 0.008). With respect to SF-36, the physical summation worsened at five years (p = 0.00) and the mental summation remained stable (n.s.) between the year and five years after surgery. DISCUSSION: Five years after a TKR, the physical exam does not vary from the year of surgery. However, the subjective evaluation measured by the function-KSS section and the physical SF-36, worsen slightly during this period. This could be due to aging patients.

INTRODUCCIÓN: Clásicamente los resultados de cualquier cirugía de reemplazo articular se evalúan en un mínimo de cinco años. Este período podría considerarse excesivo para evaluar los resultados funcionales de este procedimiento. El objetivo de este estudio es comparar los resultados funcionales y de calidad de vida a uno y cinco años de seguimiento tras una artroplastía total de rodilla (ATR). MATERIAL Y MÉTODOS: Estudio prospectivo observacional. Se incluyeron todos aquellos pacientes visitados un año después de la implantación de una ATR. Todos ellos rellenaron el cuestionario SF-36 y la escala de valoración KSS. Ambos fueron administrados nuevamente al cabo de cinco años de la cirugía. RESULTADOS: 689 pacientes fueron incluidos inicialmente en el estudio (163 hombres [23.7%] y 526 mujeres [76.3%]) con una edad media de 72.2 años. A los cinco años, 585 (84.9%) de estos pacientes fueron analizados de nuevo. Mientras que la sección rodilla de la escala KSS se mantenía similar en estos dos períodos, la sección función de la escala de valoración KSS mostraba un leve empeoramiento con el tiempo (p = 0.008). Con respecto al SF-36, el sumatorio físico empeoraba a los cinco años (p = 0.00) y el sumatorio mental se mantenía estable (n.s.) entre un año y cinco años tras la cirugía. DISCUSIÓN: Después de cinco años de una ATR, el examen físico no varía con respecto al año de la cirugía. Sin embargo, la evaluación subjetiva medida mediante la sección función-KSS y el SF-36 físico empeoran ligeramente durante este período. Esto podría ser debido al envejecimiento de los pacientes.

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PURPOSE: In 2009, the International Neuroblastoma Risk Group (INRG) published a new classification system of the childhood neuroblastic tumors. In this work, we present the results of the application of this new classification system in our patients. METHODS/PATIENTS: We conducted a retrospective analysis of the patients diagnosed with a neuroblastic tumor in our center in the last 20 years. We classified them according to the new classification and performed a survival analysis based on the Kaplan-Meier method and Mantel-Cox test. RESULTS: The five-year event-free survival (5-year EFS) was 95.8, 80.8, 50 and 45.9% for the very low, low, intermediate and high-risk groups. Mantel-Cox test showed statistically significant differences between these risk groups (p = 0.002). CONCLUSION: The 5-year EFS for the different risk groups was similar to the expected by the INRG. Therefore, this classification allows us to predict the evolution of this tumor and apply the correct intensity of treatment.

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In Latin America and the Caribbean (LAC), chikungunya (CHIK) viral infection has emerged as a significant arboviral disease. This rapidly expanding vector-borne viral illness is associated with a substantial burden of disease in terms of acute illness and also in terms of long-term sequelae. In addition, this viral pathogen has the ability to impact different populations including pregnant women and newborns. Despite the growing threat of this arboviral infection to the region, there are insufficient reports or studies attempting to delineate the clinical and epidemiological features of congenital and neonatal cases of CHIK in LAC. In this study, we present a case of congenital CHIK and a case of neonatal CHIK infection identified in Santander, Colombia. We discuss the potential neurological impact and sequelae of CHIK infection acquired during the neonatal period. There is an urgent need for further epidemiological and clinical studies to better understand the impact of CHIK in endemic areas in LAC.

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BACKGROUND: Tuberculosis (TB), a preventable and curable disease, remains a major public health threat in the poorest regions of the Americas. The DOTS strategy was implemented to control TB in the region in 1993, and the new Stop TB strategy, emphasizing high-quality DOTS expansion, in 2006. OBJECTIVES: To describe TB epidemiology in the region of the Americas from 1994 to 2005 and to analyze the progress made towards and prospects for achieving Goal 6 of the Millennium Development Goals (MDGs) by 2015. METHODS: TB incidence, mortality and prevalence rates as well as DOTS coverage and DOTS treatment success rates were collated from the World Health Organization (WHO) databases from 1994 to 2005. RESULTS: DOTS coverage and DOTS treatment success rates rose steadily from 1994 to 2005, with 88% of the population covered under DOTS by 2005, and an 80% success rate by the end of 2004. The TB incidence, prevalence and mortality rates have also decreased steadily from 1994 to date, but differ with respect to the various scenarios. CONCLUSIONS: With the exception of some countries, further reduction in TB incidence, prevalence and deaths by 2015 is possible. Widespread implementation of DOTS should continue in order to meet WHO targets and attain the MDGs.

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Oxaliplatin has been classified as an irritant drug. Less than 10 cases of oxaliplatin extravasation through a central venous access have been described to date. We present a case of extravasation through a central venous access, of the highest dose (165 mg) of oxaliplatin reported to date. We confirmed the irritant effect, and full recovery from toxicity was achieved. We describe the treatment administered and offer a review of literature.

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Two multiple ovulation and embryo transfer (MOET) programs with fresh, frozen and vitrified red deer embryos were carried out during the reproductive season of 2005 and 2006 in a local breeding farm in Argentina. Multiparous (n=10 and 9, respectively) weaned hinds were used as donors for each year. The estrous synchronization treatment of donors and recipients consisted of inserting an ovine intravaginal sponge containing medroxiprogesterone acetate (MAP) for 12 days. Superovulation was conducted with a total dose of 180 mg of NIH-FSH-P1 (Folltropin-V, Bioniche, Belleville, Ontario, Canada), given i.m. in eight decreasing doses every 12h (40, 40; 27, 27; 15, 15; 8, 8 mg), from days 10 to 13. Donor females were mated with one stag of proven fertility. The recovery rate was 84.1% (122/145), obtaining 45.1% (55/122) of transferable embryos, 24.6% (30/122) of degenerated embryos and 30.3% (37/122) of unfertilized oocytes. Pregnancy rates after transfer of fresh, OPS vitrified/warmed and ethylene glycol (EG) frozen/thawed embryos were 64.3% (18/28), 53.3% (8/15) and 70.0% (7/10), respectively. Vitrification and freezing with ethylene glycol procedures constitute an interesting alternative for red deer embryo cryopreservation.

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An interspecific embryo transfer program was conducted for genetic improvement and increasing the number of offspring from a flock of mouflon sheep in Argentina. The female donor mouflons were divided into three groups, G1 (n=5), G2 (n=4) and G3 (n=5). The total NIH-FSH-P1 dose given to each donor on the superovulatory treatment was 260, 200 and 160 mg for G1, G2 and G3, respectively. The mouflons in G3 were maidens, while the others were multiparous. Domestic Corriedale ewes (n=60) were synchronized and used as recipients. The embryo recovery and transfer was performed by a surgical method. Mouflons (n=13) responded to the superovulatory treatment with an average of 9.1+/-2.8 ovulations. A low incidence of early luteal regression was found (1 out of 14 donors). Embryo recovery rates were 60, 31 and 76% in groups G1, G2 and G3, respectively. The percentage of transferable embryos obtained in G1 and in G2 exceeded 80%. None of the embryos obtained from G3 were of transferable quality. In G1, 25 transferable embryos were recovered and transferred to 13 recipients, resulting in a pregnancy rate of 76.9% (10/13). In G2, 10 embryos were transferred to 5 recipients, resulting in a 60% pregnancy rate (3/5). Lambing rate was 60% (15/25) and 30% (3/10) for G1 and G2, respectively. Thirteen lambs were born to the 14 donors following natural service after the embryo recoveries. This study demonstrates that the application of IET technology would have great reproductive impact, especially when the donor mouflon hinds are selected according to age and reproductive history.

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The incidence of mineralization of the stylohyoid ligament complex, according to radiographic findings, was analysed in a group of patients with temporomandibular disorders (TMD), and compared with that of a control group of asymptomatic individuals (AI). Both groups were similar considering the prevalence of the female gender as well as the distribution of cases according to age. 'Elongated' was the most frequent radiographic appearance in both groups; 'partially mineralized' was the most frequent radiographic pattern in the TMD group; and the lower ramus was the most frequent location of mineralization in both groups. When comparing between groups and according to each class, there was only one significant difference in radiographic appearance, 'pseudoarticulated' being more frequent in the TMD group. We can conclude that the occurrence and characteristics of mineralization of stylohyoid ligament complex were similar in TMD patients and AIs.

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Cutaneous melanoma has received substantial attention during the last years because of the increase in its incidence which has been registered in many countries. This paper aims at describing the incidence and characteristics of all new cutaneous malignant melanoma cases during 1985-1992 reported to the Granada Cancer Registry (Spain) in the context of Mediterranean populations. A population-based study with 247 cutaneous melanoma cases was carried out. The variables used were: sex, age, anatomic site, hystological type, level of invasion and tumour thickness. The Age-Standardised incidence Rate per World population (ASRW) was 2.9 for males and 3.7 for females in the whole period. An increasing incidence trend for both males and females was found. The ASRW in 1985-1987, 1988-1990 and 1991-1992 was respectively 2.2, 2.9 and 3.2 for males and 3, 3.4, 4.7 for females. The most frequent location was trunk for males (36%) and lower extremities for females (44%). The most frequent hystological type for both males and females was superficial spreading melanoma. Seventy-six percent of males and 60% of females were diagnosed Clark's level III or over. Average tumour thickness was 3.3 mm for males and 2.4 mm for females. The results of this study can be a guidance for the setting up of health policies which would contribute to the prevention of the disease and to an improvement in care. Because of the increase in incidence rates and the high percentage of cases which were diagnosed at advanced stages, it is advised that prevention campaigns are addressed to the Granada population.

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Iron depletion was suggested to be protective against the development of ischemic heart disease. Population studies have led to conflicting results, and such an association has not been addressed in patients with heart failure due to cardiomyopathy. We studied the distribution of hemochromatosis-related mutations in 319 patients with heart failure due to cardiomyopathy of different etiologies. The genotypic distribution showed a significantly higher prevalence of heterozygotes for the C282Y mutation in patients with ischemic cardiomyopathy than in patients with cardiomyopathy of nonischemic etiologies (p = 0.0036). The frequency of the D63 mutation was not significantly different between ischemic versus nonischemic groups. In multiple logistic regression models adjusted for age, sex, ethnicity, and different degrees of disease progression, there was a strong and significant association of the C282Y mutation with ischemic cardiomyopathy compared with the nonischemic group (odds ratio 6.64, 95% confidence interval 1.71 to 25.73, after adjustment). In our sample, genetic variation in the HFE gene was associated with ischemic cardiomyopathy. Such association merits further study regarding its value as a prognostic marker in patients with ischemic heart disease.

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Malignant paratesticular tumors are uncommon. Of these, liposarcoma of the spermatic cord constitutes a rare tumor. Only a hundred cases have been reported. They are typically presented in elderly people. The usually have a good prognosis because of their low level of malignancy and their relapses tend to be localized. It has a high rate of survival over 5 years. Preoperative diagnosis is infrequent, it is suggested by the appearance of a progressively enlarging mass in the scrotum and the ultrasonography which shows a solid mass of the spermatic cord that is independent of the testicle. The choice treatment is radical orchidectomy, while long-term follow-up of these patients is mandatory because of local relapses. When local relapses become evident, the choice treatment is extensive local excision followed by adjuvant radiotherapy. In the present study we report a new case of a recurring, well differentiated spermatic cord liposarcoma of the type sclerotic, in a 50-year-old man. An exhaustive review of the literature has been made.

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Contribution of two new cases of vesicouterine fistula secondary to a cesarean incision. In one case, diagnosis was achieved through cystography and cystoscopy, while in the second case cystography, cystoscopy and stain testing (methylene blue) were used. In both cases management was through transperitoneal and transvesical fistulorrhaphy. The two cases showed favourable post-operative evolution with no relapse.

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The most common beef cattle raised in Brazil is the Nelore breed (Bos indicus). Information obtained by ultrasonography on follicular growth in Bos taurus cattle has been accumulating rapidly. However, there are few publications to date on follicular development in Bos indicus breeds. The follicular dynamics in Nelore heifers and cows during natural or prostaglandin (PG)-induced estrous cycle were studied. From the detection of estrus onward, all animals were examined daily by ultrasonography for one (n = 35) or two (n = 10) consecutive estrous cycles. The follicular dynamic in Nelore cattle was characterized by the predominance of 2 follicular waves in the cows (83.3%, n = 18, P < 0.05) and 3 waves in the heifers (64.7%, n = 16, P < 0.05). Most of the cattle observed over 2 consecutive estrous cycles presented the same pattern of follicular waves in the first and second cycle, and only 30% showed variation in the number of waves from one cycle to the other. Most of the follicular parameters analyzed were not affected by PG treatment or age but were altered by follicular waves. Consequently, data on cows and heifers were combined according to the number of follicular waves. The ovulatory follicle was larger than the other dominant follicles (P < 0.05), and the ovulatory wave was shorter than the preceding waves (P < 0.05). The interovulatory interval was longer in animals showing 3 waves than those exhibiting 2 waves (P < 0.05). Maximum diameter of the dominant follicle (around 11 mm) and of the corpus luteum (CL, approximately 17 mm) were smaller than those reported for European breeds. In conclusion, the results demonstrate that although the dominant follicle and corpus luteum are smaller than in European breeds, the follicular dynamics in Nelore cattle were similar to those observed in European breeds and were characterized by 2 or 3 follicular waves for cows and heifers, respectively, during the natural or prostaglandin-induced estrous cycle.

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Presentation of a review of vesico-vaginal fistulae diagnosed and treated in our Hospital between 1978-1992. There has been 20 cases. Etiology is varied, with predominance of cases due to gynaecological surgery. Considerations on diagnostic tests used in each case and the various therapeutical approaches applied, as well as on the results obtained. A revision is made of literature available on this condition.

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The characteristics of tobacco use by students of the Division of Health Sciences of the University of Barcelona have been studied. During the 1988-1989 school year, 382 students were individually interviewed about their use of tobacco by means of a questionnaire routinely used by the Department of Health and Social Security of the Generalitat of Catolonia (Spain), with pertinent modifications for this specific group. These interviews were performed by appropriately trained personnel. Information was also gathered on the influence of university-level studies on smoking habits, the effect of advertising and the efficacy of antitobacco programs and campaigns carried out by the government. The study sample was drawn from lists supplied by the registrars' offices, by means of a random sampling by school (Medicine, Pharmacy, Psychology, Odontology and Nursing). The prevalence of tobacco use was 40.8% (29.8% daily smokers and 11% occasional smokers). These results are similar to those described in the literature, although these values are somewhat higher than those in more developed countries with a longer tradition of resistance to the use of tobacco. It is important to note that studying health sciences does not appear to be a major influence on the student's habits, but that the social and cultural environment is the factor which weighs the most in this respect. In conclusion, to reduce the prevalence of tobacco use in this important group, educational programs must be begun at the pre-university level (secondary school) and changes should be made in the curricula of the health professional so that areas related to tobacco use are more motivational for students.

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Foram estudadas as características do hábito de fumar nos estudantes de ciências da saúde da Universidade de Barcelona. Durante o ano letivo 1988-89 foram entrevistados 382 aluno em relaçäo ao uso do fumo, por meio de questionário rotinamente utilizado por um Departamento daquela Universidade, no qual foram efetuadas modificaçöes pertinentes ao grupo estudado. Foram obtidas informaçöes relacionadas com a influência dos estudos universitários no hábito de fumar, com os efeitos da publicidade e com a eficácia dos programas e das campanhas da luta anti-fumo desenvolvidos pelas administraçöes públicas. A amostra foi obtida a partir das listagens fornecidas pelas diferentes secretarias administrativas, por meio de uma amostragem aleatória estratificada por Faculdades (Medicina, Farmácia, Psicologia, Odontologia e Enfermagem). A prevalência do tabagismo foi de 40,8 por cento (29,8 por cento de fumantes habituais e 11 por cento ocasionais). Os estudos relacionados com a saúde näo parecem influir, de uma forma destacada, no hábito dos estudantes, sendo o meio cultural e social o fator que exerce papel mais determinante nesse sentido. Assinala-se que, para poder diminuir a prevalência do fumo nesse importante grupo, devem-se iniciar programas educativos ao nível de escolarizaçäo pré-universitária (bacharelato unificado polivalente e curso de orientaçäo universitária) e introduzir modificaçöes nos futuros planos de estudo das profissöes sanitárias, de forma a que os conteúdos relacionados com o fumo sejam canais motivadores para os alunos

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We conducted a retrospective study of the autopsies performed during a 28-month period in the Department of Medicine of the Hôpital Albert Schweitzer in Haiti. We found that of 77 autopsies, the main clinical diagnosis was not confirmed at autopsy in 15 patients (19.5%). The results obtained at autopsy would have changed the treatment in 19 patients (24.7%) and the new therapeutical regimens could have had a significant impact on the outcome in six patients (7.8%). Important new information was also gained from the macroscopical examination only. The authors stress the value of the post-mortem examination in areas with limited resources.

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BACKGROUND: Acarbose is a reversible inhibitor of the intestinal alpha-glucosidases, the oral administration of which delays or diminishes the postprandial increase of glucose and insulin. METHODS: A multicentric double-blind clinical trial (11 centers), controlled versus placebo, crossed and randomized, was carried out with 137 insulin-dependent diabetic type I patients treated with diet and insulin. During the first 3 months of the trial the patients received placebo or acarbose randomly. Following one month of wash out with placebo the patients received the inverse medication for 3 more months. During the first month of each phase the patients were given 50 mg three times per day of acarbose or placebo and the two following moths received 100 mg x 3/day. RESULTS: Upon comparison of the two treatments significant statistical differences were found in HbA1 (p = 0.0005) and in postprandial glycemia (p = 0.007). There were differences, although not statistically significant, in the amounts of triglycerides, cholesterol and fasting glycemia. One hundred and two patients referred adverse events, most being gastrointestinal (flatulence, meteorism). CONCLUSIONS: Acarbose may be useful in the treatment of insulin-dependent diabetic type I patients treated with insulin and diet since it reduces the levels significantly of HbA1 and postprandial glucose.

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This study investigated differences in risk-perception among U.S., Spanish, West German, and Brazilian drivers. Subjects estimated the risk involved in slide-projected traffic scenes. The scenes, photographed in the United States and Spain, were rated for the amount of risk by using a seven-point scale. The subject groups in each country included younger, middle-aged, and older nonprofessional drivers, as well as middle-aged professional (bus, taxi, or truck) drivers. In the data analyses, the independent variables were subjects' country, age, professional driving experience, and sex, and 23 dichotomously coded characteristics of the traffic scenes. The following are the main findings: (1) Spanish drivers reported the highest risk, while U.S. drivers reported the lowest risk; (2) younger drivers tended to report lower risk than middle-aged and older drivers; (3) nineteen of the 23 analysed characteristics of traffic scenes contributed significantly to risk ratings, even after simultaneously controlling for the effects of all other scene characteristics; (4) ten scene characteristics had a differential effect on the risk ratings in the four tested countries; (5) two scene characteristics had a differential effect on the risk ratings in the four tested subject groups; (6) none of the variables affected differentially the risk ratings of professional vs. nonprofessional drivers and males vs. females. These findings provide information concerning the desirable country- and age-specific emphasis in driver education, driver licensing, and public information campaigns.

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