Intervención en lectura y escritura en un niño de 10 años con malformación de Chiari y dificultades de aprendizaje. Estudio de caso / Reading and writing intervention in a 10 year-old with Chiari malformation and learning difficulties. A case study

El artículo muestra el diseño de una intervención educativa enfocada a la enseñanza de la lectura y la escritura en un niño con malformación de Chiari Tipo I, de 10 años, que no aprende a leer a pesar de unas condiciones escolares favorables. La malformación de Chiari es una alteración en el cerebelo perfectamente descrita a nivel clínico, pero de la que no están claras las repercusiones en el desarrollo y aprendizaje. Para comprobar la eficacia de la intervención educativa se optó por un diseño pre-post. Los resultados apuntan a una mejora en los procesos básicos implicados en la lectura y la escritura: conciencia segmental y reglas de correspondencia fonema-grafema en vocales; no obstante, no se observa evolución en procesos de alto nivel (AU)

In this paper a presentation is given of the design of an educational intervention focused on the teaching of written language to a 10 year-old child with Chiari Type I, who failed to learn to read even though he have had favourable school conditions. The Chiari malformation is a structural defect in the cerebellum, which is described comprehensively at a clinical level, but its repercussions are not fully understood in the development and learning processes. In order to demonstrate the efficacy of the intervention, a pre-post design was chosen. The results point to an improvement of basic literacy processes, although meta-linguistic awareness has not yet been observed (AU)

Efficient and stable transduction of dopaminergic neurons in rat substantia nigra by rAAV 2/1, 2/2, 2/5, 2/6.2, 2/7, 2/8 and 2/9.

Dysfunction of the nigrostriatal system is the major cause of Parkinson's disease (PD). This brain region is therefore an important target for gene delivery aiming at disease modeling and gene therapy. Recombinant adeno-associated viral (rAAV) vectors have been developed as efficient vehicles for gene transfer into the central nervous system. Recently, several serotypes have been described, with varying tropism for brain transduction. In light of the further development of a viral vector-mediated rat model for PD, we performed a comprehensive comparison of the transduction and tropism for dopaminergic neurons (DNs) in the adult Wistar rat substantia nigra (SN) of seven rAAV vector serotypes (rAAV 2/1, 2/2, 2/5, 2/6.2, 2/7, 2/8 and 2/9). All vectors were normalized by titer and volume, and stereotactically injected into the SN. Gene expression was assessed non-invasively and quantitatively in vivo by bioluminescence imaging at 2 and 5 weeks after injection, and was found to be stable over time. Immunohistochemistry at 6 weeks following injection revealed the most widespread enhanced green fluorescence protein expression and the highest number of positive nigral cells using rAAV 2/7, 2/9 and 2/1. The area transduced by rAAV 2/8 was smaller, but nevertheless almost equal numbers of nigral cells were targeted. Detailed confocal analysis revealed that serotype 2/7, 2/9, 2/1 and 2/8 transduced at least 70% of the DNs. In conclusion, these results show that various rAAV serotypes efficiently transduce nigral DNs, but significant differences in transgene expression pattern and level were observed.

Protection of pigs against Chlamydia trachomatis challenge by administration of a MOMP-based DNA vaccine in the vaginal mucosa.

Plasmid DNA (pWRG7079::MOMP) expressing the major outer membrane protein of a human Chlamydia trachomatis serovar E strain was tested for the ability to induce an immune response and protect against experimental genital infection with the same serovar. The vaccine was tested in pigs, as they are genetically and physiologically related to humans and suitable for studying C. trachomatis infection of the genital system. To increase the immune response, GM-CSF, LTA and B and CpG motives were used as adjuvants. GM-CSF was administered seven days before immunization, while the other adjuvants were administered together with the vaccine. Ten pigs were randomly divided into two groups. One group received an intravaginal primo-vaccination and a booster of 500 µg pWRG7079::MOMP, while the other group received the placebo vaccine pWRG7079. All animals were challenged with 10(8) TCID(50) of C. trachomatis serovar E. Pigs immunized with the DNA vaccine showed significantly less macroscopic lesions, vaginal excretion and chlamydial replication in the genital tract, as compared to placebo-vaccinated controls. However, infection could not be completely cleared.

The fetal respiratory system as target for antenatal therapy.

The widespread use of prenatal ultrasound has made the fetus a patient. A number of conditions diagnosed as such may require therapy prior to birth. Herein we describe past, current and potential future procedures designed to treat pulmonary conditions in the antenatal period. When congenital cystic adenomatoid malformation (CCAM) is -associated with fetal hydrops, treatment is required. Prior to viability this may be in utero resection of the pathologic lung lobe or shunting of cystic lesions. More recently, fetuses with isolated congenital diaphragmatic hernia (CDH) with lethal lung hypoplasia have been offered percutaneous fetal tracheal occlusion to provoke lung growth. A very rare condition is laryngeal atresia, which requires peripartum re-establishment of the airways. As we get more -experience with access to the fetal airways, this may open the doors for novel therapies. One of these is gene delivery to treat fetuses with serious monogenic disorders or to induce transient overexpression of certain proteins. We review the individual hurdles that are being met by researchers when designing fetal gene therapeutic strategies, in particular for the fetal lung. Also the use of stem cells for pulmonary disorders is currently explored.

Síndrome de Pseudomeigs en paciente con tumor de Krukenberg / No disponible

Se presenta el caso de una mujer de 51 años con antecedente de Linfoma no Hodking y adenocarcinoma gástrico con células en anillo de sello. Acude a nuestro centro por llevar 20 meses con disnea por derrame pleural, linfedema en ambas piernas y ascitis. Se detectan en la TC y en la ecografía dos masas anexiales bilaterales, que se biopsian. El diagnóstico histológico es metástasis ovárica bilateral por adenocarcinoma de células en anillo de sello (tumor de Krukenberg). Esta paciente presenta un síndrome de Pseudomeigs, que comprende un tumor maligno de ovario asociado con ascitis y derrame pleural con citología maligna negativa. En pacientes oncológicos con ascitis y derrame pleural benignos se debería considerar en el diagnóstico diferencial el síndrome de PseudoMeigs

We report the case of a fi ftyone-year-old woman with a past medical history of Linfoma no Hodking and a gastric adenocarcinoma with signet ring cells. She came to our institution with a twenty month history of dysnea secondary to pleural effussion, bilateral lower extremity edema and probably had ascitis. On CT and US two bilateral pelvic masses were found and biopsied. The anatomopathological analysis showed bilateral ovarian implants from signet ring cell adenocarcinoma (Krukenberg tumor). This patient developed a PseudoMeigs syndrome consisting on malignant ovarian tumor asociated with ascitis and pleural effusion without malignant cells. Oncological patients who present with ascitis and benign pleural effusion, the diagnosis of PseudoMeigs syndrome should be considered

[Pseudomeigs syndrome in a patient with Krukenberg's tumor]. / Síndrome de Pseudomeigs en paciente con tumor de Krukenberg.

We report the case of a fiftyone-year-old woman with a past medical history of Linfoma no Hodking and a gastric adenocarcinoma with signet ring cells. She came to our institution with a twenty month history of dysnea secondary to pleural effussion, bilateral lower extremity edema and probably had ascitis. On CT and US two bilateral pelvic masses were found and biopsied. The anatomopathological analysis showed bilateral ovarian implants from signet ring cell adenocarcinoma (Krukenberg tumor). This patient developed a PseudoMeigs syndrome consisting on malignant ovarian tumor asociated with ascitis and pleural effusion without malignant cells. Oncological patients who present with ascitis and benign pleural effusion, the diagnosis of PseudoMeigs syndrome should be considered.

[Repeated thromboembolism during pregnancy with constitutional antithrombin deficiency]. / Thromboses récidivantes gravidiques et déficit en antithrombine.

We report the case of a twenty-three-year old woman with constitutional antithrombin deficiency, who had oral anticoagulation since she was four years old. During her first pregnancy, after the introduction of unfractionated heparin prophylactic therapy, she presented a first venous thromboembolism at nine weeks, and a second one with low-molecular-weight heparin therapy at nineteen weeks. Because of a severe antithombin deficiency, regular infusions of antithrombin concentrates were necessary until delivery to ensure effective anticoagulation by heparin. Patients with antithrombin deficiency have a very high risk of venous thromboses during the pregnancy and post-partum. We discuss the significant points of management for this period.

Effects of a milk-based bioactive micronutrient beverage on pain symptoms and activity of adults with osteoarthritis: a double-blind, placebo-controlled clinical evaluation.

OBJECTIVES: A 6 wk, double-blind, placebo-controlled study investigated the effects of a nutritional supplement beverage containing milk-based micronutrients and fortified with vitamins and minerals on pain symptoms and activity in adults with osteoarthritis. METHODS: Thirty-one subjects with osteoarthritis of both knees were randomized into two groups and given 12 oz daily of the micronutrient-containing beverage or a placebo for 6 wk. Subjects were instructed not to change their normal activities and diets. Body weights, vital signs, blood chemistries, and adverse events were monitored to assess safety. The principal outcome measurement for efficacy was the Western Ontario MacMaster Universities Osteoarthritis Index (WOMAC) derived from the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire administered weekly. RESULTS: Safety indicators remained unchanged in the test and placebo groups. All KOOS scores improved significantly (P < 0.03) over time in the micronutrient group, whereas scores only for sport function and knee-related quality of life improved in the placebo group. The overall treatment effect (based on changes in the WOMAC composite score) was significant (P = 0.016). The effect size was moderate at 0.555. CONCLUSIONS: Thus, daily consumption of the nutritional beverage containing milk-based micronutrients, vitamins, and minerals was beneficial in alleviating symptoms and dysfunction in subjects with osteoarthritis.

Hemolytic-uremic syndrome without evidence of microangiopathic hemolytic anemia on peripheral blood smear.

We report the case of an 18-year old man with hemolytic-uremic syndrome (HUS) having a classic clinical presentation and diagnostic renal pathology without evidence of microangiopathic hemolytic anemia (MAHA) by peripheral blood smear. Indirect evidence of hemolysis was suggested by mild anemia, elevation of serum lactate dehydrogenase, and examination of the patient's bone marrow. We postulate that in this case the inability to detect schistocytes in the peripheral smear reflected a low degree of hemolysis. Review of the literature revealed that evidence of fragmented erythrocytes by peripheral smear is not always present in HUS, yet this observation has received little attention. Thus, the diagnosis of HUS need not include overt evidence of MAHA as is traditionally taught.

[Epidural anesthesia and prevention of autonomic hyperreflexia in a paraplegic parturient]. / Anesthésie péridurale et prévention de l'hyperréflectivité autonome chez une parturiente paraplégique.

Pregnancy in a patient suffering from high spinal cord lesions is unusual and can lead to serious autonomic hyperreflexia during delivery. Epidural anaesthesia has been suggested as a means of decreasing such a risk. This clinical report presents the case of a paraplegic patient with lesions above the T3 level who had spinal anaesthesia for a Caesarean section. Her first delivery, six years earlier and without spinal anaesthesia was complicated by serious autonomic hyperreflexia with severe hypertension, seizures and inhalation. These symptoms were at first interpreted as eclampsia. For the Caesarean section, spinal anaesthesia using 0.25% bupivacaine in divided doses presented no difficulty, in spite of important lordosis, and permitted the delivery of a newborn with an Apgar score of 10 at one minute. The upper sympathetic level reached (T4-T6) was assessed by the discontinuing of muscular spasticity and contractures elicited by cutaneous stimuli. At the present time, spinal anaesthesia is the best method for preventing autonomic hyperreflexia. General anaesthesia, especially with halothane, is effective, but requires a deeper anaesthesia with the risk of serious hypotension and its possible repercussions on the fetus. Moreover it does not decrease the risk of autonomic hyperreflexia during the postoperative period.

[Perforations of the dura mater during epidural anesthesia. The value of epidurography]. / Problèmes posés par les perforations de la dure-mère dans l'anesthésie péridurale. Intérêt de l'épidurographie.

The authors propose a pathogenic classification of perforations of the dura mater occurring during continuous epidural anaesthesia: according to the flow through the communication with the subarochnoid space. Two clinical forms of anaesthesia affecting the cord itself may be distinguished on this basis, one frequent and of immediate onset, diagnosed by the "test dose" and the other rare, of delayed onset, where this safety measure does not suffice. Routine prior epidurography is suggested, in order to ensure the diagnosis of dura mater perforation. In the case of the latter, it show either a more or less typical appearance of radicolography only or, more rarely, a picture which combines opacification of the epidural space with the subarachnoid passage of the contrast medium. This "mixed" appearance, although rare, should be known since it makes it possible to prevent delayed total spinal anaesthesia.