Disfunción autonómica en pacientes con enfermedad pulmonar obstructiva crónica: efectos del entrenamiento sobre la recuperación de la frecuencia cardiaca / Autonomic dysfunction in patients with chronic obstructive pulmonary disease: Effects of training on heart rate recovery

Introducción: La recuperación de la frecuencia cardíaca (RFC) tras un esfuerzo máximo es un índice de función autonómica y se asocia con mayor mortalidad en algunas patologías. El objetivo de este estudio fue evaluar la prevalencia de disfunción autonómica en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable y sus eventuales cambios con un programa de rehabilitación pulmonar. Pacientes y métodos: Estudio transversal de 68 pacientes con EPOC en fase estable (edad media: 71 años [DE: 8]), 65 hombres y 3 mujeres, volumen espiratorio forzado en el primer segundo (%) medio: 36,8 (DE: 11,9), incluidos en programa de entrenamiento aeróbico y de fuerza y resistencia (25 sesiones). Se realizó prueba de esfuerzo cardiopulmonar (PECP), prerrehabilitación en todos los pacientes. En un subgrupo de 12 se realizó, además, PECP posrehabilitación. Se evaluó la RFC en valores absolutos y categorizada tras claudicación en la PECP respecto a la frecuencia cardíaca pico (normalidad RFC>12). Resultados: Hubo 52 (76,5%) pacientes con alteración de la RFC (cambios<12lpm en el primer minuto de la recuperación). La RCF no se asoció con la severidad de la EPOC, la gasometría ni los valores de DLCO. En el subgrupo con PECP, el entrenamiento mejoró la RFC en 4 (80%) y la normalizó en 3 (50%). No se observaron complicaciones durante la rehabilitación en ninguno de los pacientes con disfunción autonómica. Conclusiones: La disfunción autonómica es muy prevalente en pacientes con EPOC estable independientemente de la severidad de la enfermedad, y su relevancia ha sido subestimada. La rehabilitación pulmonar es segura en estos pacientes y modifica el grado de esta disfunción autonómica con tendencia beneficiosa. Si la morbilidad y la supervivencia de los pacientes tienen relación con la disfunción autonómica también en nuestro medio merece ser evaluada (AU)

Introduction: Heart rate recovery (HRR) after maximal effort is an indicator of autonomic function and is related to mortality in different diseases. This study was aimed to estimate prevalence of autonomic dysfunction in patients with chronic obstructive pulmonary disease (COPD) and assess potential clinical effects of a pulmonary rehabilitation program (PRP). Patients and methods: Transversal study of 68 stable COPD patients (71±8 years; 65 men and 3 women; FEV1 36.8±11.9%) who received a PRP consisting of 5-week general and specific training (25 sessions). Cycle ergometry test (CET) was performed in all patients prior to the PRP. In a subset of 12 patients, CET was performed both previously and after rehabilitation. The primary end point was the prevalence of autonomic dysfunction as assessed by abnormal heart rate recovery in the first minute of recovery following a maximal symptom limited CET, and the potential changes following a normalised PRP. Results: A total of 52 (76.5%) patients showed abnormal HRR (i.e. change from peak exercise to first recovery minute <12bpm). HRR was not associated with the severity of COPD, arterial blood gases or DLCO values. The PRP induced significant changes in exercise capacity which was related to improvement of HRR in 4 (80%) and was normalised in 3 (50%). No complications or adverse effects were observed during rehabilitation. Conclusions Autonomic dysfunction is a highly prevalent impairment in COPD patients, irrespective the severity of the disease as assessed by conventional pulmonary function test. Relevance of autonomic dysfunction has been understimated in COPD. Pulmonary rehabilitation is safe and modifies the degree of autonomic dysfunction with potential benefits. The relatioship of morbidity and mortality with autonomic dysfunction in COPD in our setting remains to be evaluated (AU)

Low diversity in the major histocompatibility complex class II DRB1 gene of the Spanish ibex, Capra pyrenaica.

During the last two centuries, the Spanish ibex (Capra pyrenaica) has shown a significant demographic decline as a result of the progressive destruction of its natural habitat, disease epidemics, and uncontrolled hunting. Partial sequencing of the class II MHC DRB1 gene revealed that the Spanish ibex has remarkably low levels of genetic variation at this locus, with only six different DRB1 alleles and an observed heterozygosity of 0.429-0.579. The rates of nonsynonymous vs synonymous substitutions were significantly different in the peptide-binding region (dN/dS=5.347, P=0.002), a feature that indicates that the DRB1 gene is under positive selection. A phylogenetic analysis of the Spanish ibex and a set of domestic goat DRB1 alleles revealed that the reported sequences represent four major allelic lineages. The limited allelic repertoire of the DRB1 gene in the Spanish ibex is likely the direct result of the recent history of population bottlenecks and marked demographic decline of this species. A genetic survey of 13 microsatellite loci was consistent with this idea. The Spanish ibex subspecies C. p. hispanica and C. p. victoriae consistently showed considerably lower levels of microsatellite heterozygosity (Ho=0.184-0.231) and allelic diversity (mean number of alleles per locus=2-2.4) than those reported in other wild ruminants. This study demonstrates the significance of both natural selection and the demographic history of populations in determining patterns of genetic variation at MHC loci. In addition, our results emphasize the importance of locally adapted populations for the preservation of genetic diversity.

Cambios musculares en la enfermedad pulmonar obstructiva crónica: la teoría de los compartimientos / Muscle changes in chronic obstructive pulmonary disease: the theory of compartments

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Effects of exogenous neurotensin on intestinal postresectional growth in the suckling rat.

BACKGROUND: In the suckling rat, massive bowel resection provokes intestinal malabsorption that leads to diminished growth. The object of this report was to test whether neurotensin, intestinal trophic peptide, enhances postresection intestinal adaptation, improving absorption and reducing the adverse effects of resection on growth. METHODS: Fifty-seven 15-day-old suckling. Wistar rats were divided into four groups: 41 rats were subjected to resection of 90% of their small bowel, while the rest (n = 16) underwent laparotomy. Half of the animals, resected and laparotomized, were treated with neurotensin for 30 days. The body weight was monitored, and samples of bone and intestinal mucosa were obtained at the end of the study period for analysis. Blood was tested to determine iron, ferritin, folic acid, and vitamin B12 levels. RESULTS: The resected animals lost body weight regardless of neurotensin administration. In the resected animals, femur weight increased significantly when they received neurotensin. Bowel resection provokes significant increases in the intestinal mucosa (crypts and villi), but after neurotensin administration, significant increases were detected only in the jejunum of the resected animals but not in the ileum of laparotomized rats. In the resected animals, significant decreases in iron, ferritin, folic acid, and vitamin B12 levels were observed. The postresection administration of neurotensin only produced a significant rise in the ferritin concentration. CONCLUSIONS: In the suckling rat, neurotensin enhances the intestinal proliferative phenomenon but does not improve the course of medium-term postresection growth.

Isolated fracture of the coracoid process of the scapula.

We present a case of an isolated fracture of the coracoid process in a 49-year-old woman. Healing after conservative treatment was entirely satisfactory, with radiographic union and painless normal range of movement.

[Effects of neurotensin on the development of suckling rats with intestinal resection]. / Efectos de la neurotensina en el desarrollo de la rata lactante con resección intestinal.

Massive intestinal resection produces malabsorption which, in the suckling rat, reduces growth. Our aim was to determine whether the proliferative action of neurotensin, can reduce the negative effects on growth induced by bowel resection. Fifteen days old suckling Wistar rats were used. Twenty rats underwent 90% midgut resection and twelve were used as controls. Half the animals were treated with neurotensin (600 micrograms/kg-day) until sacrifice 30 days later. Body and bone weight were measured and mucosal samples obtained. All resected animals lost body weight and bone weight. Neurotensin treatment reduced femur weight loss. After bowel resection, significant trophic effects were observed at mucosal level (crypt and villous size) but only in the jejunum of resected animals neurotensin treatment had a trophic effect. In conclusion, neurotensin favors intestinal adaptation after resection without improving mid-term growth in the suckling rat.

[Simultaneous dorsal luxation of metacarpophalangeal joints of the four long fingers. Apropos of a case]. / Luxation dorsale simultanée des articulations métacarpophalangiennes des quatre doigts longs.

PURPOSE OF THE STUDY: The authors describe an unusual case of simultaneous dorsal dislocation of the metacarpophalangeal joints of the index, long, ring, and little fingers. MATERIAL AND METHODS: A 67-year-old man fell on the pavement when walking, striking his outstretched left hand. A diagnosis of multiple fingers dislocation was easily clinically and radiologically established. The wound was cleaned and the dislocations reduced by closed manipulation at the operating room. RESULT: The patient had an uneventful recovery, after a three week period of immobilization with a dorsal extension block splint. DISCUSSION AND CONCLUSIONS: The use of art extension block splint allowed a minimal healing delay for disrupted volar metacarpophalangeal structures, allowing a good fingers range of motion.

[Acute compartment syndrome as a complication of a distal forearm fracture: apropos of a case of a child]. / Syndrome aigu de la loge antérieure de l'avant-bras après fracture distale des deux os: à propos d'un cas chez un enfant.

PURPOSE OF THE STUDY: We describe a case of acute volar compartment syndrome of the forearm occurred after fracture of the diaphyseal-metaphyseal junction of the distal radius and ulna. MATERIAL: A 7-year-old child fell down steps and injured his left forearm. METHODS: After reduction, the patient developed clinical signs of volar forearm compartment syndrome. Measurement of intramuscular pressure by the saline injection technique confirmed the diagnosis. RESULTS: Early decompressive fasciotomy led to uneventful healing with no residual symptoms. DISCUSSION: We discuss the mechanism, diagnosis and treatment of this injury. CONCLUSION: The development of suspicious clinical signs should be supplemented by compartment pressure measurements to determine the need of surgical decompression.

[False aneurysm of the posterior tibial artery complicating fracture of the tibia and fibula]. / Faux anévrisme de l'artère tibiale postérieure compliquant une fracture des deux os de jambe.

PURPOSE OF THE STUDY: Although tibia and fibula fractures are common, associated injury of the posterior tibial artery is rare. We present an unusual case of pseudoaneurysm of posterior tibial artery complicating a closed tibial and fibular fracture. MATERIAL: A 21-year-old man injured his left leg while playing football. METHOD: The diagnosis was suspected by the presence of persisting painful swelling at the fracture site. Echography, and later angiography confirmed it. RESULT: The patient was successfully treated with a saphenous vein interposition graft. The tibial fracture was stabilized with a Küntscher nail, and five months after surgery the fractures healed. DISCUSSION: A review of the literature revealed only 11 civilian cases of pseudoaneurysm of the posterior tibial artery. The clinical signs, specific diagnosis and operative treatment are discussed. CONCLUSION: Our case emphasizes that attention must be paid to the vascular complications of fractures, that may not become evident until some time after the initial injury.

Slipped capital femoral epiphysis in primary juvenile hypothyroidism.

We report a case of a patient with a unilateral slipped upper femoral epiphysis and primary juvenile hypothyroidism. A satisfactory outcome was observed two years after surgery.

Arteriovenous fistula with venous aneurysm as a complication of the trapeziometacarpal arthrodesis.

An iatrogenic radial artery-cephalic vein fistula with venous aneurysm occurred in a 55-year-old woman as a complication of trapeziometacarpal arthrodesis. The clinical diagnosis was confirmed by humeral arteriography. The fistula was ligated, and the aneurysm was removed successfully.

Isolated fracture of the capitate with a volar dislocated fragment.

We describe a patient with a capitate fracture with a volar dislocation of the proximal fragment. After open reduction and pin fixation an excellent range of wrist motion was achieved.

Stress fracture of the femoral neck in a young adult with Maroteaux-Lamy syndrome.

A rare case of stress fracture of the femoral neck with Maroteaux-Lamy syndrome occurred in a 20-year-old woman. The healing was achieved by the use of an autogenous ipsilateral fibular graft.

Sacral osteomyelitis due to Nocardia asteroides. A case report.

Nocardial osteomyelitis is increasing in both immunocompetent and immunosuppressed patients. We report a case of a Nocardia asteroides infection of the sacrum in a 37-year-old man who was successfully treated surgically.

[Comparative study between conservative orthopedic therapy and intramedullary osteosynthesis of diaphyseal tibial fractures]. / Vergleichende Studie zwischen konservativer orthopädischer Therapie und der intramedullären Osteosynthese diaphysärer Tibiafrakturen.

The authors present the results obtained in a series of 275 tibial shaft fractures, 216 of which were treated by a functional orthopaedic procedure and 59 with different kinds of nailing techniques. The results are evaluated according to the criteria established by Johner and Wruhs. "Good" results were obtained with both kinds of treatment; "excellent" results were slightly more frequent with nailing techniques, owing to better alignment and a lesser degree of shortening in the fractures, although the residual deformities after the functional orthopaedic treatment were tolerable.