Total knee replacement with the use of a tourniquet: more pros than cons.

Total knee replacement (TKR) is an operation that can be performed with or without the use of a tourniquet. Meta-analyses of the available Level-1 studies have demonstrated that the use of a tourniquet leads to a significant reduction in blood loss. The opponents for use of a tourniquet cite development of complications such as skin bruising, neurovascular injury, and metabolic disturbance as drawbacks. Although there may certainly be reason for concern in arteriopathic patients, there is little evidence that routine use of a tourniquet during TKR results in any of the above complications. The use of a tourniquet, on the other hand, provides a bloodless field that allows the surgeon to perform the procedure with expediency and optimal visualisation. Blood conservation has gained great importance in recent years due to increased understanding of the problems associated with blood transfusion, such as increased surgical site infection (due to immunomodulation effect), increased length of hospital stay and increased cost. Based on the authors' understanding of the available evidence, the routine use of a tourniquet during TKR is justified as good surgical practice.

The relevance of the radiological signs of acetabular retroversion among patients with femoroacetabular impingement.

Orthopaedic surgeons have accepted various radiological signs to be representative of acetabular retroversion, which is the main characteristic of focal over-coverage in patients with femoroacetabular impingement (FAI). Using a validated method for radiological analysis, we assessed the relevance of these signs to predict intra-articular lesions in 93 patients undergoing surgery for FAI. A logistic regression model to predict chondral damage showed that an acetabular retroversion index (ARI) > 20%, a derivative of the well-known cross-over sign, was an independent predictor (p = 0.036). However, ARI was less significant than the Tönnis classification (p = 0.019) and age (p = 0.031) in the same model. ARI was unable to discriminate between grades of chondral lesions, while the type of cam lesion (p = 0.004) and age (p = 0.047) were able to. Other widely recognised signs of acetabular retroversion, such as the ischial spine sign, the posterior wall sign or the cross-over sign were irrelevant according to our analysis. Regardless of its secondary predictive role, an ARI > 20% appears to be the most clinically relevant radiological sign of acetabular retroversion in symptomatic patients with FAI.

Angelman syndrome and thyroid dysfunction.

Angelman syndrome (AS) is a neurogenetic syndrome, has a prevalence of 1:10,000 to 1:40,000. Patients with AS have genetic alterations in maternal imprinting gene UB3A (15q11-q13) and molecular evaluations confirm the diagnosis. Our aim is to report a new case with AS and subclinical hypothyroidism (SCH) without goiter. Thyroid dysfunction has not been described as part of alterations in AS; the exact pathogenic mechanisms of SCH in patients with AS remains incompletely unknown.

Diseño y manufactura de una aguja para aspirado de médula ósea / Technological research for optimizing the dsign and manufacturing of a bone marrow aspiration needle

Objetivo: Manufacturar y evaluar una aguja para realizar el aspirado de médula ósea y biopsia del hueso en una sola punción para reducir el tiempo de la toma de la muestra, además de facilitar su extracción y manejo. Material y metodología: El dispositivo (Penneedle®) está constituido por una aguja de acero inoxidable y un mango de polímero ABS. La metodología estuvo constituida por la manufactura de un prototipo funcional, realización de pruebas de punción in vitro y un estudio comparativo para dispositivos similares. Resultados: Obtuvimos unas dimensiones geométricas y efectuamos los cambios convenientes en el dispositivo, ofreciendo un mejor acoplamiento ergonómico y óptimo manejo. Además, analizamos su comercialización y las ventajas competitivas que permiten un modelo de negocio atractivo (AU)

Aim: Manufacture and evaluate the prototype of an one-step-needle for bone marrow aspiration and bone biopsy. Material and methodology: consisted in the following steps, functional prototype manufacturing (Penneedle®), puncture testing in vitro and a comparative study for similar devices. Results: we obtained the pattern of the geometric dimensions and determined appropriate changes that can occur when coupling device for better ergonomic and optimum handling (AU)

Effect of a maximal treadmill test on percent body fat using leg-to-leg bioelectrical impedance analysis in children.

AIM: The purpose of this investigation was to determine the effect of a maximal treadmill exercise test on percent body fat (%BF) in children using leg-to-leg bioelectrical impedance analysis (LBIA) (Tanita Model #TBF-300A). METHODS: Fifty-four children (24 females; 30 males) between 7-10 years of age participated in this study. LBIA measures of %BF were obtained immediately before and within 5 min after completing a maximal oxygen consumption test on a motorized treadmill. RESULTS: No pre- to post-test differences in %BF were observed in either group (mean difference: females 1.6%, males 1.5%). Impedance values significantly decreased postexercise (P < 0.05) in the female subjects. No significant differences were observed for fat mass, fat free mass, total body water or body weight postexercise when compared to pre-exercise values in either group. Correlations (P = 0.0001) of 0.997 were observed between pre- and postexercise measures of %BF. CONCLUSIONS: A maximal treadmill exercise test conducted prior to LBIA has no impact on %BF in children. Therefore, normal daily activities performed prior to LBIA assessment may have a limited impact on LBIA body composition measurement in children. As such, compliance with stringent pretesting exercise guidelines may not be essential when using LBIA to assess %BF in children.

First-pass quantitative CT perfusion identifies thresholds for salvageable penumbra in acute stroke patients treated with intra-arterial therapy.

BACKGROUND AND PURPOSE: The purpose of this study was to determine whether, in acute stroke patients treated with intra-arterial (IA) recanalization therapy, CT perfusion (CTP) can distinguish ischemic brain tissue destined to infarct from that which will survive. METHODS: Dynamic CTP was obtained in 14 patients within 8 hours of stroke onset, before IA therapy. Initial quantitative cerebral blood volume (CBV) and flow (CBF) values were visually segmented and normalized in the "infarct core" (region 1: reduced CBV and CBF, infarction on follow-up), "penumbra that infarcts" (region 2: normal CBV, reduced CBF, infarction on follow-up), and "penumbra that recovers" (region 3: normal CBV, reduced CBF, normal on follow-up). Normalization was accomplished by dividing the ischemic region of interest value by that of a corresponding, contralateral, uninvolved region, which resulted in CBV and CBF "ratios." Separate CBV and CBF values were obtained in gray matter (GM) and white matter (WM). RESULTS: Mean CBF ratios for regions 1, 2, and 3 were 0.19 +/- 0.06, 0.34 +/- 0.06, and 0.46 +/- 0.09, respectively (all P < .001). Mean CBV ratios for regions 1, 2, and 3 were similarly distinct (all P < .05). Absolute CBV and CBF values for regions 2 and 3 were not significantly different. All regions with CBF ratio <0.32, CBV ratio <0.68, CBF <12.7 mL/100 g/min, or CBV <2.2 mL/100 g infarcted. No region with CBF ratio >0.44 infarcted. GM versus WM CBF and CBV values were significantly different for region 2 compared with region 3 (P < .05). CONCLUSIONS: In acute stroke patients, quantitative CTP can distinguish ischemic tissue likely to infarct from that likely to survive.

Intravascular lymphoma: magnetic resonance imaging correlates of disease dynamics within the central nervous system.

BACKGROUND: Intravascular lymphoma (IVL) is a rare non-Hodgkin's lymphoma with relative predilection for the central nervous system. In the absence of extraneural manifestations, the disease is not recognised until autopsy in the majority of cases underlining the need for new clinical markers. METHODS: This is a retrospective series of five patients with IVL seen at a single institution over three years. An advanced magnetic resonance imaging (MRI) protocol was performed at various time points prior to diagnosis and during treatment. RESULTS: MRI revealed multiple lesions scattered throughout the cerebral hemispheres; the brainstem, cerebellum, and spinal cord were less frequently involved. On initial presentation, hyperintense lesions were seen on diffusion weighted images suggestive of ischaemia in three of four patients in whom the images were obtained at that time point. In four patients lesions were also identifiable as hyperintense areas on fluid attenuated inversion recovery (FLAIR) sequences. Initial contrast enhancement was encountered in three cases. Diffusion weighted imaging lesions either vanished or followed the typical pattern of an ischaemic small vessel stroke with evolution of abnormal FLAIR signal followed by enhancement with gadolinium in the subacute stage and tissue loss in the chronic stage. Diffusion weighted imaging and FLAIR abnormalities proved to be partially reversible, correlating with the response to chemotherapy. CONCLUSION: We provide the first detailed description of the dynamic pattern of diffusion weighted MRI in IVL. These patterns in combination with systemic findings may facilitate early diagnosis and serve as a new tool to monitor treatment response.

Un espacio en construccion. Hacia la gestion territorial de la tierra comunitaria de origen Parapitiguasu

Esta investigacion aborda el analisis de una capitania perteneciente al pueblo guarani. Los temas centrales del estudio se refiere a la tenencia de la tierra y la gestion de recursos naturales que en ella se encuentran. Ambos cobran importancia, dado que reflejan el comportamiento de los indigenas guarani como de los blancos o karai. El presente estudio nos hace conocer la realidad de una parte del pueblo guarani, parecida a la situacion de los demas territorios indigenas de nuestro pais

Prenatal nicotine alters vigilance states and AchR gene expression in the neonatal rat: implications for SIDS.

Maternal smoking is a major risk factor for sudden infant death syndrome (SIDS). The mechanisms by which cigarette smoke predisposes infants to SIDS are not known. We examined the effects of prenatal nicotine exposure on sleep/wake ontogenesis and central cholinergic receptor gene expression in the neonatal rat. Prenatal nicotine exposure transiently increased sleep continuity and accelerated sleep/wake ontogeny in the neonatal rat. Prenatal nicotine also upregulated nicotinic and muscarinic cholinergic receptor mRNAs in brain regions involved in regulating vigilance states. These findings suggest that the nicotine contained in cigarette smoke may predispose human infants to SIDS by interfering with the normal maturation of sleep and wake.

Optimización de la técnica de inmunoelectrotransferencia (western blot) para la confirmación de la infección por el virus de immunodeficiencia humana (VIH) en Panamá / Optimization of the immunoelectrophoresis technic (western blot) for the confirmation of human immunodeficiency virus infection (HIV) in Panama

The purpose of this study is to report the results of the authors' investigation to apply the western blot technique (WB UP-LCS) in the diagnosis of human immunodeficiency virus type 1 (HIV-1) infection. To do this, the authors separated the proteins of the HIV-1 virus by electrophoresis, based on their molecular weight, in poliacilamide gel with SDS (SDS-PAGE) during 3 hours at 200 volts. Then they electrotransferred these proteins to nitrocellulose paper during four hours at 200 milliamperes, with the aid of external cooling. The nitrocellulose strips were evaluated considering the incubation time (1 and 16 hours), two conjugates (human anti IgG with Peroxidase and human anti IgG Biotin plus Streptatividine with Peroxidase) and two dilutions of the patients' sera (1/50 and 1/100). Based on their results the Authors conclude that, in the first place, the optimal conditions for the test include a dilution of 1/100 of the patients serum, incubation of the serum for 16 hours and the use of the conjugate of anti human IgG with Biotin and Streptavidine with Peroxidase; secondary, that the immunologic reactivity against proteins p24 and gp 160/120 is the most important diagnostic criterion for the confirmation of infection with HIV-1 and that they obtained a diagnostic correlation of 100% at a cost which was 5 to 7 times less than that of the commercial system

[Optimization of the immunoelectrophoresis technic (western blot) for the confirmation of human immunodeficiency virus infection (HIV) in Panama]. / Optimización de la técnica de inmunoelectrotransferencia (western blot) para la confirmación de la infección por el virus de immunodeficiencia humana (VIH) en Panamá.

The purpose of this study is to report the results of the authors' investigation to apply the western blot technique (WB UP-LCS) in the diagnosis of human immunodeficiency virus type 1 (HIV-1) infection. To do this, the authors separated the proteins of the HIV-1 virus by electrophoresis, based on their molecular weight, in poliacilamide gel with SDS (SDS-PAGE) during 3 hours at 200 volts. Then they electrotransferred these proteins to nitrocellulose paper during four hours at 200 milliamperes, with the aid of external cooling. The nitrocellulose strips were evaluated considering the incubation time (1 and 16 hours), two conjugates (human anti IgG with Peroxidase and human anti IgG Biotin plus Streptatividine with Peroxidase) and two dilutions of the patients' sera (1/50 and 1/100). Based on their results the Authors conclude that, in the first place, the optimal conditions for the test include a dilution of 1/100 of the patients serum, incubation of the serum for 16 hours and the use of the conjugate of anti human IgG with Biotin and Streptavidine with Peroxidase; secondary, that the immunologic reactivity against proteins p24 and gp 160/120 is the most important diagnostic criterion for the confirmation of infection with HIV-1 and that they obtained a diagnostic correlation of 100% at a cost which was 5 to 7 times less than that of the commercial system.