Toxoplasma gondii and Neospora caninum infection in epileptic dogs.

OBJECTIVES: Studies in humans have demonstrated the role of Toxoplasma gondii, a protozoan parasite, in epileptic seizures. This study aimed to investigate the serological correlation between T. gondii and N. caninum and epilepsy in dogs. MATERIALS AND METHODS: The medical record database of the Veterinary Teaching Hospital, University of Perugia, was searched for dogs serologically tested by IFAT for T. gondii and N. caninum and following specific inclusion criteria. Dogs were stratified by having a clinical diagnosis of epilepsy or suffering different conditions. RESULTS: One-hundred and twenty-eight dogs were included, 64 with epilepsy and 64 without clinical signs of epilepsy. Seventeen of the 64 epileptic dogs (26.6%; 95% CI: 15.7% to 37.4%) and twenty-one of the 64 non-epileptic dogs (32.8%; 95% CI: 21.3% to 44.3%) tested positive for T. gondii. Eight of the epileptic dogs (12.5%; 95% CI: 4.4% to 20.6%) and three of the non-epileptic dogs (4.7%; 95% CI: 0% to 9.9%) tested positive for N. caninum. There was no statistically significant difference in the rate of T. gondii or N. caninum seroreactivity between epileptic and non-epileptic dogs. CLINICAL SIGNIFICANCE: The results obtained do not seem to support the role of T. gondii and N. caninum as causative agents of dog epilepsy.

Hand Rehabilitation Treatment for Charcot-Marie-Tooth Disease: An Open Label Pilot Study.

OBJECTIVE: Charcot-Marie-Tooth neuropathy affects mainly and early the lower limbs, but hands deformities are a relevant problem, which involves the quality of life of the patients. Unfortunately, there are few studies about the evaluation of the upper limbs and very rare works about the rehabilitation. A treatment study at the moment is missing and it is important to search rehabilitation exercises to improve the dexterity and the quality of life of the patients. METHODS: We recruited 9 patients with clinical and genetic diagnosis of CMT and we proposed a rehabilitation protocol which includes muscle recruitment, stretching and proprioceptive exercises for the hand with the duration of 4 weeks (two sessions for week). We evaluated the patients before and one week after the treatment with Thumb Opposition Test, Sollerman Hand Function Scale, dynamometry (tripod pinch and hand grip). RESULTS: The rehabilitation protocol has been well tolerated and there were not dropouts. We did not observe any worsening in every scale we used. Every parameter tested showed an improvement especially in the right/dominant hand. CONCLUSION: This study demonstrates that this three phases treatment is well tolerated by patients, it is not detrimental for the hands status and perfectly reproducible by professionals. Moreover, this could be the basis for future randomized single blind projects.

Ubicación del nervio ciático a nivel del hueco poplíteo en la población adulta: relación con género y datos antropométricos estudiados. Implicaciones para la práctica diaria / Location of the sciatic nerve at the popliteal fossa in the adult population: Relationship with gender and anthropometric data studied. Implications for daily practice

Objetivo. Explorar si la ubicación del nervio ciático (NC) a nivel del hueco poplíteo se relaciona con variables antropométricas en la población adulta. Identificar posibles variaciones anatómicas y sus posibles implicaciones en la práctica clínica. Material y método. Estudio prospectivo observacional en cirugía ambulatoria programada. Se examinaron por ultrasonografía la profundidad, la lateralidad y la distancia en la que el NC se bifurca a nivel del hueco poplíteo. Se relacionaron estas mediciones según el género y otros datos antropométricos de los pacientes. Resultados. Se incluyeron 62 pacientes, siendo 124 el total de mediciones. Existe una asociación estadísticamente significativa (p < 0,001) entre la profundidad del NC y el diámetro del muslo medido a 10 cm del pliegue poplíteo. La profundidad y la lateralidad promedio, medidas a 10 cm del pliegue poplíteo, fueron de 3,32 ± 0,8 y 1,43 ± 0,9 cm, respectivamente. La distancia de la bifurcación y el diámetro del nervio promedio fueron de 61,78 ± 12 y 7,45 ± 1,17 mm, respectivamente. No hubo diferencias estadísticamente significativas entre las variables medidas y la edad/género. No se encontraron diferencias al analizar ambos miembros inferiores de cada paciente. No existe una asociación estadísticamente significativa entre la talla de los pacientes y la distancia en la que el NC se bifurca. Conclusiones. La profundidad y lateralidad del NC son variables independientes del género, el peso y la talla. La profundidad a la que el NC se localiza a nivel del hueco poplíteo está relacionada con el diámetro del muslo. La bifurcación del NC en el hueco poplíteo no está relacionada con la talla (AU)

Objective. To determine whether the location of the sciatic nerve (SN) at the popliteal fossa is related to anthropometric variables in the adult population, and to identify possible anatomical variations and their possible implications for clinical practice. Materials and method. Prospective observational study in elective ambulatory surgery patients. Patients were examined using ultrasound, looking at depth, laterality and distance at which the SN bifurcates at the level of the popliteal fossa. These measurements were linked to gender and the anthropometric data of the patients. Results. A total of 62 patients were included, with 124 measurements. A statistically significant association was found between SN depth and the diameter of the thigh measured at 10 cm from the popliteal crease (P < .001). Mean depth: 3.32 ± 0.8 cm, mean laterality: 1.43 ± 0.9 cm, mean SN bifurcation distance: 61.78 ± 12 mm and mean SN diameter: 7.45 ± 1.17 mm. There were no statistical differences when comparing the measured variables with the age and gender. Similar results were obtained between measurements when comparing both lower limbs in the same patient. There was no statistical difference between height and distance at which the SN bifurcates. Conclusions. The depth and laterality of SN are independent of gender, weight and height. The depth at which the SN is located at the level of the popliteal fossa is related to the diameter of the thigh. The bifurcation of SN in popliteal fossa is not related to height (AU)

Location of the sciatic nerve at the popliteal fossa in the adult population: Relationship with gender and anthropometric data studied. Implications for daily practice.

OBJECTIVE: To determine whether the location of the sciatic nerve (SN) at the popliteal fossa is related to anthropometric variables in the adult population, and to identify possible anatomical variations and their possible implications for clinical practice. MATERIALS AND METHOD: Prospective observational study in elective ambulatory surgery patients. Patients were examined using ultrasound, looking at depth, laterality and distance at which the SN bifurcates at the level of the popliteal fossa. These measurements were linked to gender and the anthropometric data of the patients. RESULTS: A total of 62 patients were included, with 124 measurements. A statistically significant association was found between SN depth and the diameter of the thigh measured at 10 cm from the popliteal crease (P<.001). Mean depth: 3.32 ± 0.8 cm, mean laterality: 1.43 ± 0.9 cm, mean SN bifurcation distance: 61.78 ± 12 mm and mean SN diameter: 7.45 ± 1.17 mm. There were no statistical differences when comparing the measured variables with the age and gender. Similar results were obtained between measurements when comparing both lower limbs in the same patient. There was no statistical difference between height and distance at which the SN bifurcates. CONCLUSIONS: The depth and laterality of SN are independent of gender, weight and height. The depth at which the SN is located at the level of the popliteal fossa is related to the diameter of the thigh. The bifurcation of SN in popliteal fossa is not related to height.

Tinetti and Berg balance scales correlate with disability in hereditary peripheral neuropathies: a preliminary study.

BACKGROUND: The combination of distal muscle weakness, sensory defects and feet deformities leads to disequilibrium in patients affected by Charcot-Marie-Tooth (CMT) neuropathy. Studies relating the outcome of balance scales and clinical severity of CMT are lacking. AIM: To evaluate the accuracy of the Tinetti Balance scale (TBS) and Berg Balance scale (BBS) in identifying balance disorders and quantifying disease severity in CMT patients. DESIGN: Observational study. SETTING: University of Genoa-IRCCS AOU San Martino IST-Department of Neurology, Italy. POPULATION: Nineteen individuals with a diagnosis of CMT (12 females, 7 males, age 41.26±12.42). METHODS: All subjects underwent an evaluation with both TBS and BBS. Disability was quantified with CMT neuropathy score (CMTNS). Moreover, a complete neurophysiological study was performed. Distal lower limbs strength was evaluated with MRC scale. Pearson rank order correlation was used to determine the correlation between the scores on the two tests and to identify an eventual correlation between TBS or BBS and the CMTNS. RESULTS: Both scales showed a highly significant negative correlation with the CMTNS (r=-0.78, P<0.0005 and r=-0.77, P<0.001, respectively) and distal weakness on the anterior tibial muscles (AT) (TBS: AT left: r=0.65, P<0.005 and AT right: 0.59, P<0.01; BBS: AT left r=+0.71, P<0.001 and AT right r=+0.66, P<0.005). We found also a highly significant, positive correlation between the two different balance scales (r=+0.9, P<0.0001). CONCLUSION: TBS and BBS strongly correlate with disease disability and distal muscular weakness. CLINICAL REHABILITATION IMPACT: Both TBS and BBS may play a relevant role in the assessment of disability in patients affected by CMT. Further studies are needed to validate our results in a larger population.

Measurement of ratios of νµ charged-current cross sections on C, Fe, and Pb to CH at neutrino energies 2-20 GeV.

We present measurements of ν(µ) charged-current cross section ratios on carbon, iron, and lead relative to a scintillator (CH) using the fine-grained MINERvA detector exposed to the NuMI neutrino beam at Fermilab. The measurements utilize events of energies 2

Laceración traqueal post-intubacion Postintubation tracheal laceration / No disponible

No disponible

Transoesophageal Doppler-guided fluid management in massive obstetric haemorrhage.

Massive postpartum haemorrhage is a major worldwide cause of maternal mortality. Management requires intensive fluid resuscitation and blood transfusion. Although fluid therapy is often directed by the results of a full blood count and clotting screen, recent technological advances allow monitoring of haemodynamic function and cardiac output. Transoesophageal Doppler technology has been used during haemorrhagic shock in non-obstetric patients. We present the case of a caesarean delivery complicated by massive haemorrhage where transoesophageal Doppler monitoring with the CardioQ-ODM™ was used to guide fluid therapy and the use of vasoactive drugs.

Estudio observacional sobre las técnicas de punción del bloqueo axilar para cirugía de mano en pacientes ambulantes en un hospital universitario: Aportes a la ecografía / No disponible

Objetivos: Valorar el aporte de la ecografía para la realización de bloqueos axilares en cirugía mayor ambulatoria con tres tipos de técnicas. Material y métodos: Estudio observacional, prospectivo en pacientes programados para cirugía de manos. Se construyó una base con datos demográficos, el tipo y eficacia de la técnica en cuanto al bloqueo motor y sensitivo, dolor posoperatorio, el grado de satisfacción y complicaciones asociadas. Las tres técnicas estudiadas fueron el uso de neuroestimulador, el uso de la ecografía y la combinación de ambas. Resultados: Se recogieron 151 casos. 77(51 %) se realizaron con NS solo, 36 (24 %) combinando la técnica de NS con Eco, y 38 (25 %) con Eco solo. 15 (20 %) pacientes puncionados con NS requerían un refuerzo de anestesia local versus 14 (38,9 %) en el grupo NS + Eco y 1 (2,6 %) en el grupo Eco solo (p < 0,001). La técnica combinada NS + Eco ha permitido bajar más el volumen de anestésico local comparado con la técnica Eco sola (NS + Eco: 26,2 ± 7,3; Eco solo: 31,4 ± 5,6; p = 0,001). En las 24 primeras horas posoperatorias, no hubo diferencias significativas en el consumo de analgésicos (p = 0,59). El índice de satisfacción era alto y comparable entre los tres grupos (NS: 8,4 ± 1,7/10; NS + Eco: 8,5 ± 1,9/10; Eco: 9,0 ± 1/10; p = 0,17). No hubo complicaciones ni reingresos a las 24 horas de la realización del bloqueo. Conclusión: La técnica ecográfica es segura y permite aumentar la seguridad del bloqueo con una eficacia equivalente o mejor a la técnica neuroestimulada. En cambio, la combinación de las 2 técnicas, da peores resultados, por lo que no recomendamos su uso (AU)

Objective: Asses the role of ultrasound guided axillary block in hand day case surgery with three different techniques. Materials and methods: we design a prospective, observational study in patients scheduled for day case hand surgery. Demographics data, type and efficiency of technique regarding sensitive and motor block, postoperative pain, satisfaction survey and complications were recorded. Block using neurostimulator (NS), ultrasound guide (US) and the combination of both was evaluated (NS+US). Results: 151 patients were included. 77 (51 %) were performed only by NS, 36 (24 %) using both techniques and 38 (25 %) with US solely. 15 (20 %) patients blocks by NS required an extra dose of local anesthetic in relation to 14 (38.9 %) in NS + US group and only 1 patient (2.6 %) block using US (p < 0.001). The combination technique allow to reduce total volume of local anesthetic used respect US guide block (NS + US: 26.2 ± 7.3; US: 31.4 ± 5.6; p = 0.001). In the first postoperative day, no different in analgesic consumption between three groups was found (p = 0.59).The satisfaction was high and comparable in all patients regardless of the technique used (NS: 8.4 ± 1.7/10; NS + US: 8.5 ± 1.9/10; US: 9.0 ± 1/10; p = 0.17). No complications and readmission was reported. Conclusion: US guided are a safe technique and make possible to increase block safety and efficiency. Nevertheless, the combination technique gives worse results and we should avoid their use (AU)

Prevalence of and risk factors for biliary carriage of bacteria showing worrisome and unexpected resistance traits.

Data on biliary carriage of bacteria and, specifically, of bacteria with worrisome and unexpected resistance traits (URB) are lacking. A prospective study (April 2010 to December 2011) was performed that included all patients admitted for <48 h for elective laparoscopic cholecystectomy in a Spanish hospital. Bile samples were cultured and epidemiological/clinical data recorded. Logistic regression models (stepwise) were performed using bactobilia or bactobilia by URB as dependent variables. Models (P < 0.001) showing the highest R(2) values were considered. A total of 198 patients (40.4% males; age, 55.3 ± 17.3 years) were included. Bactobilia was found in 44 of them (22.2%). The presence of bactobilia was associated (R(2) Cox, 0.30) with previous biliary endoscopic retrograde cholangiopancreatography (ERCP) (odds ratio [OR], 8.95; 95% confidence interval [CI], 2.96 to 27.06; P < 0.001), previous admission (OR, 2.82; 95% CI, 1.10 to 7.24; P = 0.031), and age (OR, 1.09 per year; 95% CI, 1.05 to 1.12; P < 0.001). Ten out of the 44 (22.7%) patients with bactobilia carried URB: 1 Escherichia coli isolate (CTX-M), 1 Klebsiella pneumoniae isolate (OXA-48), 3 high-level gentamicin-resistant enterococci, 1 vancomycin-resistant Enterococcus isolate, 3 Enterobacter cloacae strains, and 1 imipenem-resistant Pseudomonas aeruginosa strain. Bactobilia by URB (versus those by non-URB) was only associated (R(2) Cox, 0.19) with previous ERCP (OR, 11.11; 95% CI, 1.98 to 62.47; P = 0.006). For analyses of patients with bactobilia by URB versus the remaining patients, previous ERCP (OR, 35.284; 95% CI, 5.320 to 234.016; P < 0.001), previous intake of antibiotics (OR, 7.200; 95% CI, 0.962 to 53.906; P = 0.050), and age (OR, 1.113 per year of age; 95% CI, 1.028 to 1.206; P = 0.009) were associated with bactobilia by URB (R(2) Cox, 0.19; P < 0.001). Previous antibiotic exposure (in addition to age and previous ERCP) was a risk driver for bactobilia by URB. This may have implications in prophylactic/therapeutic measures.

Miocardiopatia periparto. A proposito de un caso / No disponible

La miocardiopatía periparto es una cardiomiopatía dilatada, acompañada de insuficiencia cardiaca secundaria a disfunción ventricular izquierda, que se presenta entre el último trimestre del embarazo y los 5 primeros meses posteriores al parto, y cuya etiología es desconocida. Constituye un reto para el anestesiólogo, debido al riesgo de descompensación hemodinámica de la paciente, principalmente en el parto o cesárea. Se recomienda realizar buen control del dolor por lo que la anestesia regional es la mejor opción. Presentamos el caso de una mujer, secundigesta, quien desarrolla una insuficiencia cardiaca descompensada posterior a ser intervenida de cesárea, con favorable respuesta al tratamiento y recuperación parcial de la función ventricular a los 3 meses después del parto (AU)

The peripartum cardiomiopathy is a dilated myocardiopathy associated with cardiac failure as a consequence of a left ventricular dysfunction. It is usually occurs between the last trimester of pregnancy and 5 months after delivery, its’ etiology being still unknown. The management of such patients is a challenge for anesthesiologists due to the risk of hemodynamic instability during labor or cesarean section. For this reason a good control of pain is recommended, and regional anesthesia is the best option. We present the case of a woman at the end of her second pregnancy who developed a decompensated cardiac failure after a cesarean section. The instauration of Afterwards she improves as a result of the treatment and partially recovers her left ventricular functionality 3months postpartum (AU)

Implicaciones anestésicas del síndrome de Gorham / Anaesthetic implications of Gorham syndrome

No disponible

Renal Replacement Therapy in Acute Kidney Failure due to Rhabdomyolysis.

Rhabdomyolysis is a syndrome caused by skeletal muscle cells destruction which can occur for many reasons, including prolonged immobilization. The main complication of the syndrome is the development of acute renal failure. Rhabdomyolysis and myoglobinuria are responsible for approximately 5% of all causes of acute renal failure in the USA. The cause of rhabdomyolysis is often multifactorial, and approximately 8-20% of such patients develop myoglobinuric acute renal failure.

The role of surgery in the management of solitary pulmonary nodule in breast cancer patients.

AIMS: To assess the role of surgery in the diagnosis and treatment of a solitary pulmonary nodule (SPN) in patients who had received previous surgery for breast cancer. METHODS: A series of 79 consecutive patients who underwent surgery for an SPN between 1990 and 2003 after a curative resection for breast cancer were reviewed. RESULTS: Surgical diagnosis was obtained by open procedure before 1996 (37 cases), and by video-assisted thoracoscopic surgery (VATS) after 1996 (33 out of 42 cases, 9 open procedures) and intraoperative evaluation. Histology of SPN was primary lung cancer in 38 patients, pulmonary metastasis of breast cancer in 27, and benign condition in 14. VATS was converted to open procedure for anatomical resection in primary lung cancer and for the palpation of the lung in metastatic disease. Average disease-free interval from the initial mastectomy was significantly longer in primary lung cancer than in metastatic patients (179+/-107 vs 51+/-27 moths). Manual palpation identified multiple pulmonary nodules in 3 out of 27 metastatic patients. Five-year survival rate after pulmonary metastasectomy was 38% and was significantly influenced by disease-free interval; 5-year survival rate after resection of primary lung cancer was 43% and was significantly influenced by the pathological stage. CONCLUSIONS: VATS is a good procedure for diagnostic management of peripheral SPN. As SPN in breast cancer patients is primary lung cancer in half cases, it deserves confirmation of pathological diagnosis and appropriate surgical treatment. When breast cancer metastasis is demonstrated, open procedure must be performed to palpate the entire lung to exclude previously unknown nodules.

Multimodal management of stages III-IVa malignant thymoma.

PURPOSE: The optimal therapy for locally advanced malignant thymoma is controversial. We review our experience with a multimodal approach in 63 consecutive cases. PATIENTS AND METHODS: Forty-three patients had stage III and 20 stage IVa disease. Surgery with radical intent was initially performed in 30 cases, while 33 cases not amenable to radical surgery underwent neoadjuvant treatment (radiotherapy in 8 and chemotherapy in 25) before surgical reassessment. All patients, whether or not surgically resected, received radiation therapy. RESULTS: Radical resection (RR) was performed in 20 patients ab initio (all stage III) and in 12 patients after neoadjuvant treatment (eight stage III and four stage IVa). With the addition of patients radically operated with neoadjuvant treatment, the radical resection rate increased from 46 to 65% in stage III patients, and from 0 to 20% in those with stage IVa disease, respectively. Radical surgery was associated with longer progression free survival and overall survival according to both univariate analysis ( P< 0.001 and P<0.01, respectively) and multivariate analysis after adjustment for age, gender, histology and disease stage ( P<0.001 and <0.02, respectively). Progression free survival (median 56.9 months) was slightly lower in patients undergoing radical surgery after neoadjuvant approaches than in those radically resected ab initio (median not achieved), but overall survival (median not achieved) was similar in both groups. Subtotal surgical resection promoted complete response to subsequent radiation therapy. This condition significantly correlated with a better outcome. CONCLUSIONS: Complete surgical resection is an independent prognostic parameter in locally advanced thymoma treated with a multimodal approach. Preoperative treatment to increase the complete resection rate could improve the overall survival of these patients.