Inserción anómala del músculo subclavio como causa de síndrome de estrecho torácico superior / Anomalous subclavius muscle insertion as a cause of thoracic outlet syndrome

Se presenta una causa inusual de síndrome de estrecho torácico superior secundario a la inserción anómala del músculo subclavio en una mujer de mediana edad con síntomas de cervicobraquialgia y parestesias en la mano derecha. La paciente requirió tratamiento quirúrgico mediante la resección del músculo subclavio, tras la cual sus síntomas remitieron completamente. El presente caso resulta de gran interés por la rareza de la causa de la compresión, pero además resalta la importancia de considerar el síndrome de estrecho torácico superior en el diagnóstico diferencial del dolor cervical y cervicobraquial(AU)

An unusual cause of the thoracic outlet syndrome secondary to an anomalous subclavius muscle insertion that was diagnosed in a middle-aged woman who had neck and upper limb pain with parenthesis in her right hand is presented. The patient was successfully treated by surgical muscle resection. The importance of this case is the uncommon cause of the compression. We would like to emphasize the relevance of considering the thoracic outlet syndrome for the differential diagnosis of cervical and cervicobrachial pain(AU)

Silicon-hydroxyapatite bioactive coatings (Si-HA) from diatomaceous earth and silica. Study of adhesion and proliferation of osteoblast-like cells.

The aim of this study consisted on investigating the influence of silicon substituted hydroxyapatite (Si-HA) coatings over the human osteoblast-like cell line (SaOS-2) behaviour. Diatomaceous earth and silica, together with commercial hydroxyapatite were respectively the silicon and HA sources used to produce the Si-HA coatings. HA coatings with 0 wt% of silicon were used as control of the experiment. Pulsed laser deposition (PLD) was the selected technique to deposit the coatings. The Si-HA thin films were characterized by Fourier Transformed Infrared Spectroscopy (FTIR) demonstrating the efficient transfer of Si to the HA structure. The in vitro cell culture was established to assess the cell attachment, proliferation and osteoblastic activity respectively by, Scanning Electron Microscopy (SEM), DNA and alkaline phosphatase (ALP) quantification. The SEM analysis demonstrated a similar adhesion behaviour of the cells on the tested materials and the maintenance of the typical osteoblastic morphology along the time of culture. The Si-HA coatings did not evidence any type of cytotoxic behaviour when compared with HA coatings. Moreover, both the proliferation rate and osteoblastic activity results showed a slightly better performance on the Si-HA coatings from diatoms than on the Si-HA from silica.

Dissection of the HLA association with multiple sclerosis in the founder isolated population of Sardinia.

Several studies have indicated that multiple sclerosis (MS) is associated and linked to the major histocompatibility complex (MHC)/human leukocyte antigen (HLA) region of chromosome 6p21.3, but the exact location and nature of the primarily associated locus within the HLA complex is still controversial and largely presumptive. By linkage disequilibrium mapping, we have systematically investigated this chromosome region in the founder population of Sardinia to determine the relative associations of the various loci with MS. An overall 11.4 Mb region, which encompasses the whole HLA complex, was scanned with 19 microsatellite markers and with single nucleotide polymorphisms within 12 functional candidate genes and assessed for MS association using the extended transmission disequilibrium test (ETDT). A peak of association represented by the three adjacent DRB1, -DQA1 and -DQB1 loci was detected in the class II region. Two additional less significant areas of association were detected, respectively, in the centromeric side of the class II region at the DPB1 locus and, telomeric of the classically defined class I loci, at the D6S1683 microsatellite. Conditional ETDT analysis indicated that these regions of association could be independent of each other. Within the main peak of association, DRB1 and DQB1 contribute to the disease association independently of each other whereas DQA1 had no detectable primary genetic effects. We evaluated the haplotype distribution at the region showing the strongest association and found five DQB1-DRB1 haplotypes positively associated with MS in Sardinia. These consistently included all the haplotypes previously found associated with MS in the various human populations, thus supporting a primary effect of the products of these loci in MS. Overall these results are consistent with a multilocus model of the MHC encoded susceptibility to MS.

A genome screen for multiple sclerosis in Sardinian multiplex families.

The prevalence of multiple sclerosis in Sardinia is significantly higher than in neighbouring Mediterranean countries, suggesting that the isolated growth of the population has concentrated genetic factors which increase susceptibility to the disease. The distinct HLA association of multiple sclerosis in Sardinia supports this interpretation. We have performed a whole genome screen for linkage in 49 Sardinian multiplex families using 327 markers. Non parametric linkage analysis of these data reveal suggestive linkage in the region of Chr 1q31, Chr 10q23 and Chr 11p15.

[Properties of stored platelet concentrates: effect of the suspension media and type of pouch used]. / Propiedades de los concentrados de plaquetas almacenados: influencia del medio de suspensión y del tipo de bolsas utilizadas.

PURPOSE: We have evaluated in vitro the effects of using plasma (group A) or PAS-2 (group B) in storing platelets, regarding as well the type of container (conventional polyolefin--PL732--or new oxygen permeable platelet containers--PL2410, Compoflex--), on the metabolism of platelet concentrates--PC--from pools of five buffy coats. MATERIAL AND METHODS: 87, A and B pools of PCs collected in two types of bags were studied. The samples were taken on days 2, 5 and 7, and cell counts, pH, glucose, platelet activation (% CD62) and aggregation response were measured. RESULTS: In group A, when we compared the two types of bags, we observed a difference (p < 0.01) in values of pH and glucose on day 5. These values were more advantageous in new oxygen permeable platelet containers. The rest of the parameters analysed didn't show significant differences. When we compared the PL-2410 containers from groups A and B, we found a lower level of glucose (p < 0.01) in group B, although the levels of glucose in this group on days 5 and 7 of storage were sufficient to support the platelet metabolism. CONCLUSIONS: The use of new oxygen permeable polyolefin containers and additive solutions, PAS-2, allows us to obtain pools of PC with suitable metabolic parameters during storage.

Spontaneous reversibility of bone loss induced by gonadotropin-releasing hormone analog treatment.

OBJECTIVE: To verify if a 6-month period of hypoestrogenism due to chronic treatment with GnRH analogue (GnRH-a) causes irreversible bone loss in young women. DESIGN: Controlled clinical study in volunteer women. SETTING: Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy. PATIENTS: Twenty-eight women (mean age +/- SE 81.1 +/- 0.99 years) with endometriosis diagnosed by laparoscopy and 25 healthy, normally cycling women of the same age (28.3 +/- 1.14 years). INTERVENTIONS: In women with endometriosis, six SC implants of the GnRH-a compound, 3.6 mg goserelin acetate depot, were administered every 28 days starting within 15 days of laparoscopy. Compounds interfering with bone metabolism or hormonal formulations were not taken by control women during the entire period of the study. MAIN OUTCOME MEASURE: Evaluation of lumbar bone mineral density at the start of the study and 6, 12, and 30 months later. RESULTS: At the onset of the study, lumbar bone mineral density did not differ in women with endometriosis and control women. Lumbar bone mineral density values significantly decreased after 6 months of GnRH-a treatment. This reduction was still evident 6 months after GnRH-a interruption. However, 24 months after treatment withdrawal, bone mineral density reduction disappeared and bone mineral density values were completely superimposable (+/- O.4 percent) to those observed before treatment. In contrast, control women lumbar bone mineral density values did not change during the entire period of observation. CONCLUSIONS: These data suggest that GnRH-a treatment for 6 months is not associated with long-term effects on lumbar bone density.

Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome.

OBJECTIVE: Our purpose was to investigate the advantages of laparoscopic myomectomy versus laparotomy. STUDY DESIGN: A prospective, randomized trial was performed on 40 women, 22 to 44 years old, undergoing myomectomy. Patients were randomized to have laparoscopy (n=20) or laparotomy (n=20). The intensity of pain was assessed by a visual analog scale at 0, 1, 2, and 3 days postoperatively. The proportions of patients who were analgesic free on day 2, discharged from the hospital by day 3, and feeling fully recuperated on day 15 were also compared. RESULTS: The intensity of postoperative pain was lower (p<0.05) after laparoscopy than after laparotomy. A higher (p<0.05) proportion of patients was analgesic free on day 2, discharged from hospital by day 3, and feeling fully recuperated on day 15 after laparoscopy compared with laparotomy. CONCLUSION: Laparoscopic myomectomy may offer the benefits of lower postoperative pain and shorter recovery time in comparison with laparotomy.

[A combination of buprenorphine and bupivacaine for peridural anesthesia. Our experience]. / Buprenorfina in associazione con bupivacaina per l'anestesia peridurale. Nostra esperienza.

The Authors report the results of a study on 204 patients anesthetized with epidural administration of buprenorphine with bupivacaine. The data obtained were compared with a sample of 236 patients treated with local anesthetic alone. On the whole, the first group of patients presented better anesthesia, with a significantly longer anesthetic effect and more effective sedative and postoperative analgesic effects. Side effects observed were of acceptable entity and incidence.

[Use of a new synthetic prostaglandin (sulprostone) in various obstetrical conditions]. / L'uso di una nuova prostaglandina di sintesi (sulprostone) in diverse condizioni ostetriche.

PIP: A new prostaglandin E2 (PGE2) derivative, the 16 phenoxy-omega-tetranor PGE2 methylsulphonylamide of Sulprostone, was administered to 56 patients to induce preoperative cervix dilatation (1st trimester) and termination of pregnancy for missed abortion (1st and 2nd trimester), or fetal death (3rd trimester). Different dose schedules have been administered intramuscularly. Hourly side effects were recorded. Among 46 patients, Sulprostone induced cervical dilatation (8 mm or more) in 36 subjects. In the others, the cervix dilated at least 6 mm. With regard to the termination of pregnancy, uterine contractions and discharge occurred within a short time. The incidence of side effects was minimal. Our study seems to indicate the usefulness, efficacy, and acceptability of Sulprostone in the management of different obstetric conditions. (author's modified)^ieng