Surgical Resection Combined with Adjuvant Radiotherapy and Non-Steroidal Anti-Inflammatory Drugs in the Treatment of Heterotopic Ossification Following Total Hip Arthroplasty.

Heterotopic ossification (HO) is a well-known complication following total hip arthroplasty (THA), with an average incidence of 30%. Patients are classified according to Brooker's staging system. In advanced stages (III and IV), HO may limit hip motion and cause intolerable pain. For these symptomatic stages, surgical excision is mandatory, usually combined with prophylaxis of recurrence with non-steroidal anti-inflammatory drugs (NSAIDs) and/or radiotherapy. We present the case of a 70-year-old woman who developed Stage IV HO after undergoing THA for left hip osteoarthritis. Surgical excision of the HO was performed eighteen months after THA, with adjuvant radiotherapy and indomethacin. After two years of follow-up, the patient had a good hip function with no recurrence of HO. Several authors have studied the effect of NSAIDs and radiotherapy in HO prophylaxis and in HO treatment but there is lack of reports concerning the combination of the two strategies with surgery in the postoperative period. We therefore report this successful case of post-THA HO treatment with surgical excision and post-operative radiotherapy and NSAIDs.

A ossificação heterotópica (OH) é uma complicação frequente após artroplastia total da anca (ATA), com uma incidência média de 30%. Os doentes são classificados de acordo com o sistema de estadiamento de Brooker. Nos estádios avançados (Brooker III e IV), a OH pode restringir a mobilidade da anca e causar dores insuportáveis. Nestes estádios sintomáticos, o tratamento indicado consiste na excisão cirúrgica combinada com profilaxia da recorrência com anti-inflamatórios não esteróides (AINEs) e/ou radioterapia. Apresentamos o caso de uma mulher de 70 anos que desenvolveu OH grau IV após ATA por osteoartrose da anca esquerda. Realizou-se excisão da OH um ano e meio após a ATA, com radioterapia e indometacina adjuvantes. Após dois anos de seguimento, não se verifica recorrência da OH e apresenta uma boa função da anca. O efeito dos AINEs e radioterapia adjuvante na profilaxia e no tratamento da HO está bem estabelecido, mas não há muitos relatos das duas estratégias combinadas com cirurgia no pós-operatório. Descrevemos, portanto, um caso de tratamento de OH pós-ATA com excisão das ossificações e radioterapia e AINEs no pós-operatório.

Antireflux surgery is required after endoscopic treatment for Barrett's esophagus.

<b>Introduction:</b> Barrett's esophagus is an acquired condition that develops as a result of transformation of normal stratified squamous epithelium in the lower part of the esophagus into columnar epithelium. Barrett's esophagus is considered to be a complication of gastroesophageal reflux disease (GERD). Various endoscopic techniques have been shown to be successful in the treatment of this condition. However, long-term success in preventing further esophageal dysplasia is not clear. Biological welding consists in the application of controlled high-frequency current on living tissues and has been used to stop gastrointestinal bleeding, similarly to the APC technique which involves ablation of small intestinal metaplasia of the esophageal mucosa.<br/> <b>Aim:</b> The goal of this study was to evaluate the effectiveness of endoscopic techniques in the treatment of Barrett's esophagus and verify the need for a subsequent surgical intervention in patients with GERD complicated by Barrett's esophagus. <br/><b> Material and methods: </b> Patients with Barrett's esophagus C1-3M2-4 (Prague classification from 2004) and high dysplasia without nodules, as well as patients with confirmed GERD without hiatal hernia, were included in this study. Endoscopic treatment was performed with the use of argonoplasmic coagulation (APC) and high-frequency welding of living tissues (HFW). After the examination the patients were re-examined. Patients with recurrence of metaplasia and high DeMeester score (˃ 100) underwent antireflux surgery - crurography and Nissen fundoplication with creation of a soft and short cuff.<br/><b>Results:</b> A total of 89 patients were included in the study, 81 of whom were reexamined after ablation of Barrett's esophagus.In 12 patients, a recurrence of intestinal metaplasia resembling the small intestine was identified. Implementation of two-stage treatment was required for 9 patients - it involved a second procedure of ablation of the esophagus, followed by antireflux surgery. Surgical treatment was refused by 3 patients, who underwent only the second ablation procedure. All patients received drug therapy, consisting of prokinetics and proton pump inhibitors. Esophageal pH monitoring was repeated 3 months after surgery, showing normalization of the DeMeester score. As a result, the patients experienced no complaints such as heartburn, chest pain or dysphagia, which significantly improved their quality of life. Esophagogastroduodenoscopy and biopsy of the mucous membrane of the lower third of the esophagus were performed in accordance with the Seattle Protocol. After examining histological specimens, no regions of metaplasia were identified. <br/><b>Conclusion:</b> Antireflux surgery is required as a part of the treatment for Barrett's esophagus, which prevents further dysplasia and development of esophageal cancer.<br/>.

Tonic GABAergic inhibition, via GABAA receptors containing αßƐ subunits, regulates excitability of ventral tegmental area dopamine neurons.

The activity of midbrain dopamine neurons is strongly regulated by fast synaptic inhibitory γ-Aminobutyric acid (GABA)ergic inputs. There is growing evidence in other brain regions that low concentrations of ambient GABA can persistently activate certain subtypes of GABAA receptor to generate a tonic current. However, evidence for a tonic GABAergic current in midbrain dopamine neurons is limited. To address this, we conducted whole-cell recordings from ventral tegmental area (VTA) dopamine neurons in brain slices from mice. We found that application of GABAA receptor antagonists decreased the holding current, indicating the presence of a tonic GABAergic input. Global increases in GABA release, induced by either a nitric oxide donor or inhibition of GABA uptake, further increased this tonic current. Importantly, prolonged inhibition of the firing activity of local GABAergic neurons abolished the tonic current. A combination of pharmacology and immunohistochemistry experiments suggested that, unlike common examples of tonic inhibition, this current may be mediated by a relatively unusual combination of α4ßƐ subunits. Lastly, we found that the tonic current reduced excitability in dopamine neurons suggesting a subtractive effect on firing activity.

seroprevalencia de la leucosis enzoótica bovina y su asociación con signos clínicos y factores de riesgo en rebaños lecheros del estado barinas, venezuela / Seroprevalence of Enzootic Bovine Leukosis and its Association with Clinical Signs and Risk Factors in Dairy Herds from Barinas State, Venezuela

Se realizó un estudio sobre la seroprevalencia de la leucosis enzoótica bovina (LEB) en 360 bovinos lecheros, representativos de los municipios Pedraza y Barinas del estado Barinas, Venezuela, durante el periodo comprendido entre julio y noviembre 2007. En todos ellos se evaluó la presencia de signos clínicos compatibles con LEB (caquexia, decaimiento, y tumefacciones en los ganglios linfáticos supraescapulares e inguinales superficiales). Se recolectaron muestras de sangre, para la detección de anticuerpos y la proporción de linfocitos, lo cual se hizo mediante la prueba de ELISA y por contaje de linfocitos, respectivamente, relacionándose el porcentaje de animales seropositivos con el hallazgo de signos, tumefacciones en los ganglios y valores linfocíticos. Adicionalmente, se evaluó la seropositividad entre sexos, grupos etarios y número de partos, como factores de riesgo, mediante la prueba de Chi cuadrado (X²). Se detectaron 219 de 360 (60,83%) bovinos con anticuerpos específicos contra el virus de la LEB (VLEB), indicando una prevalencia elevada de distribución uniforme, en ambos municipios. La proporción de animales seropositivos con signos clínicos resultó ligeramente superior (33,79%) a la de los seronegativos (19,86%), aunque estos valores no fueron estadísticamente significativos. De igual manera, no se encontraron diferencias entre los seropositivos y seronegativos, en cuanto a las tumefacciones detectadas en los ganglios detectados, indicando que la ausencia de ellas no implica ausencia de infección. Las elevadas proporciones de linfocitos en los bovinos seropositivos y seronegativos resultaron similares, revelando no estar relacionadas con la infección por el VLEB. Con respecto a los factores de riesgo, la edad y el número de partos, mostraron estar asociados con la presencia de anticuerpos (P=0,0030 y P=0,0001, respectivamente), mientras que para el sexo no se detectaron. Estos resultados representan una contribución al conocimiento del comportamiento de la LEB en Venezuela.

An investigation was conducted to study the seroprevalence of enzootic bovine leukosis (EBL) in dairy cattle from the municipalities of Pedroza and Barinas, located at the State of Barinas, Venezuela, from July to November 2007. A total of 360 dairy cows were used. In all animals, the presence of clinical signs compatible with EBL, such as emaciation, weakness, tumefaction in suprascapular and superficial inguinal lymph nodes, were assessed. Blood samples positive to antibodies against EBLV were collected, specific antibodies to EBLV and lymphocyte proportion in samples were determined through the ELISA test and lymphocyte count, respectively. The percentage of positive animals was related to clinical findings, tumors, and lymphocytes values. Additionally, seropositivity among sex, age groups, and calving number, considered as risk factors, were also analyzed using the Chi square (X²) test. Of a total of 360 animals, 219 (60.83%) were positive to EBLV antibodies, indicating an elevated prevalence of uniform distribution in both municipalities. The proportion of seropositive animals with clinical signs was slightly higher (33.79%), when compared to seronegative animals (19.86%), although these values were not statistically significant. Likewise, no differences were found between serpositives and seronegatives regarding tumefaction detected, indicating that absence of such tumefaction does not imply lack of infection. The elevated amount of lymphocytes in both seropositive and seronegative animals was similar, reflecting no relationship with the infection through the EBLV. Concerning risk factors, age and calving number showed to be associated with the presence of antibodies (P=0.0030 and P=0.0001, respectively). In contrast, such association was not found for the variable sex. These results represent a contribution to the comprehension of EBL behaviour in Venezuela.

Aislamiento de leptospira interrogans en vacas mestizas Holstein en el Municipio Girardot del estado Aragua / Isolation of leptospira interrogans in crossbred Holstein cows in Aragua state

Con el objeto de aislar Leptospira interrogans serovar georgia en vacas mestizas Holstein en el municipio Girardot del estado Aragua, se tomó como área de estudio una finca de ganadería mestiza Holstein que mostraba alta actividad serológica contra el serovar en estudio. Para seleccionar el grupo de estudio, se tomaron 42 vacas en producción láctea y se escogió como muestra aquellas que presentaron anticuerpos con títulos mínimos de 1/100 contra el serovar georgia, a través de la prueba de Microaglutinación (Micro Aglutination Test, MAT), resultando el tamaño de la muestra de 16 vacas. De las 16 vacas se recolectaron muestras de sangre y orina, las cuales fueron sembradas en 3 medios de cultivo selectivos para Leptospiras y en 3 diluciones diferentes. Los cultivos se revisaron quincenalmente durante tres meses, tiempo después del cual se observó crecimiento del género Leptospira en dos (2) de los medios sembrados a partir de muestras de orina, a la dilución de 10-¹ y en el medio de cultivo Fletcher. Posterior al aislamiento, se inició la identificación a nivel de serogrupo a través de la prueba de MAT utilizando 13 sueros hiperinmunes de conejo de los serogrupos de Leptospira mas conocidos; a nivel de serovar, la identificación se realizó por la prueba de MAT con anticuerpos monoclonales. Los aislados reaccionaron a los sueros hiperinmunes de los serogrupos hardjo, pomona y sejroe, observándose los mayores títulos para el serogrupo sejroe, que es antigénicamente compatible con el serogrupo mini al cual pertenece el serovar georgia. A nivel de serovar, ambos aislados fueron identificados como Leptospira interrogans serovar pomona. Con base a estos resultados, se concluyó que los bovinos en estudio estaban infectados por mas de un serovar de Leptospira interrogans y que la serología no se correspondió con la bacteriología, lo que indica que la presencia de anticuerpos en suero contra un serovar de Leptospira no es indicativo de su presencia en los riñones.