Analysis of the competitive demands in 7-a-side football players with cerebral palsy

Inertial devices allow for obtaining a large amount of information related to external load during official competitions. The study aimed to analyse fatigue in different functional classification players of a Football 7-a-side for people with cerebral palsy or acquired brain injury team, considering the movements, speed changes and impacts during the 2020 Spanish National League matches (n = 12). The analyzed independent variables were the different functional classifications (FC) of the players, FC1, FC2 and FC3, and also time. Regarding the dependent variables, kinematic objective external load (displacements and speed changes), and neuromuscular objective external load (impacts) were considered. This study is an empirical investigation that follows an associative and descriptive analysis, ANOVA test, and a Bonferroni post hoc test (multiple comparisons) were carried out between the external load variables based on FC and time. The results show differences between FC1 for people with greater functional limitation to FC3, and athletes with less functional limitation depending on the time of the match. FC2 players presented greater competitive demands in specific moments of the match than FC3 athletes because of the requirements of the competition. Furthermore, evaluating different FC players with inertial devices in official competitions provides useful information regarding the demands of Fa7PC players, which is fundamental for daily training tasks management and injury risk prevention in Fa7PC. The large number of variables associated with inertial devices data collection during training sessions and official competitions in Fa7PC allows us to understand the demands of CP players, as well as how to make decisions during the games and training process, namely for reducing the injury risk. (AU)

Retrospective observational study on safety of sedation for colonoscopies in ASA I and II patients performed by a nurse and under the supervision of anesthesiology.

INTRODUCTION: Out of operating room sedation with propofol by non-anaesthesiologists (Non Anaesthesiologist Administration of Propofol: NAAP) is a growing practice. This is due to the increase in minimally invasive diagnostic and therapeutic procedures requiring sedation, and the difficulty of anaesthesiology services to respond adequately to this demand. OBJECTIVE: The main objective of this study is to assess the safety of a programme of nurse sedationist-administered target controlled infusion (TCI) of propofol in colonoscopies supervised by anaesthesiologists. MATERIAL AND METHODS: Over a period of 6 months, all ASA I and II patients who required colonoscopy and met the inclusion criteria were included in the study. A total of 381 colonoscopies were performed. Episodes of desaturation, hypo- or hypertension, bradycardia or tachyarrhythmia and the need for anaesthesiology assistance during sedation were analysed. After the procedure, patient satisfaction was assessed on a scale of 1-5, and pain was assessed on a numerical verbal scale of 1-5. RESULTS: A small percentage (5%) of patients presented oxygen saturation of less than 90%, without requiring mask ventilation; 7.35% presented hypotension, 3.94% presented bradycardia, and the supervising anaesthesiologist was called in 22% of cases. Patient satisfaction at the end of the procedure was 4.27 out of 5. CONCLUSION: Sedation during colonoscopy in ASA I and II patients following an agreed protocol can be safely administered by nurse sedationists under the supervision of an anaesthesiologist.

Estudio observacional retrospectivo sobre la seguridad de la sedación para colonoscopias en pacientes ASA I y II realizada por enfermería y tutelada por anestesiología / Retrospective observational study on safety of sedation for colonoscopies in ASA I and II patients performed by a nurse and under the supervision of anesthesiology

Introducción: La sedación con propofol por no anestesiólogos es una práctica creciente en áreas fuera de quirófano resultado del incremento de procedimientos diagnóstico-terapéuticos mínimamente invasivos que precisan sedación y de la dificultad de los servicios de anestesiología para responder adecuadamente a esta demanda. Objetivo: El objetivo principal de este estudio es valorar la seguridad de un programa de sedación para colonoscopias administrada por enfermería formada y tutelada por anestesiólogos, aplicando un protocolo de sedación con sistemas Target Controlled Infusion. Material y métodos: Durante un periodo de 6 meses se incluyeron en el estudio todos los pacientes ASA I y II que precisaron la realización de una colonoscopia programada y cumplían los criterios de inclusión. Se realizaron 381 colonoscopias. En el procedimiento se analizaron los episodios de desaturación, hipo- o hipertensión, bradicardia o taquiarritmia y la necesidad de asistencia por anestesiología. Tras el procedimiento se evaluó en una escala de 1 a 5 el nivel de satisfacción y el dolor mediante escala verbal numérica de 0 a 10. Resultados: El 5% de los pacientes presentó una saturación de oxígeno menor del 90% sin requerir ventilación con máscara; el 7,35% presentó hipotensión, el 3,94% bradicardia y fue necesario consultar al anestesiólogo responsable en el 22% de los casos. El grado de satisfacción alcanzado por los pacientes al final del proceso fue de 4,27 sobre 5. Conclusión: La sedación durante colonoscopias, en pacientes ASA I y II, siguiendo un protocolo consensuado puede ser administrada de forma segura por personal de enfermería tutelado por anestesiología.(AU)

Introduction: Out of operating room sedation with propofol by non-anaesthesiologists (Non Anaesthesiologist Administration of Propofol) is a growing practice. This is due to the increase in minimally invasive diagnostic and therapeutic procedures requiring sedation, and the difficulty of anaesthesiology services to respond adequately to this demand. Objective: The main objective of this study is to assess the safety of a programme of nurse sedationist-administered target controlled infusion of propofol in colonoscopies supervised by anaesthesiologists. Material and methods: Over a period of 6 months, all ASA I and II patients who required colonoscopy and met the inclusion criteria were included in the study. A total of 381 colonoscopies were performed. Episodes of desaturation, hypo- or hypertension, bradycardia or tachyarrhythmia and the need for anaesthesiology assistance during sedation were analysed. After the procedure, patient satisfaction was assessed on a scale of 1 to 5, and pain was assessed on a numerical verbal scale of 1 to 5. Results: A small percentage (5%) of patients presented oxygen saturation of less than 90%, without requiring mask ventilation; 7.35% presented hypotension, 3.94% presented bradycardia, and the supervising anaesthesiologist was called in 22% of cases. Patient satisfaction at the end of the procedure was 4.27 out of 5. Conclusion: Sedation during colonoscopy in ASA I and II patients following an agreed protocol can be safely administered by nurse sedationists under the supervision of an anaesthesiologist.(AU)

Efectos adversos y complicaciones de la infusión intestinal continua de levodopa-carbidopa en una cohorte de pacientes con enfermedad de Parkinson de un hospital terciario / Adverse effects and complications of continuous intestinal infusion of levodopa-carbidopa in a cohort of patients with Parkinsons disease in a tertiary hospital

Introducción: La infusión intestinal continua de levodopa/carbidopa (IICLC) es un tratamiento de segunda línea indicado en fases avanzadas de la enfermedad de Parkinson (EP). Para su implantación se debe realizar una gastrostomía endoscópica percutánea. Objetivos: El objetivo principal ha sido describir la frecuencia y las características de los efectos secundarios asociados a este tratamiento. Como objetivo secundario se han analizado las características epidemiológicas y clínicas de pacientes afectos de EP que han recibido o reciben tratamiento con IICLC. Pacientes y métodos: Estudio descriptivo, unicéntrico y retrospectivo para una muestra consecutiva de pacientes con EP tratados con IICLC desde principios de 2006 hasta finales de agosto de 2021. Resultados: Se han analizado 81 planificaciones. El éxito del tratamiento (duración mayor de 12 meses) se alcanzó en el 78,1% (n = 50) de los pacientes en los que se disponía de ese período de seguimiento. La duración media del tratamiento fue de 35 meses. El 58,6% de los pacientes presentó algún tipo de complicación. Se notificaron 43 complicaciones leves y 16 complicaciones graves. Conclusión: La constitución de un equipo multidisciplinar experimentado es fundamental para garantizar un manejo y seguimiento adecuado de estos pacientes.(AU)

Introduction: Continuous intestinal infusion of levodopa/carbidopa is a second-line treatment indicated in advanced stages of Parkinson’s disease (PD). For its implantation, a percutaneous endoscopic gastrostomy must be performed. Objectives: The main objective has been to describe the frequency and characteristics of the side effects associated with this treatment. As a secondary objective, we have analyzed the epidemiological and clinical characteristics of the PD patients who have received this treatment in our hospital. Patients and methods: Descriptive, single-center, retrospective study for a consecutive sample of PD patients treated with Continuous intestinal infusion of Levodopa/Carbidopa from the beginning of 2006 to the end of August 2021. Results: 81 treatment planifications have been analyzed. Treatment success (duration greater than 12 months) was achieved in 78.1% (n = 50) of the patients in whom this follow-up period was available. The median duration of treatment was 35 months. 58.6% of the patients presented some type of complication. A total of 43 minor complications and 16 serious adverse events were reported. Conclusion: The constitution of an experienced multidisciplinary team is essential to guarantee the adequate management and follow-up of these patients.(AU)

[Adverse effects and complications of continuous intestinal infusion of levodopa-carbidopa in a cohort of patients with Parkinson's disease in a tertiary hospital]. / Efectos adversos y complicaciones de la infusión intestinal continua de levodopa-carbidopa en una cohorte de pacientes con enfermedad de Parkinson de un hospital terciario.

INTRODUCTION: Continuous intestinal infusion of levodopa/carbidopa is a second-line treatment indicated in advanced stages of Parkinson's disease (PD). For its implantation, a percutaneous endoscopic gastrostomy must be performed. OBJECTIVES: The main objective has been to describe the frequency and characteristics of the side effects associated with this treatment. As a secondary objective, we have analyzed the epidemiological and clinical characteristics of the PD patients who have received this treatment in our hospital. PATIENTS AND METHODS: Descriptive, single-center, retrospective study for a consecutive sample of PD patients treated with Continuous intestinal infusion of Levodopa/Carbidopa from the beginning of 2006 to the end of August 2021. RESULTS: 81 treatment planifications have been analyzed. Treatment success (duration greater than 12 months) was achieved in 78.1% (n = 50) of the patients in whom this follow-up period was available. The median duration of treatment was 35 months. 58.6% of the patients presented some type of complication. A total of 43 minor complications and 16 serious adverse events were reported. CONCLUSION: The constitution of an experienced multidisciplinary team is essential to guarantee the adequate management and follow-up of these patients.

TITLE: Efectos adversos y complicaciones de la infusión intestinal continua de levodopa-carbidopa en una cohorte de pacientes con enfermedad de Parkinson de un hospital terciario.Introducción. La infusión intestinal continua de levodopa/carbidopa (IICLC) es un tratamiento de segunda línea indicado en fases avanzadas de la enfermedad de Parkinson (EP). Para su implantación se debe realizar una gastrostomía endoscópica percutánea. Objetivos. El objetivo principal ha sido describir la frecuencia y las características de los efectos secundarios asociados a este tratamiento. Como objetivo secundario se han analizado las características epidemiológicas y clínicas de pacientes afectos de EP que han recibido o reciben tratamiento con IICLC. Pacientes y métodos. Estudio descriptivo, unicéntrico y retrospectivo para una muestra consecutiva de pacientes con EP tratados con IICLC desde principios de 2006 hasta finales de agosto de 2021. Resultados. Se han analizado 81 planificaciones. El éxito del tratamiento (duración mayor de 12 meses) se alcanzó en el 78,1% (n = 50) de los pacientes en los que se disponía de ese período de seguimiento. La duración media del tratamiento fue de 35 meses. El 58,6% de los pacientes presentó algún tipo de complicación. Se notificaron 43 complicaciones leves y 16 complicaciones graves. Conclusión. La constitución de un equipo multidisciplinar experimentado es fundamental para garantizar un manejo y seguimiento adecuado de estos pacientes.

SARS-CoV-2 infection in Spanish children with chronic kidney pathologies.

BACKGROUND: There is little information about Coronavirus Disease 2019 (COVID-19) in children with underlying chronic renal pathologies. CASES REPORT: From March until April 15, 2020, 16 children with chronic renal pathologies were diagnosed with COVID-19 in Spain. Of these, 6 had end-stage kidney disease (ESKD) (3 transplant recipients and 3 on chronic hemodialysis). The severity of symptoms was mild in all the patients, with little radiological involvement. Three patients were asymptomatic. Fever and upper respiratory symptoms were the most frequent findings. Basal glomerular filtration worsened in 3 patients; however, recovery was rapidly achieved with rehydration and drug dose adjustment. In 2 patients diagnosed with steroid-dependent nephrotic syndrome, COVID-19 provoked a disease relapse. None required oxygen therapy, and 7 could be managed as outpatients. CONCLUSIONS: COVID-19 disease appears to have a similar clinical course in children with underlying chronic renal pathologies, even in immunosuppressed cases, as in healthy children of the same age; however, special attention must be paid to fluid management and drug dose adjustment.

Estudio sobre el uso de plaguicidas y su posible relación con daños a la salud / Study on the use of pesticides and their possible relationship with health damage

Los efectos nocivos de los plaguicidas en la salud humana se encuentran documentados. Sin embargo, la información se encuentra limitada por una serie de barreras que dificultan la obtención de evidencias estadísticas para mostrar a la sociedad las afectaciones adversas de esos productos químicos. El objetivo de este estudio fue analizar la frecuencia del uso, así como el conocimiento que tienen los agricultores sobre los efectos negativos de la aplicación de plaguicidas y su posible relación con daños a la salud de habitantes del Ejido Guadalupe Victoria Municipio de Nuevo Casas Grandes, Chihuahua, México. Los datos se obtuvieron mediante encuestas realizadas a personas mayores de 20 años de edad, que han vivido en la localidad durante toda su vida. Los resultados mostraron que el 83% de la población evaluada trabaja en labores agrícolas, los agroquímicos mostrados como posibles cancerígenos se aplican con frecuencia, la mayoría de las personas indicaron desconocimiento del uso y aplicación de agroquímicos, mientras que el 73% no utilizan protección cuando los aplica. Asimismo, el 55.9% reportó tener algún miembro de la familia fallecido por causa de algún tipo de cáncer; de los cuales los más comunes fueron pulmón y estómago. Son necesarios estudios a largo plazo para corroborar la relación de los plaguicidas con daños a la salud

The harmful effects of pesticides on human health are documented. However, the information is limited by a series of barriers that make it difficult to obtain statistical evidence to show society the adverse effects of these chemicals. The objective of this study was to decide the frequency of use, as well as the knowledge about the negative effects of pesticide application and its possible relationship with damage to the health of inhabitants of the Ejido Guadalupe Victoria Municipality of Nuevo Casas Grandes, Chihuahua, Mexico. The data were obtained through surveys conducted on people over 20 years of age, who have lived in the town throughout their lives. The results showed that 83% of the population evaluated work in agricultural work, agrochemicals shown as possible carcinogens are frequently applied, most people indicated ignorance of the use and application of agrochemicals, while 73% do not use protection when applies them. Also, 55.9% reported having a family member who died due to some type of cancer; of which the most common were lung and stomach. Long-term studies are necessary to corroborate the relationship of pesticides with health damage

Dielectric characterization of healthy and malignant colon tissues in the 0.5-18 GHz frequency band.

Several reports over the last few decades have shown that the dielectric properties of healthy and malignant tissues of the same body organ usually show different values. However, no intensive dielectric studies of human colon tissue have been performed, despite colon cancer's being one of the most common types of cancer in the world. In order to provide information regarding this matter, a dielectric characterization of healthy and malignant colon tissues is presented. Measurements are performed on ex vivo surgery samples obtained from 20 patients, using an open-ended coaxial probe in the 0.5-18 GHz frequency band. Results show that the dielectric constant of colon cancerous tissue is 8.8% higher than that of healthy tissues (p = 0.002). Besides, conductivity is about 10.6% higher, but in this case measurements do not have statistical significance (p = 0.038). Performing an analysis per patient, the differences in dielectric constant between healthy and malignant tissues appear systematically. Particularized results for specific frequencies (500 MHz, 900 MHz, 2.45 GHz, 5 GHz, 8.5 GHz and 15 GHz) are also reported. The findings have potential application in early-stage cancer detection and diagnosis, and can be useful in developing new tools for hyperthermia treatments as well as creating electromagnetic models of healthy and cancerous tissues.

Combined thermal and herbicide stress in functionally diverse coral symbionts.

Most reef building corals rely on symbiotic microalgae (genus Symbiodinium) to supply a substantial proportion of their energy requirements. Functional diversity of different Symbiodinium genotypes, endorsing the host with physiological advantages, has been widely reported. Yet, the influence of genotypic specificity on the symbiont's susceptibility to contaminants or cumulative stressors is unknown. Cultured Symbiodinium of presumed thermal-tolerant clade D tested especially vulnerable to the widespread herbicide diuron, suggesting important free-living populations may be at risk in areas subjected to terrestrial runoff. Co-exposure experiments where cultured Symbiodinium were exposed to diuron over a thermal stress gradient demonstrated how fast-growing clade C1 better maintained photosynthetic capability than clade D. The mixture toxicity model of Independent Action, considering combined thermal stress and herbicide contamination, revealed response additivity for inhibition of photosynthetic yield in both tested cultures, emphasizing the need to account for cumulative stressor impacts in ecological risk assessment and resource management.

[Hemobilia secondary to a broken pseudoaneurysm: case report]. / Hemobilia secundaria a pseudoaneurisma roto: reporte de caso.

A patient presents with abdominal pain associated with jaundice and upper gastrointestinal bleeding (hematochezia, melena) caused by hemobilia secondary to rupture of pseudoaneurysm of a branch of the right hepatic artery. The diagnosis was made by upper endoscopy, performing arteriography with selective embolization ceased bleeding.

Hemobilia secundaria a pseudoaneurisma roto: reporte de caso / Hemobilia secondary to a broken pseudoaneurysm: case report

Se presenta un caso de paciente con dolor abdominal asociado a ictericia y hemorragia digestiva alta (hematoquezia, melena) causado por hemobilia secundaria a ruptura de pseudoaneurisma de una rama de la arteria hepática derecha. El diagnóstico se realizó por medio de endoscopía digestiva alta, realizando arteriografía con embolización selectiva cesando el sangrado.

A patient presents with abdominal pain associated with jaundice and upper gastrointestinal bleeding (hematochezia, melena) caused by hemobilia secondary to rupture of pseudoaneurysm of a branch of the right hepatic artery. The diagnosis was made by upper endoscopy, performing arteriography with selective embolization ceased bleeding.

Insertion of self-expanding metal stent for treatment of malignant obstruction in a pregnant woman.

Colorectal cancer (CRC) is the second most frequent cancer both in incidence and mortality in women, especially in those over 60 years of age. Diagnosis in women at gestational age is rare, so its incidence during pregnancy is low. However, an increase in its diagnosis is expected during the next years because of the raise in the average age of pregnancy.In most cases, the diagnosis is delayed because symptoms related to CRC can be attributed to pregnancy itself. Up to 30 % of CRC cases may present as an intestinal obstruction. In this situation, the main objective is to solve the clinical emergency in the safest way for mother and fetus, together with performing an accurate diagnostic approach to offer the best possible therapeutic management knowing the limitations and difficulties related to pregnancy. The self-expanding metallic stent (SEMS) can be particularly useful in colon obstruction in a pregnant patient with CRC because it allows solving the acute condition providing time to perform a more accurate staging study and to prepare the patient for surgery, thus reducing both post-surgical morbidity and mortality.We report on the case of a patient who early in the second trimester of pregnancy presented with an acute colonic obstruction due to CRC which was successfully managed with the placement of a self-expanding metal stent.

Remoción de terceros molares mandibulares con asistencia endoscópica: nota técnica de un nuevo procedimiento quirúrgico para prevenir lesiones del NAI y formación de defectos óseos / Removal of mandibular third molars with endoscopic approach. Technical note of a new surgical procedure to avoid IAN damage and bone defect formation

La variada posición anatómica de los terceros molares mandibulares presenta importantes desafíos asociados a su profundidad y grado de inclinación. Las complicaciones más habituales del procedimiento quirúrgico convencional de extracción se relacionan con la extensa osteotomía y poca visualización del sitio quirúrgico, que pueden generar consecuencias post-quirúrgicas como inflamación, dolor, trismus, lesiones reversibles e irreversibles del nervio alveolar inferior (NAI) o nervio lingual, riesgo de fractura y formación de defectos periodontales del segundo molar. La implementación de soportes rígidos en la óptica endoscópica ha permitido utilizar esta tecnología para realizar abordajes mínimamente invasivos para remover terceros molares mediante accesos flapless con una mínima osteotomía de la zona oclusal, conservando la pared bucal y lingual a través de la visualización directa y magnificada del sitio quirúrgico, adaptable a los movimientos del paciente durante la intervención. En este reporte se presenta un nuevo procedimiento quirúrgico mínimamente invasivo a través de asistencia endoscópica para la conservación ósea en la remoción de terceros molares mandibulares con riesgo de lesión del nervio alveolar inferior.

Anatomic variability of the position of mandibular third molars represents significant challenges associated with its depth and angulation. The most common complications of conventional surgical procedure are related to extensive osteotomy and poor visualization, which can cause postsurgical effects such as inflammation, pain, trismus, reversible and irreversible lesions of the inferior alveolar nerve (IAN) or lingual nerve, fracture risk and formation of a deep periodontal defect on the distal aspect of the second molar. The implementation of rigid endoscopy in optics has allowed to use this technology via a minimally invasive approach to remove third molars by a minimally occlusal flapless ostectomy, preserving the buccal and lingual walls through direct and magnified visualization of the surgical site, adaptable to the patient’s movements during the surgery. In this report, we present a new and minimally invasive procedure through endoscopic assistance for bone conservation in the removal of third molars at risk of inferior alveolar nerve injury.

Efectos de la manipulación lumbar y técnica de inducción miofascial toracolumbar sobre el patrón de activación del erector espinal / Effects of lumbar spine manipulation and thoracolumbar myofascial induction technique on the spinae erector activation pattern

Objetivo Estudiar el comportamiento del músculo erector espinal así como el rango de movimiento (ROM) lumbar durante la flexo-extensión de tronco, tras la aplicación de una técnica manipulativa y una técnica de inducción miofascial. Hipótesis Tras dichas técnicas podría haber una ganancia de ROM articular y una disminución en la intensidad de la actividad electromiográfica (EMG) del erector espinal. Metodología En 17 sujetos voluntarios sanos se registraron simultáneamente la actividad EMG de superficie del erector espinal y el ROM lumbar, durante la realización de cinco flexo-extensiones de tronco, antes y después de cada una de las técnicas. Metodología Las variables del estudio fueron los porcentajes de flexión lumbar al inicio y al final del silencio mioeléctrico del erector espinal, la actividad EMG media durante ese tiempo y la actividad EMG máxima y media del erector espinal durante sus contracciones concéntrica y excéntrica. Resultados Tras la técnica miofascial se observó una disminución significativa en la actividad EMG media del erector espinal durante la contracción excéntrica, así como un aumento del porcentaje de flexión lumbar en el inicio del silencio.Conclusión Tras una intervención combinada de manipulación vertebral a nivel de L3 y una técnica de inducción miofascial de la fascia toracolumbar, el silencio electromiográfico del erector espinal aparece después y la contracción es menos intensa en la fase excéntrica, lo que podría deberse a una inhibición de dicha musculatura (AU)

Objective To study erector spinae behavior and lumbar range of movement (ROM) during trunk flexion and extension, following the application of a spinal manipulation and a myofascial induction technique.HypothesisThe application of these techniques could cause an increase in lumbar ROM and a decrease in the electromyographic activity (EMG) of erector spinae.Methodology Surface EMG of erector spinae and lumbar ROM during five trunk flexion and extension, before and after both techniques, were recorded in 17 healthy volunteer subjects.Methodology The study variables were erector spinae myoelectric silence onset and offset (expressed as a percentage of the maximum lumbar flexion value), erector spinae average EMG during myoelectric silence and erector spinae maximum and average EMG during concentric and eccentric phases. Results A significant reduction in the erector spinae average EMG during eccentric contraction and an increase in lumbar flexion at the erector spinae onset were observed following the application of the myofascial technique.Conclusion After a combined intervention of spinal manipulation at L3 level and a myofascial induction technique of the thoracolumbar fascia, the myoelectric silence of erector spinae appears later and its contraction intensity is lower during the eccentric phase. This could be produced by an erector spinae inhibition (AU)

Different algal symbionts explain the vertical distribution of dominant reef corals in the eastern Pacific.

Symbiotic reef corals occupy the entire photic zone; however, most species have distinct zonation patterns within the light intensity gradient. It is hypothesized that the presence of specific symbionts adapted to different light regimes may determine the vertical distribution of particular hosts. We have tested this hypothesis by genetic and in situ physiological analyses of the algal populations occupying two dominant eastern Pacific corals, over their vertical distribution in the Gulf of California. Our findings indicate that each coral species hosts a distinct algal taxon adapted to a particular light regime. The differential use of light by specific symbiotic dinoflagellates constitutes an important axis for niche diversification and is sufficient to explain the vertical distribution patterns of these two coral species.

The direct antiglobulin test in a hospital setting.

To evaluate the current use of the DAT in our hospital,we reviewed the charts of all patients who had a DAT performed in our laboratory. The collected data included DAT results and a previously completed laboratory evaluation of suspected hemolytic anemia. Four hundred sixty-three DATs were performed in our laboratory from April 1999 to October 2001. The DAT was negative in 434 (93.7%) cases and positive in 29 (6.3%) cases. A complete laboratory evaluation of suspected hemolytic anemia was seen in 179 (38.7%) cases. The incidence of a positive DAT was higher in the group of patients with > 2 signs of hemolysis (4/34 cases; 11.8%) than in the group of patients with

Autoanti-D in a patient after cladribine treatment for lymphoplasmocytic lymphoma.

We report the case of a 62-year-old woman who developed an autoanti-D after cladribine treatment. In May 2000, the patient underwent splenectomy for a stage IV-B lymphoplasmocytic lymphoma. She was transfused with ABO- and Rh(D)-matched blood. A month later, she received chemotherapy with cladribine. In February 2001, blood grouping showed her to be AB, D+ and the direct antiglobulin test was positive for IgG. An autoanti-D was identified in the eluate. Genotypic analysis confirmed the Rh phenotype of the patient as ccDEe. No hemolysis was evident, as judged by the absence of anemia, a bilirubin of 15.7 micromol/L, and lactic dehydrogenase of 412 IU/L. When an anti-D is identified in a D+ blood recipient, a passive transfer of anti-D, and an alloimmunization in a recipient with a weak D phenotype, should be ruled out. Finally, as in our case, an autoantibody is an additional possibility.

Open total talus dislocation: case report and review of the literature.

An open pure total lateral dislocation of the right talus with extrusion of the whole talar body is reported. Immediately surgical debridement, reduction, and primary closure were accomplished under antibiotic coverage. The ankle was immobilized for 6 weeks, and weight-bearing was restricted for 6 more weeks. Neither avascular necrosis (AVN) of the talus nor infection developed. Both ankle and foot regained full pain-free range of motion at 16 weeks, except for a mild restriction of the last 5 degrees of supination. Four years postinjury, the patient continues in the same preinjury occupation. A thorough review of the literature suggested that (a) immediate closed or open reduction is preferable; (b) if AVN develops, it can be treated in most cases by weight-bearing restrictions; and (c) talectomy, alone or associated with a tibiocalcaneal arthrodesis, should be reserved for an eventual reconstructive procedure, particularly in the event of talus infection.