Optical coherence tomography and visual evoked potential and its relationship with neurological disability in patients with relapsing-remitting multiple sclerosis.

INTRODUCTION: To evaluate the relationship between retinal nerve fiber layer involvement and visual evoked potential with the neurological disability scale in relapsing remitting multiple sclerosis. METHODS: Fifty-two patients diagnosed with relapsing-remitting multiple sclerosis were evaluated for the study. Optical coherence tomography (retinal nerve fiber layer or RNFL and macular volume or MV), pattern visual evoked potential or VEP (latency and P100 wave amplitude), and neurological disability scale (EDSS) were performed. A baseline evaluation was carried out and it was repeated after one year and two years. RESULTS: The baseline values ​​in the retinal nerve fiber layer were 82.5 (75-93.5), the latency and amplitude of the VEP of 116 (108-125.5) and 9 (7-11), respectively, while the EDSS was 2 (1.5-3). A correlation was found between higher EDSS with prolonged latency and decreased amplitude of the P100 wave. There was an association between a higher EDSS with the prolongation of the latency of the P100 wave and a longer time of evolution of MS. No relationship was found between EDSS and macular volume. A higher EDSS was associated with a significant decrease in RNFL. When the discriminative performance of disability was evaluated, the latency of the VEP presented an area under the curve of 0.79 (CI95% 0.67- 0.92), the amplitude of the VEP an area under the curve of 0.71 (CI95% 0.56 - 0.87) and RNFL a area under the curve of 0.76 (95% CI 0.62 - 0.90. When comparing RNFL, MV and PEV in eyes without and with previous optic neuritis with RNFL values ​​of 88 (81-97) and 76 (71-81) (p 0.0007), MV of 246 (232-261) and 241 (229-251) (p 0.2541), PEV latency of 109 (105-117) and 125 (118-129) (p 0.0001), VEP amplitude of 9 (7-10) and 9 (7-11) (p 0.9391), respectively, which shows a statistically significant correlation between decrease in RNFL and prolongation of VEP latency in eyes with previous optic neuritis. In the 2-year follow-up there were no significant differences between the values ​​of RNFL, VEP and EDSS. DISCUSSION: In our study, a relationship was evidenced between retinal nerve fiber thickness, PEV and the degree of disability measured by EDSS in patients with relapsing MS - remissions in their baseline values. A lower RNFL thickness was correlated with prolonged latency and decreased amplitude in the PEV and was associated with a higher EDSS. This relationship was more significant in eyes with previous optic neuritis in terms of decreased RNFL thickness and prolongation of PEV latency. No significant differences were found in the 2-year follow-up in the measurements made.

Ecosystem service valuation method through grey water footprint in partially-monitored subtropical watersheds.

The valuation of ecosystem services of pollution regulation in basins with partial monitoring does not have only one consolidated methodology which can be applied in all countries, biomes and across spatio-temporal scales. While different metrics can incorporate elements of uncertainty for decision makers, changes in land use, climate and sectoral demands in basins increase the need for the efficiency and complexity of valuation methods. Here, based on adapting a pre-existing method, we present a new ecosystem service valuation applied to river basins under different characteristics in the biomes of the Atlantic Forest and Brazilian savannah. Our assumptions of ecosystem service valuation concern an analogy based on willingness-to-pay for not marketable services, but adapted by data from the river basins' ecohydrological monitoring. First, the method depicts river ecosystem valuation with probabilistic criteria of both the water yield, as supply, and the grey Water Footprint (greyWF), as demand. Second, we introduced the comparison between water supply and demand carried out on the continuous flow regime and monitored loads in rivers with different land uses, sizes and biomes. Third, this new ecosystem service valuation method enabled us to quickly visualize the possible stages of sustainability concerning the Brazilian legal framework among different basins. The methodology was applied in 12 Brazilian river basins, with drainage areas between 17 and 26,500 km2, and changes in land use with variable percentages of urban (62-92%), forest (51-84%) and agriculture (51-89%) areas. The most polluted basins, with greyWF values far above those allowed, have the most significant, almost asymptotic valuation curves. Results range from a minimum reference value of 61 US$/ha/year for conservation, adapted from the Brazilian Water Producer, to US$ 330 for restoring high polluted basins. The results show the viability of this method and discuss further opportunities for water security, especially for climate change and non-stationary sectorial demands.

Dermatitis actínica crónica / Chronic actinic dermatitis

RESUMEN La dermatitis actínica crónica (DAC) - dermatitis por fotosensibilidad, reacción solar persistente o su variante extrema el reticuloide actínico- es una fotodermatosis crónica, propia del adulto más frecuente en el sexo masculino provocada por rayos ultravioletas (UVB), (UVA) y luz visible. El diagnóstico es clínico, caracterizado por placas eccematosas y liquenificadas pruriginosas en aéreas expuestas al sol. Se cree que el DAC se debe a la fotosensibilización secundaria de un antígeno endógeno de la piel.

ABSTRACT Chronic actinic dermatitis (ACD) - photosensitivity dermatitis, persistent solar reaction or its extreme variant actinic reticuloid - is a chronic photodermatosis, typical of the adult male caused by ultraviolet (UVB), (UVA) and visible light. The diagnosis suggested by clinical researchers, characterized by eczematous and lichenified pruritic plaques in areas exposed to the sun. It is believed that DAC is due to the secondary photosensitization of an endogenous skin antigen.

Giant aneurysm of the ascending aorta.

An ascending aortic aneurysm is a rare entity. The authors encountered an 85-year-old female patient with an uncomplicated ascending aortic aneurysm measuring 9 cm in diameter. She underwent an urgent operation involving replacement of the ascending aorta. Postoperatively, she developed mild renal failure and atrial flutter requiring direct current cardioversion. However, further recovery was good. The authors present this case including the operative management and a brief overview of this rare condition to reiterate that with an ageing population, this procedure can be done with an acceptable morbidity.

Pulmonary artery catheter induced pulmonary haemorrhage.

Since its introduction three decades ago, the pulmonary artery (PA) catheter has brought insights into pathophysiology of many diseases enabling intensivists to treat critical conditions much more precisely and securely. PA indications are widening, and those working in an intensive care environment feel more secure in handling critical conditions with objective data. However, PA-induced pulmonary haemorrhage is a well-recognised, uncommon, yet potentially lethal, complication of PA catheter. We report a case with PA haemorrhage induced by placement of the PA catheter during coronary artery bypass surgery. A contrast-enhanced CT scan of the chest confirmed spontaneous remission of the haemorrhage after 7 weeks of the injury without the need for any intervention.

Cyclosporine profiling with C2 and C0 monitoring improves outcomes after heart transplantation.

BACKGROUND: Cyclosporine (CsA) level at 2 hours post-dose (C2) is a more sensitive marker for rejection risk than trough (C0) level. A combination of C2 and C0 monitoring may prove optimal. METHODS: We compared efficacy and safety outcomes among 28 de novo heart transplant patients in whom both C2 and C0 monitoring were undertaken (Group 1), with a single CsA profile at Weeks 2 to 6, versus 28 historic controls monitored by only C0 (Group 2). Patients received anti-thymocyte globulin (ATG) induction with CsA, steroids and azathioprine maintenance therapy. RESULTS: The CsA microemulsion dose was significantly higher in Group 1 than Group 2 up to 3 months post-transplant. Mean C2 values in Group 1 at 3 and 12 months were 1,248 +/- 328 ng/ml and 1,039 +/- 362 ng/ml, respectively. One patient in Group 1 and 7 in Group 2 (25%) discontinued CsA, either due to CsA-related neurotoxicity or two or more episodes of early rejection. At 12 months, graft and patient survival were 100% in both groups. Six patients in Group 1 (21%) and 11 in Group 2 (39%) had at least one episode of biopsy-proven acute rejection (not significant). Over the first 12 months post-transplant, the proportion of biopsies showing Grade 3 rejection was 5% in Group 1 and 11% in Group 2 (p < 0.002). Gloerular filtration rate (GFR) was significantly lower in Group 1 than Group 2 at both 3 and 12 months. CONCLUSIONS: Combined use of C2 and C0 monitoring results in improved efficacy versus C0 monitoring alone. Regular measurement of C2 levels should be undertaken in de novo heart transplant recipients.

Donor CCR5 Delta32 polymorphism and outcome following cardiac transplantation.

BACKGROUND: Chemokines regulate the recruitment and trafficking of leukocytes during an immune response. Animal models have shown correlations between chemokine production and leukocyte infiltration during allograft rejection. Also, antagonism of chemokine receptors in transplant models has produced prolonged graft survival. Individuals homozygous for a 32 base pair deletion in the CC chemokine receptor 5 (CCR5) gene have an inactive receptor. Renal transplant recipients homozygous for the deletion have been shown to survive significantly longer than those heterozygous or homozygous for the wild type allele. CCR5 ligands are upregulated during allograft rejection aiding infiltration of leukocytes. We investigated the influence of CCR5Delta32 polymorphism on outcome following human cardiac transplantation. METHODS: Recipients and corresponding donors were genotyped for CCR5Delta32 polymorphism using polymerase chain reactions. RESULTS: We found no correlation between recipient genotype and outcome following transplantation. However, there was a significant correlation between donor genotype and mortality in patients transplanted for a nonischemic condition (DD = n/a, ID = 4%, II = 25%, P = .0014). CONCLUSIONS: The induction of CCR5 expression in endomyocardial biopsy tissue is known to correlate with leukocyte graft infiltration. We suggest that donor CCR5 may be more important for leukocyte trafficking during rejection than recipient CCR5 expression. The CCR5 gene is highly conserved, and due to the small population available for this study, more work is required from other centers.

Donor heart selection: Wythenshawe experience.

BACKGROUND: The decline in the number of suitable donor hearts has led to an increasing interest in the use of previously unacceptable donors. This study aimed to evaluate the outcome of recipients of donor hearts considered medically unsuitable for transplantation at this center that were used in other centers in the United Kingdom. METHODS: Forty donor hearts (group 1) were declined by Wythenshawe Hospital and used in other units in the United Kingdom in the period extending from April 1998 to March 2003. One hundred four hearts (group 2) were transplanted at Wythenshawe Hospital during the same period. Donors and recipient data were obtained from the United Kingdom Cardiothoracic Transplant Audit database. Mortality in both groups was analyzed using SPSS software. RESULTS: Mortality in patients receiving grafts from group 1 donors was significantly higher than in group 2 (P < .0009). Of the early deaths in this group 50% (6 of 12) were the result of graft failure. These donors were receiving high doses of inotropes, had ischemic time exceeding 3.5 hours, and the grafts were transplanted into high-risk patients. CONCLUSION: Hearts declined on medical grounds by one center should be evaluated with caution before being considered suitable for transplantation, especially when more than one adverse factor is present.

Estudio retrospectivo del cáncer de piel / Retrospective research of the skin cancer

Motivados por la falta de datos estadísticos de cáncer de piel en nuestra provincia, realizamos un estudio retrospectivo en 3325 biopsias realizadas en nuestro servicio entre los años 1982 y 1999; encontrando un total de 326 casos de piel, de los cuales 222 corresponden a epitolioma basocelular, 71 a epitelioma espinocelular y 33 melanoma maligno(AU)

Estudio retrospectivo del cáncer de piel / Retrospective research of the skin cancer

Motivados por la falta de datos estadísticos de cáncer de piel en nuestra provincia, realizamos un estudio retrospectivo en 3325 biopsias realizadas en nuestro servicio entre los años 1982 y 1999; encontrando un total de 326 casos de piel, de los cuales 222 corresponden a epitolioma basocelular, 71 a epitelioma espinocelular y 33 melanoma maligno

Antinociceptive properties of morusin, a prenylflavonoid isolated from Morus nigra root bark.

The antinociceptive effects of morusin (1), the main prenylflavonoid present in the Morus nigra root barks have been investigated in classical models of pain in mice. The results showed that 1 exhibits a promising antinociceptive or analgesic profile by the intraperitoneal route, being more potent than some standard drugs used as reference. The mechanism by which the morusin exerts antinociceptive activity still remains undetermined, but our results strongly suggest that it involves the participation of the opioid system.

Antinociceptive activity of I3,II8-binaringenin, a biflavonoid present in plants of the guttiferae.

This paper describes the antinociceptive action of 13,118-binaringenin (GB-1a), a biflavonoid isolated from Clusia columnaris and present in several plants of the family Guttiferae, in a writhing test and a formalin test. It was found that it exhibits potent and dose-related antinociceptive action in both experimental models, with ID50 values of 22 mumol/kg against the writhing test and 28 mumol/kg against the second phase of the formalin test. It was more potent than some well-known analgesic drugs used as reference. Based on a hot-plate test its mechanism of action seems to be unrelated with the opioid receptors.

Evaluación de la consulta estomatológica en la infancia / Stomatological consultation evaluation in the infancy

Se efctua un estudio retrospectivo de la consulta estomatológica en el servicio de dermatología pediátrica desde mayo de 1997 a mayo de 1999. Mostramos la prevalencia de la patología, tipo de lesiones, su frecuencia y su relación con la edad y el sexo. Concluímos que las patologías más frecuentes fueron Mucocele y Enfermedad Mano-pie-boca, con un predominio en ambas del sexp femenino

Evaluación de la consulta estomatológica en la infancia / Stomatological consultation evaluation in the infancy

Se efctua un estudio retrospectivo de la consulta estomatológica en el servicio de dermatología pediátrica desde mayo de 1997 a mayo de 1999. Mostramos la prevalencia de la patología, tipo de lesiones, su frecuencia y su relación con la edad y el sexo. Concluímos que las patologías más frecuentes fueron Mucocele y Enfermedad Mano-pie-boca, con un predominio en ambas del sexp femenino(AU)

Melanoma acrolentiginosos interdigital / Interdigital acral melanoma

Se presentan dos casos de melanoma acral de localización imterdigital en una mujer de 67 años y en un hombre de 65. Se realiza una reseña bibliográfica de 28 trabajos de la literatura médica, con 843 casos de esta enfermedad. Se aprecia de este modo que la mayor frecuencia es la plantar seguida por la ungueal, siendo la ubicada en los espacios de los dedos, la de menor cuantía

Melanoma acrolentiginosos interdigital / Interdigital acral melanoma

Se presentan dos casos de melanoma acral de localización imterdigital en una mujer de 67 años y en un hombre de 65. Se realiza una reseña bibliográfica de 28 trabajos de la literatura médica, con 843 casos de esta enfermedad. Se aprecia de este modo que la mayor frecuencia es la plantar seguida por la ungueal, siendo la ubicada en los espacios de los dedos, la de menor cuantía(AU)

[Toxoplasmosis IgG avidity: what importance does it have in pregnancy?]. / Toxoplasmose-IgG-Avidität: Welchen Stellenwert hat sie in der Schwangerschaft?

Avidity describes the binding strength of specific antibody to antigen. It was found to be low in the first phase after primary infection but then to increase over time. In addition to classic serodiagnosis of toxoplasmosis, measurement of avidity provides information making it possible to distinguish between acute and chronic infection and is of particular interest in pregnant women. In 229 women we found IgG and IgM antibodies suggestive of acute infection. A total of 188 (82%) had an avidity index > 0.3, indicating that the infection had occurred at least four months earlier. Based on this additional information, repeated testing and unnecessary anxiety can be avoided.

[Familial hemifacial spasm: report of 2 cases]. / Espasmo hemifacial familiar. Relato de dois casos.

The authors report the clinical and angiographical findings of two cases of familial hemifacial spasm. This is the fifth description in the literature and presents mother and daughter at the ages of 76 and 51 respectively, in whom the left side was affected. They underwent exams of angioresonance that showed dolichobasilar with left side origin in both patients. The exams also demonstrated postero-inferior cerebellar artery very developed and irregularities in the walls of the vertebral and basilar arteries suggestive of arteriosclerosis in the mother and slightly elongated intracranial vessels in the daughter. Literature review and etiology data of the hemifacial spasm are focused.

Quantitative study of the effect of dacryocystorhinostomy on lacrimal drainage.

Using scintigraphy, we have studied the lacrimal drainage from the conjunctival sac of normal subjects and patients who have undergone dacryocystorhinostomy. A mathematical model of drainage was constructed that accurately described the complete activity curves for both groups. The initial rate of drainage was shown to be a relevant parameter to characterize drainage, and it was found to be different from normals to patients, indicating that the lacrimal pump mechanism is affected by dacryocystorhinostomy.