Quiste óseo aneurismático en el sacro: caso clínico y revisión de la literatura / Aneurysmal bone cyst in the sacrum: Case report and literature review

Los quistes óseos aneurismáticos son lesiones óseas benignas infrecuentes, de localización inusual en el sacro. Sintomatológicamente son inespecíficas. Tras un traumatismo aparece dolor, pudiendo acompañarse de complicaciones de estructuras adyacentes por edema asociado. Los hallazgos de las imágenes suelen ser característicos, aunque el diagnóstico debe confirmarse por biopsia y realizar diagnóstico diferencial con otros tumores. El tratamiento a aplicar en huesos largos consiste en legrado y relleno con material de reemplazo óseo. En el sacro pueden conllevar complicaciones neurológicas, siendo la embolización arterial selectiva una alternativa en su manejo. Describimos un caso de quistes óseos aneurismáticos en el sacro en un varón de 71 años con antecedente de leucemia linfoide crónica e hiperplasia benigna de próstata. El informe incluye la presentación clínica, los hallazgos de imagen y la evolución tras el tratamiento mediante embolización arterial selectiva. Este caso destaca las opciones terapéuticas y las dificultades encontradas en el manejo de estas lesiones en el sacro que complican su tratamiento habitual. La embolización arterial selectiva es una opción terapéutica en pacientes con quistes óseos aneurismáticos en el sacro, permitiendo tratamientos menos agresivos y prósperos resultados (AU)

Aneurysmal bone cysts are rare benign bone lesions. Location in the sacrum is unusual. Symptoms are nonspecific. After an injury, pain develops and complications of adjacent structures can be triggered by the associated oedema. Radiological presentation is usually characteristic but must be confirmed by biopsy and a differential diagnosis must be made with other tumours. Treatment in long bones is based in curettage and refill with bone replacement material. In the sacrum, neurological complications can develop with selective arterial embolisation being an alternative in their management. We describe the case of a 71-year-old male patient with sacral aneurysmal bone cysts and a history of chronic lymphoid leukaemia and benign prostatic hyperplasia. The report includes the clinical presentation, imaging findings and outcome after treatment with selective arterial embolisation. This case highlights the therapeutic options and difficulties encountered in the management of these lesions when located in the sacrum, which complicates their usual treatment. Selective arterial embolisation is a therapeutic option in patients with sacral aneurysmal bone cysts, allowing less aggressive treatments and favourable results (AU)

[Aneurysmal bone cyst in the sacrum: Case report and literature review]. / Quiste óseo aneurismático en el sacro: caso clínico y revisión de la literatura.

Aneurysmal bone cysts are rare benign bone lesions. Location in the sacrum is unusual. Symptoms are nonspecific. After an injury, pain develops and complications of adjacent structures can be triggered by the associated oedema. Radiological presentation is usually characteristic but must be confirmed by biopsy and a differential diagnosis must be made with other tumours. Treatment in long bones is based in curettage and refill with bone replacement material. In the sacrum, neurological complications can develop with selective arterial embolisation being an alternative in their management. We describe the case of a 71-year-old male patient with sacral aneurysmal bone cysts and a history of chronic lymphoid leukaemia and benign prostatic hyperplasia. The report includes the clinical presentation, imaging findings and outcome after treatment with selective arterial embolisation. This case highlights the therapeutic options and difficulties encountered in the management of these lesions when located in the sacrum, which complicates their usual treatment. Selective arterial embolisation is a therapeutic option in patients with sacral aneurysmal bone cysts, allowing less aggressive treatments and favourable results.

Revisión sistemática del tratamiento de la espasticidad en el adulto con daño cerebral adquirido / Systematic review of the treatment of spasticity in acquired adult brain damage

La espasticidad es un trastorno motor, caracterizado por un aumento del tono muscular, y que aparece como consecuencia de un trastorno del sistema nervioso central, dando lugar a déficit y discapacidad, con deterioro de la calidad de vida. En el daño cerebral adquirido del adulto, la espasticidad constituye un problema grave y frecuente, apareciendo en un 20-30% de pacientes con ictus y en un 13-20% de pacientes con traumatismo craneoencefálico moderado-grave. El objetivo principal de este trabajo es realizar una revisión sistemática de los tratamientos utilizados en la espasticidad del paciente adulto con daño cerebral adquirido secundario a ictus y traumatismo craneoencefálico. Como objetivo secundario se pretende averiguar las principales escalas de valoración utilizadas para la medida de la espasticidad en estos pacientes. Se ha realizado una búsqueda sistemática de ensayos controlados aleatorizados, publicados entre el 1 de enero de 2013 y 30 de junio de 2017 en inglés y castellano, en las bases de datos PubMed, Biblioteca Cochrane plus y Ovid. Se han seleccionado finalmente 17 estudios, con una calidad metodológica al menos aceptable, según la escala de Jadad. Los tratamientos más frecuentemente investigados son la toxina botulínica, especialmente el serotipo A, junto a medidas rehabilitadoras. Las escalas clínicas son las más frecuentemente utilizadas para la evaluación de la espasticidad

Spasticity is a motor disorder characterised by an increase in muscle tone that appears as a consequence of a central nervous system disorder, leading to deficit and disability and impairing quality of life. In acquired adult brain damage, spasticity is a severe and frequent problem, appearing in 20-30% of patients with stroke and in 13-20% of patients with moderate-severe traumatic brain injury. The main objective of this study was to perform a systematic review of the treatments used in spasticity in adult patients with acquired brain damage secondary to stroke and head trauma. A systematic search of randomised controlled trials, published between January 1, 2013 and June 30, 2017 in English and Spanish, was carried out in the PubMed, Cochrane plus Library and Ovid databases. We finally selected 17 studies, with methodological quality that was at least acceptable according to the Jadad scale. The most frequently investigated treatments are botulinum toxin, especially serotype A, together with rehabilitative measures. Clinical scales are the most frequently used to assess spasticity

[Systematic review of the treatment of spasticity in acquired adult brain damage]. / Revisión sistemática del tratamiento de la espasticidad en el adulto con daño cerebral adquirido.

Spasticity is a motor disorder characterised by an increase in muscle tone that appears as a consequence of a central nervous system disorder, leading to deficit and disability and impairing quality of life. In acquired adult brain damage, spasticity is a severe and frequent problem, appearing in 20-30% of patients with stroke and in 13-20% of patients with moderate-severe traumatic brain injury. The main objective of this study was to perform a systematic review of the treatments used in spasticity in adult patients with acquired brain damage secondary to stroke and head trauma. A systematic search of randomised controlled trials, published between January 1, 2013 and June 30, 2017 in English and Spanish, was carried out in the PubMed, Cochrane plus Library and Ovid databases. We finally selected 17 studies, with methodological quality that was at least acceptable according to the Jadad scale. The most frequently investigated treatments are botulinum toxin, especially serotype A, together with rehabilitative measures. Clinical scales are the most frequently used to assess spasticity.

Dupuytren's disease involving Guyon's canal.

Ectopic localization of Dupuytren's contracture is extremely rare. To the best of our knowledge, there have been only six cases reported in the literature. The authors present a case with Dupuytren's contracture involving Guyon's canal where the patient had limited wrist range of motion and ulnar neuropathy.

Probiotic gut effect prevents the chronic psychological stress-induced brain activity abnormality in mice.

BACKGROUND: A probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175 combination, Probio'Stick(®) ) displays anxiolytic-like activity and reduces apoptosis in the lymbic system in animal models of depression. Based on the hypothesis that modulation of gut microbiota by this probiotic formulation has beneficial effects on brain activity in stress conditions, we report a set of probiotic-evoked physiological, cellular, and molecular events in the brain of Probio'Stick(®) pretreated mice submitted to chronic psychological stress. METHODS: Water avoidance stress (WAS) was applied or not (sham). Hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) responses to the chronic stress were assessed through plasma corticosterone and catecholamine measurements. Specific markers for neuronal activity, neurogenesis, and synaptic plasticity were used to assess brain activity. In addition, gut permeability and tight junction (TJ) proteins levels were also determinated. KEY RESULTS: We observed that a pretreatment with the probiotic formulation attenuated HPA axis and ANS activities in response to WAS, and reduced cFos expression in different brain areas but Lactobacillus salivarius (a negative control) treatment was ineffective on these parameters. Moreover, probiotic pretreatment prevented the WAS-induced decrease hippocampal neurogenesis and expression changes in hypothalamic genes involved in synaptic plasticity. These central effects were associated with restoration of TJ barrier integrity in stressed mice. CONCLUSIONS & INFERENCES: These data suggest that chronic stress-induced abnormal brain plasticity and reduction in neurogenesis can be prevented by a pretreatment with the Probio'Stick(®) formulation, suggesting that probiotics modulate neuroregulatory factors and various signaling pathways in the central nervous system involved in stress response.

Native fructose extracted from apple improves glucose tolerance in mice

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Fructose is one of the most abundant monosaccharide in nature. It is also the sweetest naturally occurring carbohydrate. Since decades, fructose used for food preparations is not provided by fruit or vegetable but by a chemical process of starch or inulin conversion. We processed a new method of fructose extraction from apple and investigated the acute and long term effect of this carbohydrate on glucose metabolism in C57Bl6/j mice. By using the glycemic index (GI), we have shown that one of the sugars obtained from apple, FructiLight, has a very low impact on glycemic and insulin response during acute treatment compared to other sugars. This carbohydrate, essentially constituted by fructose, has also beneficial properties when administrated for long term treatment. Indeed, as two other sugars extracted from apple (FructiSweetApple and FructiSweet67), FructiLight exposure during 21 weeks in beverage has promoted an enhancement of glucose tolerance compared to glucose treatment without affecting food intake and weight. All these results indicate that apple-extracted sugars and more precisely fructose from these fruits could be a promising way to produce new food and sweet beverages (AU)

Native fructose extracted from apple improves glucose tolerance in mice.

Fructose is one of the most abundant monosaccharide in nature. It is also the sweetest naturally occurring carbohydrate. Since decades, fructose used for food preparations is not provided by fruit or vegetable but by a chemical process of starch or inulin conversion. We processed a new method of fructose extraction from apple and investigated the acute and long term effect of this carbohydrate on glucose metabolism in C57Bl6/j mice. By using the glycemic index (GI), we have shown that one of the sugars obtained from apple, FructiLight, has a very low impact on glycemic and insulin response during acute treatment compared to other sugars. This carbohydrate, essentially constituted by fructose, has also beneficial properties when administrated for long term treatment. Indeed, as two other sugars extracted from apple (FructiSweetApple and FructiSweet67), FructiLight exposure during 21 weeks in beverage has promoted an enhancement of glucose tolerance compared to glucose treatment without affecting food intake and weight. All these results indicate that apple-extracted sugars and more precisely fructose from these fruits could be a promising way to produce new food and sweet beverages.

Risk factors for the development of bronchiolitis obliterans in children with bronchiolitis.

BACKGROUND: Bronchiolitis obliterans (BO) is an uncommon and severe form of chronic obstructive lung disease in children that results from an insult to the lower respiratory tract. METHODS: A case-control study of children under the age of 3 years was performed in 109 cases and 99 controls to determine risk factors for the development of BO. Participants were evaluated by immunofluorescence viral tests, pulmonary function tests, and questions to assess tobacco and other exposures. RESULTS: Bronchiolitis due to adenovirus (odds ratio (OR) 49, 95% confidence interval (CI) 12 to 199) and the need for mechanical ventilation (OR 11, 95% CI 2.6 to 45) were strongly and independently associated with an increased risk for BO. Factors not associated with post-infectious BO included age of the child, sex, and environmental tobacco exposure (either in utero or during infancy). CONCLUSIONS: Adenovirus infection and need for mechanical ventilation are significant risk factors for developing BO in children. Further research is needed to determine why these risk factors are so strong and how they may contribute to the development of the disease.

Lung graft dysfunction in the early postoperative period after lung and heart lung transplantation.

BACKGROUND: We present a retrospective study of 9 years of experience in the management of graft dysfunction in the early postoperative period after lung transplantation (LT) and heart lung transplantation (HLT). MATERIAL AND METHODS: There were 190 LT and HLT (22.63% single LT, 71.05% bilateral sequential LT, and 7.36% HLT) performed from 1993 to 2002. Hemodynamic and respiratory parameters were monitored during the operative technique and critical care for the first 24 hours. We analyzed ischemic time, bypass need, and type of transplant. RESULTS: Lung graft dysfunction occurred in 37.2% of patients, but only in 12.2% was it severe. Nearly all patients were ventilated on a 50% fraction of inspired oxygen during the first 24-48 hours; 61.56% of patients were extubated before the first 5 postoperative day and 38.43% thereafter. The mean ischemia time for the first lung was 220 +/- 28 minutes: for the second lung, it was 378 +/- 31 minutes. The anesthetic time was 500-600 minutes. The variables associated with a significantly increased graft dysfunction were as follows: bilateral LT, and cardiopulmonary bypass requirement. The residence in the intensive care unit (ICU) was longer for patients with graft dysfunction than for those without that problem. Mortality directly related to graft dysfunction was only 4.07%. CONCLUSIONS: A correlation among graft ischemia and early postoperative morbidity and duration of ICU stay did not have a significant impact on mortality.

Arthroscopic treatment of bilateral humeral head osteonecrosis.

A 37-year-old woman with a renal transplant was treated by arthroscopic debridement for bilateral steroid-induced humeral head osteonecrosis. Radiologically, the right shoulder had been categorized as stage III and the left as stage IV according to Arlet and Ficat. Relief of pain and improved range of motion were obtained especially on the right shoulder. Arthroscopy is an efficient procedure for treatment of humeral head osteonecrosis in the renal transplant recipient including radiological stages III with episodes of locking.

Sodium-dependent glutamate transport in Müller glial cells: regulation by phorbol esters.

The regulation of the Na(+)-dependent high affinity glutamate/aspartate transporter system expressed in cultured Müller glia cells from chick retina was studied. Treatment of the cells with the Ca(2+)/diacylglycerol dependent protein kinase C (PKC) activator, phorbol 12-tetradecanoil-13-acetate (TPA) produced a decrease in [(3)H]D-aspartate uptake which was reversed by staurosporine and partially by H7 [1-(5-isoquinolinesulfonyl)-2-methylpiperazine dihydrochoride], two PKC inhibitors. Long-term treatment with TPA resulted in a drastic decrease in the uptake activity, correlated with a substantial fall in the expression of the transporter protein. These findings suggest that PKC is involved in transport modulation at two different levels: phosphorylation and transporter expression in retinal Müller glial cells.

Capillary zone electrophoresis with indirect UV detection of haloacetic acids in water.

A capillary zone electrophoresis (CZE) system for determining haloacetic acids in water was optimized with indirect photometric detection. Two different carrier electrolytes, potassium hydrogenphthalate and sodium 2,6-naphthalenedicarboxylate, were evaluated in terms of sensitivity and two different electroosmotic flow modifiers, tetradecyltrimethylammonium bromide and hexadecyltrimethylammonium bromide, were tested. Parameters such as electrolyte concentration and pH, and the concentration of the electroosmotic flow modifiers, which affect the CZE separations, were investigated. The method was used to determine haloacetic acids in chlorine tap water using the liquid-liquid extraction process.

Heterogeneous distribution of acetylcholine receptors in chick myocytes induced by cholesterol enrichment.

The cholesterol concentration at the cell surface of cultured chick myocytes was increased in order to determine the effects of high levels of cholesterol on the ion channel properties of the nicotinic acetylcholine receptor. Single channel recordings and fluorescence polarization studies using 1,6-diphenyl-1,3,5-hexatriene (DPH) were performed under equivalent conditions for normal and cholesterol enriched myocytes. In cell attached patches from myocytes with a cholesterol to phospholipid molar ratio (c/p) of 0.24 and a microviscosity of 1.35 poise a single conductance of 51 pS was detected. The cholesterol enriched myocytes with a c/p of 0.52 and a microviscosity of 2.05 poise showed two conductances, a 54 pS and a 39 pS channel: both were blocked by alpha-bungarotoxin. The 39 pS channel was detected with the simultaneous appearance of a slow component of tau m (modulation time) for DPH fluorescence measured by phase demodulation. The 80% reduction in the open time constant (tau 2) of the 39 pS channel suggest an inhibition of the normal conformational state. The combined results suggest that cholesterol enrichment may induced a more heterogeneous lipid environment and that the two types of channel properties could result from the distribution of the receptors in different domains.