[Minor amputations - a maxi task. Part 1: From the principles to transmetatarsal amputation]. / Minor-Amputationen - eine "Maxi-Aufgabe". Teil 1: Von den Grundlagen bis zur transmetatarsalen Amputation.

A threatening major amputation represents a fateful turning point for diabetics. This occurs in 50% of cases of amputations in diabetics. This increases the demand for another therapeutic route not only because of the limitations in quality of life but also due to substantially higher mortality. Even if an osteomyelitic ischemic situation is often present specialized centers have succeeded in substantially reducing the rate of major amputations in such patients. The term "minor amputation" commonly used in vascular surgery is not uniformly understood. Following the "vascular surgery working model" developed by Rümenapf, the significance of "minor amputations" for retention of extremities and the associated controversies have been shown. "Minor amputations" therefore represent a maxi-task if patients undergoing such a procedure are to be timely and competently treated. The necessary interdisciplinary cooperation with other specialists should in the future also include orthopedic surgeons.

[Minor amputations: a maxi task : Part 2: From transmetatarsal amputation to hindfoot amputation]. / Minor-Amputationen - eine "Maxi-Aufgabe" : Teil 2: Von der transmetatarsalen Amputation bis zur Rückfußamputation.

The definitive aim of a minor amputation is limited resection with retention of feet and legs resulting in a completely loadable extremity, in contrast to the lower leg stump. A shift in the amputation level in the sense of a shortening is inevitably accompanied by a reduction in the stand area, an increase in axial pressure and a disruption of muscle equilibrium in the extent of movement of the rest of the foot. This knowledge forms the central issue for further treatment of minor amputations in addition to the subtle treatment of the skin of the sole for coverage of a tension-free tip of the stump. Advantageous are longitudinal partial amputations of the forefoot and midfoot.

Somatic cell count in milk of selenium-supplemented dairy cows after an intramammary challenge with Staphylococcus aureus.

The objective of this study was to evaluate the effect of selenium (Se) supplementation on milk somatic cell count (SCC) in dairy cows. Twelve multiparous Holstein-Friesian cows were fed a diet containing a suboptimal Se concentration (<0.05 ppm, dry basis) starting 2 months before calving. Supplemented cows (n=6) received a single s.c. injection of barium selenate (1 ml/50 kg BW) 45 days prior to calving, whereas control group was kept unsupplemented. Twenty weeks after calving, two mammary quarters (right side) of each cow were challenged with 205,000 cfu/ml of Staphylococcus aureus (strain Newbould 305). Blood was collected bi-weekly until day 150 of lactation for the analysis of blood glutathione peroxidase (GPx1; EC 1.11.1.9) activity. To re-isolate the challenging pathogen and to evaluate SCC, aseptic milk samples were collected daily starting on the day of challenge, and finishing 7 days after inoculation. Unsupplemented cows had a lower activity of GPx1 through the experiment (P<0.001). Natural log SCC (lnSCC) was higher in unsupplemented than Se-supplemented cows (P=0.04), showing evidence of significance after 5 days. Selenium supplementation of dairy cows fed a diet containing a suboptimal Se concentration, resulted in higher blood activity of GPx1, and lower mean lnSCC after an intramammary challenge with Staph. aureus.

En las primeras infecciones urinarias febriles en niños, la ecografía permite diagnosticar anomalías clínicamente relevantes, no relacionadas con el reflujo vesicoureteral / Ultrasonography after the first febrile urinary tract infection in children permits to diagnose clinically relevant abnormalities, not related to vesicoureteral reflux

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Effect of grazing pasture with a low selenium content on the concentrations of triiodothyronine and thyroxine in serum, and GSH-Px activity in erythrocytes in cows in Chile.

AIM: To determine the effect of grazing pasture that had a low selenium (Se) concentration on serum concentrations of triiodothyronine (T3) and thyroxine (T4), and erythrocyte glutathione peroxidase (GSH-Px) activity in dairy cows. METHODS: Forty pregnant Friesian cows were grazed on pasture that contained 0.03-0.04 ppm Se on a dry matter (DM) basis. Two months before parturition, 20 cows were randomly selected and treated with 1 mg Se/kg bodyweight subcutaneously, as barium selenate (Group Se-S). The other group (Se-D) was not supplemented. Blood samples were taken before supplementation (-60 days) and 30, 60, 90, 180 and 270 days after parturition, for determination of concentrations of T3 and T4 in serum, and GSH-Px activity in erythrocytes. RESULTS: Erythrocyte GSH-Px activity in the Se-D group was <60 U/g haemoglobin (Hb) throughout the experiment. Supplementation increased (p<0.05) activities to >130 U/g Hb throughout lactation. Mean serum concentrations of T4 in Se-D and Se-S cows increased from 23.7 (SEM 0.7) and 23.4 (SEM 0.8) nmol/L, respectively, in the prepartum period to 69.6 (SEM 0.1) and 67.6 (SEM 0.2) nmol/L, respectively, at 180 days of lactation (p<0.01), and no effect of Se supplementation was evident. Serum concentrations of T3 in Se-D cows decreased (p<0.05) from 1.6 (SEM 0.1) nmol/L prepartum to 1.0 (SEM 0.2) nmol/L at the beginning of lactation, and remained lower (p<0.05) than those in the Se-S cows which did not decrease after calving and ranged from 1.9 (SEM 0.1) to 2.4 (SEM 0.2) nmol/L throughout lactation. CONCLUSIONS: Serum T3 concentrations decreased during early lactation in unsupplemented cows grazing pastures low in Se (0.03-0.04 ppm) and both serum T3 and erythrocyte GSHPx activities were consistently lower throughout lactation compared with Se-supplemented cows. Se supplementation had no effect on serum T4 concentrations.

Cementoblastoma benigno: caso clínico y revisión de la literatura / Benign cementoblastoma: report of a case and review of the literature

El cementoblastoma benigno o cementoma verdadero se describe como una lesión poco común que se presenta con mayor frecuencia en pacientes menores de 25 años no existiendo predilección por el sexo. La lesión es de crecimiento lento y puede causar expansión de las corticales del hueso asociadas, sin embargo es por lo general asintomática. Radiográficamente se observa una masa radioopaca, densa y circunscripta adherida a la raiz del diente. Se presenta un caso clínico de una pciente del sexo femenino, 31 años de edad, que consulta en el servicio de Cirugía Maxilofacial Hospital Carlos Van Buren, Valparaíso. Se realiza una revisión de la literatura, en relación a aspectos clínicos, radiográficos, histológicos, diagnóstico diferncial y alterantivas de tratamiento

Stability of alkoxycarbonylamidine prodrugs.

PURPOSE: Alkoxycarbonylamidine prodrug modification was used to mask the positively-charged amidine moiety of an Arg-Gly-Asp peptidomimetic and enhance oral bioavailability. The aqueous stability of ethoxycarbonylamidine (ECA), ethanethiocarbonylamidine (ETCA) and phenoxycarbonylamidine (PCA) prodrugs was examined. METHODS: Degradation was followed by RP-HPLC and rate constants were determined from a degradation scheme defined by product analysis. RESULTS: ECA gave a pH of maximum stability at pH approximately 7 and was independent of pH below pH approximately 4. A novel degradation pathway of ECA, conversion to ethoxycarbonyl- aminocarbonyl, was observed below pH 7. The relative rates below pH 7 were ECA approximately ETCA < PCA, in the same order of decreasing pKa of the conjugate acid of the substituted amidino group. Base-catalyzed cleavage of ECA to yield the amidine derivative gave the relative rates ECA < ETCA < PCA, in agreement with the decreasing pKa of the leaving groups. CONCLUSIONS: The observed rate constants at all pHs were small enough that only 5-30% (depending on the substituent) undesirable degradation is predicted during transit time of the gut. The spontaneous post-absorptive conversion to the amidine drugs at neutral pH is predicted to be 6x greater for the PCA than the ECA prodrugs.

From peptide to non-peptide. 3. Atropisomeric GPIIbIIIa antagonists containing the 3,4-dihydro-1H-1,4-benzodiazepine-2,5-dione nucleus.

The benzodiazepinedione class of non-peptidal GPIIbIIIa antagonists has been modified to allow the isolation of noninterconverting rotational isomers, or atropisomers, with the aim of examining their structure-activity relationships as compared to active RGD-containing peptides and other non-peptidal antagonists. Resolution of these antagonists was accomplished by the introduction of a tert-butyl group at N1 and a chlorine at C9 on the 3,4-dihydro-1H-1,4-benzodiazepine-2,5-dione nucleus and enantiospecific substitution on the beta-alanine side chain attached to N4. The relative configuration was determined by single-crystal X-ray analysis. Further, conformational analyses using ab initio calculations were performed to assess the conformational preferences about the beta-alanine side chain. The data support a good topographical correlation between the benzodiazepinedione class of antagonists and the "cupped" presentation of the RGD tripeptide sequence found in the cyclic peptide G4120. The relationship between these compounds with other peptidal and non-peptidal antagonists is discussed.

Stress response and drug metabolism in mice.

A modified stress model was studied to investigate the relationship between the stress response and drug metabolism in mice. Stress was induced in male CD-1 mice by a daily i.p. injection of hypertonic (1.5 M) saline for up to 3 days, whereas control animals received isotonic (0.15 M) saline. Two hours after receiving the saline injection on the first, second, and third day, animals were euthanized, and serum corticosterone (CORT) and liver aminopyrine N-demethylase (AD) and aniline hydroxylase (AH) activities were determined. To detect any effect of osmotic stimulation, a second control group was given 1.5 M saline as drinking water. There was no difference in CORT levels, AD activity, or AH activity between untreated animals and 0.15 M saline treatment. Intra-peritoneal injection of 1.5 M saline markedly increased serum CORT concentrations compared to 0.15 M saline regardless of the duration of the treatment. Injection of 1.5 M saline also decreased both hepatic enzyme activities each time point. Osmotic stimulation alone by hypertonic drinking water had no significant effect on CORT levels, AD activity, or AH activity. In another series of experiments, intact, sham-operated, and adrenalectomized mice were exposed to the stress model. Injected hypertonic saline decreased AD and AH activities in intact and sham-operated animals compared to isotonic saline-treated animals but both enzyme activities were reduced after adrenalectomy regardless of saline treatment used. In conclusion, a suitable model was established to study the interactions between the stress response and the hepatic drug metabolism in mice.

Estrogen production by bovine binucleate and mononucleate trophoblastic cells in vitro.

The bovine placenta has long been known as a source of steroid hormones. We performed three experiments to compare production of estrogens by bovine mononucleate and binucleate trophoblastic cells and examined effects of cortisol, progesterone, pregnenolone, testosterone, and androstenedione. In the first experiment, binucleate trophoblastic cells were purified by unit gravity sedimentation from six enzymatically dispersed placentas between 150 and 180 days of gestation. Cells (8 x 10(5)/ml) were incubated first at 37 degrees C for 6 h with Medium 199 alone (M199/6h) or with 10(-7) M cortisol (cortisol/6h). Medium then was replaced with 10(-7) M progesterone, 10(-7) M pregnenolone, 10(-7) M testosterone, or M199, and a second incubation was conducted for 4 h. Estradiol production did not differ between cells incubated for the first 6 h in M199 vs. cortisol and was not affected by progesterone or pregnenolone. Testosterone increased (p < 0.05) estradiol production. Estrone production did not differ between cells incubated for the first 6 h in M199 vs. cortisol; estrone production was not affected by either progesterone, pregnenolone, or testosterone. Mononucleate as well as binucleate cells were purified from placentas between 165 and 180 days of gestation and used in two other experiments. In the first of these, enriched populations of binucleate and mononucleate cells were incubated first for 6 h with Medium 199 (M199) or 10(-7) M cortisol. Medium then was replaced with 10(-7) M testosterone, 10(-7) M androstenedione, or M199 and incubation continued for 4 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheter-related bacteremia and fungemia. Reliability of two methods for catheter culture.

The purpose of this study was to analyze 98 febrile patients with suspected catheter-related bacteremia (CRB) or fungemia (CRF) and compare two different methods, one semiquantitative (SQ) (Maki's method) and the other quantitative (Q) (modification of Brun-Buisson method) to determine each ability for diagnosing CRB. Twelve patients had CRB or CRF. The sensitivity, specificity, positive, and negative predictive values, and efficiency using the Maki method were 83%, 84%, 42%, 97%, and 83%, respectively. The same parameters using the other method were as follows: 92%, 84%, 44%, 99%, and 84%, respectively. Although the diagnostic reliability in each method was similar, the Maki method was quicker and easier to perform in clinical microbiology laboratories.

[Exulceratio simplex Dieulafoy]. / Die Exulceratio simplex Dieulafoy.

"Exulceratio simplex Dieulafoy" is a rare cause of massive upper gastrointestinal haemorrhage from a submucosal artery. Dieulafoy's disease is rarely recognized. We present 9 cases of Dieulafoy's lesion and have collected 176 cases described in the literature.

Effects of hemolysis and storage on quantification of hormones in blood samples from dogs, cattle, and horses.

Veterinary diagnostic endocrinology laboratories frequently receive hemolyzed plasma, serum, or blood samples for hormone analyses. However, except for the previously reported harm done by hemolysis to canine insulin, effects of hemolysis on quantification of other clinically important hormones are unknown. Therefore, these studies were designed to evaluate effects of hemolysis on radioimmunoassay of thyroxine, 3,5,3'-triiodothyronine, progesterone, testosterone, estradiol, cortisol, and insulin in equine, bovine, and canine plasma. In the first experiment, hormones were measured in plasma obtained from hemolyzed blood that had been stored for 18 hours. Blood samples were drawn from pregnant cows, male and diestrous female dogs, and male and pregnant female horses. Each sample was divided into 2 equal portions. One portion was ejected 4 times with a syringe through a 20-gauge (dogs, horses) or 22-gauge (cows) hypodermic needle to induce variable degrees of hemolysis. Two subsamples of the blood were taken before the first and after the first, second, and fourth ejections. One subsample of each pair was stored at 2 to 4 C and the other was stored at 20 to 22 C for 18 to 22 hours before plasma was recovered and stored at -20 C. The second portion of blood from each animal was centrifuged after collection; plasma was recovered and treated similarly as was blood. Concentrations of thyroxine in equine plasma, of 3,5,3'-triiodothyronine, estradiol, and testosterone in equine and canine plasma, and of cortisol in equine plasma were not affected by hemolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Monitoring of somatosensory evoked potentials in carotid surgery: results, usefulness and limitations of the method.

We have monitored cortical somatosensory evoked potentials (SEP) during 177 carotid operations (167 carotid endarterectomies). An intraluminal shunt was always used for endarterectomy of the internal carotid artery (CEA). SEP was not readable in 21 operations. During 126 carotid operations, no alteration of SEP occurred. However, three patients had an immediate postoperative neurologic deficit while the SEP remained normal. Abnormal SEP occurred in 30 patients. In two cases irreversible loss of SEP was seen. Both patients awoke with a new neurologic deficit after the operation. We found reversible abnormal SEP in 28 cases. In 63 cases with contralateral stenosis, abnormal SEP caused by carotid clamping was observed in 15 (24%). The diagnostic sensitivity of intraoperative SEP monitoring in predicting neurologic outcome following carotid operation was 100% with a specificity of 40%. Monitoring of SEP during carotid surgery is a reliable and useful method to detect incipient cerebral ischemia and to determine the need for shunting. The prognostic value of SEP monitoring to predict postoperative neurologic deficits is limited by the low specificity of the method.