Lumbar Spinal Stenosis Severity by CT or MRI Does Not Predict Response to Epidural Corticosteroid versus Lidocaine Injections.

BACKGROUND AND PURPOSE: Epidural steroid injections may offer little-to-no short-term benefit in the overall population of patients with symptomatic spinal stenosis compared with lidocaine alone. We investigated whether imaging could identify subgroups of patients who might benefit most. MATERIALS AND METHODS: A secondary analysis of the Lumbar Epidural Steroid Injections for Spinal Stenosis prospective, double-blind trial was performed, and patients were randomized to receive an epidural injection of lidocaine with or without corticosteroids. Patients (n = 350) were evaluated for qualitative and quantitative MR imaging or CT measures of lumbar spinal stenosis. The primary clinical end points were the Roland-Morris Disability Questionnaire and the leg pain numeric rating scale at 3 weeks following injection. ANCOVA was used to assess the significance of interaction terms between imaging measures of spinal stenosis and injectate type on clinical improvement. RESULTS: There was no difference in the improvement of disability or leg pain scores at 3 weeks between patients injected with epidural lidocaine alone compared with corticosteroid and lidocaine when accounting for the primary imaging measures of qualitative spinal stenosis assessment (interaction coefficients for disability score, -0.1; 95% CI, -1.3 to 1.2; P = .90; and for the leg pain score, 0.1; 95% CI, -0.6 to 0.8; P = .81) or the quantitative minimum thecal sac cross-sectional area (interaction coefficients for disability score, 0.01; 95% CI, -0.01 to 0.03; P = .40; and for the leg pain score, 0.01; 95% CI, -0.01 to 0.03; P = .33). CONCLUSIONS: Imaging measures of spinal stenosis are not associated with differential clinical responses following epidural corticosteroid injection.

Specific neurotrophic factors support the survival of cortical projection neurons at distinct stages of development.

Repair of specific neuronal circuitry in the neocortex may be possible via neural precursor transplantation or manipulation of endogenous precursors in situ. These approaches will almost certainly require a detailed understanding of the mechanisms that control survival and differentiation of specific neuronal lineages. Such analysis has been hampered by the overwhelming diversity of neuronal types intermixed in neocortex and the inability to isolate individual lineages. To elucidate stage-specific controls over the survival of individual lineages of cortical neurons, we purified immature callosal projection neurons (CPN) at distinct stages of development from embryonic and postnatal mouse cortex by retrograde fluorescence labeling, followed by fluorescence-activated cell sorting. Purified CPN survive well in culture, acquire stage-specific projection neuron morphologies, and express appropriate neurotransmitters and growth factor receptors. Purified CPN are dependent on exogenous trophic support for survival in a stage-specific manner. Survival of postnatal day 2 (P2) to P3 and P6-P7 CPN is promoted by overlapping but distinct sets of neurotrophic factors, whereas embryonic day 19 CPN show less specificity of dependence on peptide factors. These studies demonstrate for the first time the stage-specific control by peptide growth factors over the survival of a specific cortical neuronal lineage. Such information may be critical for the future goal of directed differentiation of transplanted or endogenous precursors toward cellular repair of complex cortical circuitry.

Valoración de los informes médicos recibidos del segundo nivel / Evaluation of the medical reports received from the second care level

Objetivos. Cuantificar la tasa de interconsulta mensual (TIM), porcentaje de informes médicos recibidos, calidad de éstos y tiempo de demora de la primera consulta al segundo nivel. Diseño. Estudio descriptivo, transversal. Emplazamiento. Centro de salud rural. Muestra. Las 498 primeras consultas solicitadas al segundo nivel de 3 cupos de médicos de familia desde junio a noviembre de 1999. Se excluyeron 132 por presentar algún criterio de exclusión (consultas entre el segundo nivel, revisiones, consultas a las que el paciente no acudió y aquellas que no se pudieron registrar), quedando un tamaño muestral de 366 (n).Mediciones y resultados. La TIM media fue del 34 . Los servicios de oftalmología (21,9 por ciento), ginecología (15,3 por ciento) y traumatología (13,9 por ciento) fueron los más solicitados. Se recibieron 69 informes (18,8 por ciento), quedando 297 (81,2 por ciento) sin recibir. Los servicios de neumología (100 por ciento) y medicina interna (81,8 por ciento) fueron los que más informes remitieron, mientras que hematología y rehabilitación (0 por ciento) fueron los que menos. La puntuación media de los informes fue de 8 ñ 2 sobre un máximo de 10. La demora media fue de 73 ñ 46 días. Conclusión. La TIM se encuentra entre los valores descritos en la bibliografía. El porcentaje de informes recibidos es muy inferior a lo hallado en la bibliografía, pero su calidad es buena (AU)

[Enteroendocrine cells modifications in Helicobacter pylori gastritis]. / Modificaciones de las células enteroendócrinas en gastritis por Helicobacter pylori.

OBJECTIVE: The aim of the present study was to analyze the modifications in the number and distribution of enteroendocrine cells (EEC) in antrum of patients with Helicobacter pylori (HE) gastritis. We also wanted to demonstrate their possible participation in the immune response. MATERIAL AND METHODS: Twenty-six (26) biopsies of gastric antrum from patients between the ages of 40 and 60 were used. Slides were stained with H&E, Giemsa for HP, and chromogranin A to visualize EEC. Five (5) patients were normal controls. Eleven (11) patients had antral chronic gastritis (ACG) with different grades of activity, and ten (10) patients had multifocal atrophic gastritis (MAG), both groups associated to HP. EEC were quantified in relation to 100 epithelial cells. Results were statistically compared. RESULTS: In the normal control group, EEC were sparsely distributed, deep in antral glands, with an average 19.51 EEC/100 epithelial cells. In ACG there were 12.01/100. Besides EEC were irregularly distributed, close to inflammatory areas, or near lymphoid follicles. CONCLUSION: The decrease in EEC is probably due to degranulation and later to a disappearance or inhibition of stem cells by inflammatory products in HP gastritis. The proximity of EEC to prominent inflammatory zones may indicate EEC modulate the immune response. They produce and excrete peptides that interact with membrane receptors found in T lymphocytes and macrophages.

Modificaciones de las células enteroendocrinas en gastritis por Helicobacter pylori / Enteroendocrine cells modifications in Helicobacter pylori gastritis

Objetivo: Estudiar las modificaciones en número y distribución de las células entero endocrinas (CEE) en el antro gástrico de pacientes con infección por Helicobacter pylori (HP), para demostrar su participación en la respuesta inmune. Material y Método: Se utilizaron biopsias de antro gástrico de veintiseis (26) pacientes, entre 40 y 60 años de edad. Las muestras se colorearon con HE y giemsa modificado e inmunomarcaron con Cromogranina A. Cinco pacientes integraron el grupo control. Once pacientes mostraron gastritis crónica activa y los diez restantes gastritis atrófica multifocal (AMF), ambas asociadas a HP. Las CEE se cuantificaron refiriéndoselas cada 100 células epiteliales y se evaluó el patrón de distribución de las mismas. Resultados: En antros de pacientes controles (normales), la distribución de las CEE relacionadas fue uniforme con una media de 19,51 CEE/100. En los procesos inflamatorios, se detectó 12.01 CEE/100 en las gastritis crónicas y 6.31 CEE/100 en las AMF. Asimismo se observó una distribución irregular de las CEE relacionadas con áreas inflamatorias o con folículos linfoides. Conclusiones: La disminución de las CEE correspondería a una degranulación y luego debido a la agresión del HP, a la desaparición o inhibición de las stem cell hacia la línea endócrina. La persistencia de CEE en proximidad a las áreas de mayor infiltrado inflamatório, sugeriría su participación modulando esta respuesta, probablemente liberando péptidos que interactúan con linfócitos T, macrófagos y eosinófilos. Las CEE en el antro gástrico tendrían una intervención activa en la reacción inmune provocada por el HP.

Modificaciones de las células enteroendócrinas en gastritis por Helicobacter pylori. / [Enteroendocrine cells modifications in Helicobacter pylori gastritis]

OBJECTIVE: The aim of the present study was to analyze the modifications in the number and distribution of enteroendocrine cells (EEC) in antrum of patients with Helicobacter pylori (HE) gastritis. We also wanted to demonstrate their possible participation in the immune response. MATERIAL AND METHODS: Twenty-six (26) biopsies of gastric antrum from patients between the ages of 40 and 60 were used. Slides were stained with H&E, Giemsa for HP, and chromogranin A to visualize EEC. Five (5) patients were normal controls. Eleven (11) patients had antral chronic gastritis (ACG) with different grades of activity, and ten (10) patients had multifocal atrophic gastritis (MAG), both groups associated to HP. EEC were quantified in relation to 100 epithelial cells. Results were statistically compared. RESULTS: In the normal control group, EEC were sparsely distributed, deep in antral glands, with an average 19.51 EEC/100 epithelial cells. In ACG there were 12.01/100. Besides EEC were irregularly distributed, close to inflammatory areas, or near lymphoid follicles. CONCLUSION: The decrease in EEC is probably due to degranulation and later to a disappearance or inhibition of stem cells by inflammatory products in HP gastritis. The proximity of EEC to prominent inflammatory zones may indicate EEC modulate the immune response. They produce and excrete peptides that interact with membrane receptors found in T lymphocytes and macrophages.

Modificaciones de las células enteroendocrinas en gastritis por Helicobacter pylori / Enteroendocrine cells modifications in Helicobacter pylori gastritis

Objetivo: Estudiar las modificaciones en número y distribución de las células entero endocrinas (CEE) en el antro gástrico de pacientes con infección por Helicobacter pylori (HP), para demostrar su participación en la respuesta inmune. Material y Método: Se utilizaron biopsias de antro gástrico de veintiseis (26) pacientes, entre 40 y 60 años de edad. Las muestras se colorearon con HE y giemsa modificado e inmunomarcaron con Cromogranina A. Cinco pacientes integraron el grupo control. Once pacientes mostraron gastritis crónica activa y los diez restantes gastritis atrófica multifocal (AMF), ambas asociadas a HP. Las CEE se cuantificaron refiriéndoselas cada 100 células epiteliales y se evaluó el patrón de distribución de las mismas. Resultados: En antros de pacientes controles (normales), la distribución de las CEE relacionadas fue uniforme con una media de 19,51 CEE/100. En los procesos inflamatorios, se detectó 12.01 CEE/100 en las gastritis crónicas y 6.31 CEE/100 en las AMF. Asimismo se observó una distribución irregular de las CEE relacionadas con áreas inflamatorias o con folículos linfoides. Conclusiones: La disminución de las CEE correspondería a una degranulación y luego debido a la agresión del HP, a la desaparición o inhibición de las stem cell hacia la línea endócrina. La persistencia de CEE en proximidad a las áreas de mayor infiltrado inflamatório, sugeriría su participación modulando esta respuesta, probablemente liberando péptidos que interactúan con linfócitos T, macrófagos y eosinófilos. Las CEE en el antro gástrico tendrían una intervención activa en la reacción inmune provocada por el HP. (Au)

Transplanted neuroblasts differentiate appropriately into projection neurons with correct neurotransmitter and receptor phenotype in neocortex undergoing targeted projection neuron degeneration.

Reconstruction of complex neocortical and other CNS circuitry may be possible via transplantation of appropriate neural precursors, guided by cellular and molecular controls. Although cellular repopulation and complex circuitry repair may make possible new avenues of treatment for degenerative, developmental, or acquired CNS diseases, functional integration may depend critically on specificity of neuronal synaptic integration and appropriate neurotransmitter/receptor phenotype. The current study investigated neurotransmitter and receptor phenotypes of newly incorporated neurons after transplantation in regions of targeted neuronal degeneration of cortical callosal projection neurons (CPNs). Donor neuroblasts were compared to the population of normal endogenous CPNs in their expression of appropriate neurotransmitters (glutamate, aspartate, and GABA) and receptors (kainate-R, AMPA-R, NMDA-R. and GABA-R), and the time course over which this phenotype developed after transplantation. Transplanted immature neuroblasts from embryonic day 17 (E17) primary somatosensory (S1) cortex migrated to cortical layers undergoing degeneration, differentiated to a mature CPN phenotype, and received synaptic input from other neurons. In addition, 23.1 +/- 13.6% of the donor-derived neurons extended appropriate long-distance callosal projections to the contralateral S1 cortex. The percentage of donor-derived neurons expressing appropriate neurotransmitters and receptors showed a steady increase with time, reaching numbers equivalent to adult endogenous CPNs by 4-16 weeks after transplantation. These results suggest that previously demonstrated changes in gene expression induced by synchronous apoptotic degeneration of adult CPNs create a cellular and molecular environment that is both permissive and instructive for the specific and appropriate maturation of transplanted neuroblasts. These experiments demonstrate, for the first time, that newly repopulating neurons can undergo directed differentiation with high fidelity of their neurotransmitter and receptor phenotype, toward reconstruction of complex CNS circuitry.

Eficacia y seguridad de la cefodizima en el tratamiento de pacientes con infección complicada de las vías urinarias o pielonefritis aguda no complicada / Efficiency and safeness of cefodizime in the treatment of patients with complicated urinary tract infection or acute uncomplicated pielonephritis

Se presentan los resultados de un estudio clínico abierto binacional, no controlado, llevado a cabo en 85 pacientes hospitalizados con infección complicada del tracto genitourinario o pielonefritis aguda no complicada, tratados con 1 g de cefodizima una vez al día, administrada parenteralmente por inyección intramuscular o intravenosa o perfusión, durante siete a 10 días (mínimo cinco días y máximo 14). El objetivo principal fue evaluar la eficacia y seguridad del tratamiento. La tasa de curación clínica fue alcanzada en el 92.7 por ciento de los pacientes tratados con cefodizima, observando una marcada remisión de los signos y síntomas clínicos al final del tratamiento. La erradicación bacteriológica fue observada en 95.9 por ciento de los enfermos. El microorganismo aislado con mayor frecuencia fue Eschirichia coli (80.2 por ciento). La cefodizima fue bien tolerada, con escasos y leves eventos adversos. Se concluye que 1 g de cefodizima administrada parenteralmente una vez al día en pacientes hospitalizados con infección complicada de vías urinaria con pielonefritis aguda no complicada es un tratamiento eficaz y seguro

Eficacia y seguridad de la cefodizima en el tratamiento de pacientes con infección de vías respiratorias bajas adquirirdas en la comunidad / Efficiency and safeness of cefodizime in the treatment of patients with community acquired of low respiratory tract

Se presentan los resultados de un estudio clínico abierto, no controlados, binacional, conducido en 73 pacientes hospitalizados con infecciones de vías respiratorias bajas adquiridas en la comunidad, tratados con 1 g de cefodizima una vez al días (OAD) administrada parenteralmente por inyección intramuscular, intravenosa o por infusión endovenosa. El objetivo fue evaluar la eficacia y seguridad del medicamento. La curación clínica, se evaluó por la desparición y/o mejoría de los síntomas relacionados a la infección (esputo purulento, tos, disnea y dolor torácico) y la resolución de la fiebre (ó 38ºC). La tasa de éxito se obtuvo en el 92.3 por ciento de los pacientes. La erradicación bacteriológica fue del 98 por ciento. Los microorganismos patógenos aislados con mayor frecuencia fueron: S. pneumoniae (53 por ciento), S aureus (20 por ciento) y K. pneumoniae (10 por ciento). En tres pacientes, los eventos adversos clínicos fueron considerados posiblemente relacionados con la medicación en estudio. Los resultados clínicos muestran que 1 g de cefodizima adminstrada una vez al día es un tratamiento eficaz y seguro en el tratamiento de pacientes adultos hospitalizados con neumonía adquirida en la comunidad

Development of a research-based standard for assessment, intervention, and evaluation of pain after neonatal and pediatric cardiac surgery.

This analysis of retrospective and prospective data quantified children (age range 0-18 years, total n = 132) during their stay in a cardiothoracic intensive care unit and examined pain management and sedation practices. Data on both factors that could potentially affect pain and its management, and analgesics/sedatives ordered for and administered to subjects were collected from chart review. In the prospective group, pain intensity was measured twice daily using the Wong-Baker FACES Pain Rating Scale. Repeat cardiac surgical procedure subjects reported significantly more pain than nonrepeat subjects on the first postoperative night. Subjects with sternal incisions reported significantly more pain than subjects with submammary incisions. Not all subjects were premedicated with analgesia for invasive procedures. Significantly greater amounts of analgesia were received by the 0-3 year-old subjects. Large amounts of sedation were used, especially in children under 3 years of age. The results prompted development of a nursing standard to assess and manage pain and sedation in this population.

Bacterial translocation occurs in humans after traumatic injury: evidence using immunofluorescence.

UNLABELLED: We evaluated the occurrence of bacterial translocation (BT) in humans after traumatic injury. Twenty trauma patients (18 with blunt trauma) requiring celiotomy and without hollow viscus injury were studied. After surgical hemostasis and repair, portal venous blood (PVB) was sampled for culture. Additionally, a mesenteric lymph node (MLN) was harvested for culture and indirect immunofluorescence analysis using, first, mouse monoclonal antibody to E. coli beta-galactosidase, then goat anti-mouse immunoglobulin G (IgG). Injury Severity Score (ISS), Trauma Score (TS), and period of hemorrhagic shock (HS; systolic BP < 90 mm Hg with blood loss > 500 mL) were recorded before specimens were obtained. RESULTS: Fifteen patients initially had HS (mean period of 60 minutes). Mean TS and ISS were 10 and 29, respectively. Seven patients did not have HS (mean TS and ISS, 10 and 13). Three patients received antibiotics preoperatively. Portal venous blood culture produced positive results in only three patients (two with HS) and culture of the MLN specimen was positive in one. However E. coli beta-galactosidase was detected within the cytoplasm of macrophages in all MLNs. One patient developed multiple organ failure. CONCLUSION: Bacterial translocation occurs in humans following traumatic injury and may be independent of HS. Culture techniques may not detect BT since organisms may have been phagocytized by macrophages. The clinical significance of BT in trauma patients remains unclear.

[Carney's triad: a short review apropos a case]. / Tríada de Carney: breve revisión a propósito de un caso.

We communicate a case with the Carney triad (gastric leiomyosarcoma, pulmonary chondromatosis and extra-adrenal paraganglioma). It is, to our knowledge, the first case to be communicated in the Spanish scientific literature. We discuss some peculiar aspects of the debut and clinical evolution of this syndrome, together with its prognosis. We conclude that in clinical practice, the appearance in a young subject, specifically females, of multiple gastric myogenic tumors, should elicit the performance of further noninvasive procedures, needed to discard the diagnosis of the Carney triad.