Intervención de ejercicios de habilidad motora manual en el dolor y función en sujetos adultos con artritis reumatoide: serie de casos / Intervention of manual motor skill exercises on pain and function in ality adults subjets with rheumatoid arthritis: case series

Introducción: La artritis reumatoide tiene un significativo impacto negativo en la capacidad para realizar labores diarias, incluyendo el trabajo, las tareas del hogar y la calidad de vida. Los hallazgos experimentales y clínicos sugieren que el reentrenamiento de la habilidad motora puede proporcionar mejoras en pacientes con dolor crónico de muñeca y mano. Objetivo: Describir los cambios en la función manual, en la fuerza de puño y en el dolor, a la sexta semana y al tercer mes tras la aplicación de ejercicios enfocados en la habilidad motora manual en adultos con artritis reumatoide. Método: Estudio de diseño no experimental, descriptivo serie de casos, muestra 17 participantes con diagnóstico de artritis reumatoide. Los pacientes realizaron un programa de ejercicios enfocados en la habilidad motora manual durante 6 semanas. Se midieron las variables de función, dolor, fuerza de puño y pinza, a la sexta semana y al tercer mes. Resultados: No existe diferencia significativa en la intensidad del dolor, función y fuerza de puño, postintervención p > 0,05. Existe diferencia significativa a la sexta semana en la fuerza de pinza p = 0,002. Durante el seguimiento al tercer mes solo hubo diferencia significativa en la fuerza de puño p = 0,01. Conclusión: La aplicación de un programa de ejercicios enfocados en la habilidad motora manual generó cambios a nivel de la fuerza de puño y pinza. Con respecto a la funcionalidad e intensidad del dolor no se apreciaron diferencias significativas (AU)

Introduction: Rheumatoid arthritis has a significant negative impact on the ability to perform daily tasks, including work, household chores and quality of life. Experimental and clinical findings suggest that retraining of motor skills may provide improvements in patients with chronic pain the wrist and hand. Objective: To describe the changes in the manual function, the grip strength and pain, to the sixth week and to the third month after the application of exercises focused on manual motor skills, in adults with rheumatoid arthritis. Method: Non-experimental design study, descriptive case series, sample 17 participants with diagnosis of rheumatoid arthritis. The patients performed a program of exercises focused on manual motor skill for 6 weeks. Were measured at the variables of function, the grip strength , digtal clamp and pain, the sixth week and at the third month. Results: There was no significant difference in pain intensity, function and the grip strength, post intervention p > 0,05. There was significant difference at the sixth week in the digital clamp p = 0.002. During follow-up at the third month, there was only significant difference in the grip strength p = 0.01. Conclusion: The application of a program of exercises focused on the manual motor skill, generated changes a level of the grip strength and clamp. Regarding the functionality and intensity of pain, there were no significant differences (AU)

Prosthetic valve endocarditis caused by Pasteurella dagmatis.

This case of prosthetic valve endocarditis due to Pasteurella dagmatis is the first to be reported in the English language medical literature. The two reported cases of native valve endocarditis due to P dagmatis are reviewed, and the treatment of Pasteurella-induced endocarditis is discussed.

New water equivalent liquid scintillation solutions for 3D dosimetry.

Despite recent advances in radiochromic film and gel dosimetry techniques, radiation therapy still lacks an efficient, accurate, and convenient dose measurement method capable of measuring the dose simultaneously over a plane or a volume (3D). A possibility for creating such a 3D method based on observing scintillation photons emitted from an irradiated volume was recently reported [A. S. Kirov et al., Med. Phys. 26, 1069 (1999)]. In the present article, we investigate the potential to use a liquid scintillation solution (LS) as a dose sensitive media and, simultaneously, as a water equivalent phantom material which fills the measurement volume. We show that matching water density in addition to energy absorption properties is important for using the LS solution as a phantom. Through a parametric study of the LS attenuation and absorption coefficients as well as Monte Carlo dose calculations and scintillation efficiency measurements we developed novel LS materials. For the new solutions, the calculated dose in LS is within 8% of the dose to water for depths up to 5 cm for photons having energies between 30 keV and 2 MeV. The new LS solutions, which are loaded with a Si containing compound, retain more than 85% of the scintillation efficiency of the unloaded solutions and exhibit high localization of the scintillation process. The new LS solutions are superior with respect to efficiency and water equivalence to plastic scintillator materials used in dosimetry and may be used apart from the mentioned 3D method.

[Congenital defects of antithrombin III and proteins C and S during pregnancy]. / Defectos congénitos de antitrombina III y proteínas S y C durante el embarazo.

We report 10 patients with congenital deficiencies of the natural anticoagulant proteins S, C and antithrombin III. Thirteen of a total of 30 pregnancies were managed at the perinatal branch of our department. We discuss the mechanism of action of these proteins and their role in thrombotic events. We analyze the most frequent thrombotic complications and we discuss the general guidelines for the investigation of a patient with a suspected congenital thrombophilia with special regard to its management during pregnancy, delivery and perinatal outcome.

Characterization of the translocation of protein kinase C (PKC) by 3,4-methylenedioxymethamphetamine (MDMA/ecstasy) in synaptosomes: evidence for a presynaptic localization involving the serotonin transporter (SERT).

3, 4-methylenedioxymethamphetamine (MDMA or Ecstasy) is a substituted amphetamine whose acute and long-term effects on the serotonin system are dependent on an interaction with the 5-HT uptake transporter (SERT). Although much of the work dedicated to the study of this compound has focused on its ability to release monoamines, this drug has many important metabolic consequences on neurons and glial cells. The identification of these physiological responses will help to bridge the gap that exists in the information between the acute and neurotoxic effects of amphetamines. Substituted amphetamines have the ability to produce a long-term translocation of protein kinase C (PKC) in vivo, and this action may be crucial to the development of serotonergic neurotoxicity. Our earlier results suggested that PKC activation occurred through pre- and postsynaptic mechanisms. Because the primary site of action of these drugs is the 5-HT transporter, we now expand on our previous results and attempt to characterize MDMA's ability to translocate PKC within cortical 5-HT nerve terminals. In synaptosomes, MDMA produced a concentration-dependent increase in membrane-bound PKC (as measured by 3H-phorbol 12, 13 dibutyrate, 3H-PDBu) bindings sites. This response was abolished by cotreatment with the specific serotonin reuptake inhibitor (SSRI), fluoxetine, but not by the 5-HT2A/2C antagonist, ketanserin. In contrast, full agonists to 5-HT1A and 5-HT2 receptors did not produce significant PKC translocation. MDMA-mediated PKC translocation also requires the presence of extracellular calcium ions. Using assay conditions where extracellular calcium was absent prevented in vitro activation of PKC by MDMA. Prolonged PKC translocation has been hypothesized to contribute to the calcium-dependent neurotoxicity produced by substituted amphetamines. In addition, many physiological processes within 5-HT nerve terminals, including 5-HT reuptake and vesicular serotonin release, are susceptible to modification by PKC-dependent protein phosphorylation. Our results suggest that prolonged activation of PKC within the 5-HT nerve terminal may contribute to lasting changes in the homeostatic function of 5-HT neurons, leading to the degeneration of specific cellular elements after repeated MDMA exposure.

Activation of protein kinase C (PKC) by 3,4-methylenedioxymethamphetamine (MDMA) occurs through the stimulation of serotonin receptors and transporter.

This report further characterizes the intermediate metabolic effects of the psychotropic amphetamine derivative, 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy"), on the activity of second messenger-dependent kinases. Previous work has demonstrated that two injections of MDMA (20 mg/kg) elicits a prolonged translocation of the calcium and phospholipid-dependent enzyme, protein kinase C (PKC) in rats. However, because MDMA has actions at the 5-HT transporter and 5-HT2A/2C receptors, our experiments were directed at uncovering which of these many sites may be involved in this second messenger dependent response. A single injection of MDMA produced a time- and dose-dependent increase in the density of cortical and hippocampal PKC (as measured by 3H-phorbol 12,13-dibutyrate (PDBu) binding sites. MDMA-mediated PKC translocation was long-lasting and remained above control (saline-treated rats) for up to 24 h after injection. This effect was mimicked by another substituted amphetamine, p-chloroamphetamine (pCA), but with a temporal-response curve that was to the left of MDMA's. However, pure uptake inhibitors like fluoxetine, cocaine, and the selective 5-HT2A/2C agonist, DOB, were unable to produce a long-lasting translocation of PKC binding sites in rat cortex. Fluoxetine, a selective serotonin uptake inhibitor (SSRI) and ketanserin a 5-HT2A antagonist, attenuated PKC translocation by MDMA with differing efficacies; however, both compounds completely prevented the loss of 5-HT uptake sties after multiple doses of MDMA. These results suggest that MDMA increases PKC translocation by two interrelated mechanisms that involve 5-HT2A/2C receptors and the 5-HT transporter. This pathway appears to include: (1) the drug binding to the 5-HT transporter, (2) the release of cytosolic 5-HT stores into the extracellular space, and (3) the activation of post-synaptic 5-HT2A/2C receptors linked to G-protein-mediated phospholipid hydrolysis.

Irreducible dorsal dislocation of the distal interphalangeal joint: case report and literature review.

An irreducible dorsal dislocation of the DIP joint is a rare injury. Irreducibility is primarily caused, in closed injuries, by the interposed volar plate, and in open injuries by the dislocated FDP tendon. It is important to recognize the complex nature of this dislocation and to limit attempts at closed reduction. Early surgical exploration, anatomic reduction, and early mobilization are prerequisites to good functional recovery.

Toxic shock syndrome as a complication of breast prostheses.

A case of a 21-year-old woman who developed toxic shock syndrome 6 days after augmentation mammaplasty with saline breast implants is reported. The infecting organism was S. aureus that was toxic shock syndrome exotoxin 1-negative and staphylococcal endotoxin B-positive. The causes and etiology of this rare postoperative complication are discussed.

3,4-Methylenedioxymethamphetamine ('Ecstasy') promotes the translocation of protein kinase C (PKC): requirement of viable serotonin nerve terminals.

The metabolic effects of the neurotoxic, ring-substituted amphetamine 3,4-methylenedioxy-methamphetamine (MDMA or 'Ecstasy') were examined in vivo. In this study, we focused on the ability of MDMA to induce a translocation of the calcium and phospholipid-dependent protein kinase C (PKC) from the cytosol to the cortical plasma membrane. Two injections of MDMA (20 mg/kg; 10 h apart; s.c.) increased the density of membrane bound PKC sites by 48.0% over saline treated animals without mediating a significant change in ligand ([3H]phorbol 12,13 dibutyrate; [3H]PDBu) affinity. Longer drug treatments (8 x 20 mg/kg) induced a lasting (up to 5 days post-treatment) increase in the density of membrane-bound PKC. Prior destruction of cortical 5-HT nerve terminals with p-chloroamphetamine (PCA) prevents this effect and suggests that viable 5-HT uptake sites are essential for MDMA-induced PKC translocation. These results demonstrate that MDMA-induced PKC translocation is mediated by viable cortical 5-HT nerve terminals, and that prolonged kinase activation may contribute to MDMA-induced serotonergic neurotoxicity.

Activation of glycogen phosphorylase by serotonin and 3,4-methylenedioxymethamphetamine in astroglial-rich primary cultures: involvement of the 5-HT2A receptor.

Neurotransmitters, neuropeptides, and ions regulate glycogen levels in the brain by modulating the activity of glycogen synthase (GSase) and glycogen phosphorylase (GPase). GPase is co-localized with glial fibrillary acidic protein (GFAP), an astroglia-specific marker, suggesting that glycogen is localized in astroglial cells. Additionally, functional serotonin (5-HT) receptors are found in both neurons and glia, and 5-HT is known to stimulate glycogenolysis. It is reported that 3,4-methylenedioxymethamphetamine (MDMA), a drug of abuse, stimulates the release and inhibits the reuptake of 5-HT, and selectively inhibits the activity of MAO-A. These biochemical consequences of MDMA lead to increased extra-cellular 5-HT levels. This study investigates the effects of MDMA(+) and serotonin (5-HT) on glycogen metabolism in the rat brain. A histochemical method was designed to visualize active glycogen phosphorylase (GPase) in an astroglial-rich primary culture. Serotonin activated GPase in a concentration-dependent manner (100 nM-100 microM). Maximal activation by 5-HT was achieved by 50 microM and resulted in a 167% increase in the number of reactive sites (P < 0.001). MDMA(+) (500 nM-50 microM) directly stimulated GPase activity with maximal activation induced by 5 microM, which caused a 70% increase in the number of reactive sites (P < 0.001). The 5-HT2 receptor agonist, 1-(2,5-dimethoxy-4-bromophenyl)-2-aminopropane (DOB), also displayed a concentration-dependent increase in the number of GPase reactive sites. Maximal stimulation by DOB occurred at 100 nM which increased the number of reactive sites by 166% (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Ptosis after blepharoplasty.

Ptosis is a complication that can arise after blepharoplasty resulting in lid asymmetry. It should be recognized early and intervention directed at its underlying anatomical cause. Ptosis can be secondary to lid edema, hematoma, septal levator adhesions, septal suturing, supratarsal fixation, and levator complex injury. Injury to the levator complex can be rarefaction, dehiscence, or disinsertion. Evaluation of this condition involves assessment of the degree of ptosis and the amount of levator function. Severe ptosis with poor levator function requires reexploration and repair of the levator mechanism. Mild or moderate ptosis may resolve spontaneously and can be managed expectantly. Chronic cases (longer than 3 months) may need exploration, and the procedure used is guided by the amount of levator function present.

Neurosonographic abnormalities associated with maternal history of cocaine use in neonates of appropriate size for their gestational age.

PURPOSE: To determine whether increased incidence of neurosonographic abnormalities (predominantly of the basal ganglia and thalamus) in cocaine-exposed neonates who are small for their gestational age is attributable to the cocaine or to neonatal size. METHODS: Neonates whose sizes were appropriate for their gestational age with no evidence of hypoxia or respiratory distress were identified prospectively by a maternal history of cocaine use. Scans were performed within 72 hours of birth using a 7.5-MHz transducer following a standard protocol. The images were analyzed without access to patient information. Forty study neonates were compared with 34 control subjects who were appropriate in size for their gestational age, scanned using the same protocol. Comparisons were made using Fisher Exact Test, t test, and logistic regression. RESULTS: No control infant had neurosonographic abnormalities. In the study group, gestational age ranged from 27 to 41 weeks. Of the 40 study neonates, 14 (35%) had one neurosonographic abnormality; two had two abnormalities. The predominant lesion was focal echolucencies, mainly in the area of the basal ganglia (10 of 40, 25%). Other findings were caudate echogenicity (3 of 40, 7.5%), ventricular dilation (2 of 40, 5%) and one "moth-eaten" appearance of the thalamus. Lesions were more likely approaching term and were not related to prematurity or alcohol use. CONCLUSION: Apparently normal neonates with a maternal history of cocaine use are likely to have degenerative changes or focal infarctions in their basal ganglia attributable to cocaine. Neurosonography should be used to evaluate these neonates. The long-term significance of these lesions needs further evaluation.

Neurosonographic imaging of small-for-gestational-age neonates exposed and not exposed to cocaine and cytomegalovirus.

We sought to prospectively identify the role of neurosonography in the evaluation of a consecutive group of small-for-gestational-age (SGA) neonates, and also to identify the association of neurosonographic findings with cocaine exposure and cytomegalovirus (CMV) infection. Neurosonographic imaging was performed in 180 SGA neonates within 72 hours of birth. Urine samples were screened for CMV and cocaine metabolites (CM) in all cases. Sixty-five neonates (37.5%) had an abnormal neurosonographic appearance. Nine neonates were positive for CMV and 31 neonates were positive for CM. Focal echolucencies (27), ventricular dilation (27), and subependymal hemorrhages (12) were the most common neurosonographic abnormalities. The first two were more common with CM (p < .05). An abnormal neurosonographic pattern was seen more often in SGA neonates with CM (54.8%, 17 of 31; p < .05) and CMV (67%, 6 of 9; p < .01) as compared with the rest (32.6%, 44 of 135; p < .01). Among those without CM or CMV, prematurity was associated with an increased risk for abnormality (p < .001 between groups), specifically subependymal hemorrhage, ventricular dilation, and porencephalic cysts. Five CMV-positive neonates showed periventricular, echogenic foci mainly in the area of the frontal horn. Two new findings with SGA were caudate nucleus echogenicity and a "moth-eaten" appearance of the thalamus, each found in three infants. Neurosonographic imaging is useful in the evaluation of SGA neonates. Focal echolucencies and caudate echogenicity suggest maternal cocaine use, and periventricular echogenic foci strongly suggest fetal CMV infection.

[Alcohol consumption in the adult population from the metropolitan region: prevalence and consumption modalities]. / Consumo de alcohol en población adulta de la región metropolitana: prevalencia y modalidad de consumo.

A representative sample from the adult population of metropolitan Santiago was surveyed for prevalence and modality of alcohol consumption. The "problem drinker" was identified according to the CAGE questionnaire. Socioeconomic situation was classified according to the method of Graffar. 70% of male and 50% of female drinkers consumed less than 400 ml of ethanol per month. Prevalence of drinking in males and females was: all categories 56.2 and 19.8%, regular drinkers 40.8 and 14.4%; heavy drinkers 4 and 0.82% and problem drinkers 12.4 and 1.5%, respectively. 85% were weekend drinkers, 11% consumed alcohol throughout the week. Males consumed mostly wine and mixed alcoholic beverages, females mostly the latter. In males, drinking was related to age and not to socioeconomic condition, except for problem drinkers who were mostly found in the low category. Females problem drinkers were found mostly in the high socioeconomic group. These data may be used in planing intervention strategies to prevent damage caused by alcohol consumption.