Presurgical Perspective and Postsurgical Evaluation of Tibial Pilon Fractures.

Tibial pilon fractures represent only a small percentage of all fractures of the lower limb. But they are a feared entity, both for the interpreting radiologist and the treating surgeon and, ultimately, for the patient because they involve the weight-bearing area of the joint and often have associated soft tissue injury. These factors make them technically challenging, with poor clinical and functional results in many patients, even when a perfect joint reduction is achieved. Presurgical evaluation with computed tomography and individualized staged management is critical for the prognosis, a definitive treatment strategy, and the prevention of future complications.

Cervical intramedullary solitary fibrous tumor: Case report and review of the literature.

BACKGROUND: Solitary fibrous tumors (SFTs) are benign tumors derived from mesenchymal tissues that predominantly occur in the pleura. Establishing the diagnosis of these very rare intramedullary spinal lesions, with no clear-cut pathognomonic radiographic characteristics, is particularly challenging. CASE DESCRIPTION: Two males, 30 and 41 years of age, presented with progressive cervical myelopathies attributed to a cervical intramedullary exophytic tumor with associated spinal cord edema. One patient showed that the lesion was highly vascularized. Both patients underwent surgical excision of firm, solid, focal, and, particularly in one of them, very vascular/hemorrhagic tumors; at surgery, there was some adherence between the tumors and the cord tissue, but gross-total resections were achieved in both cases, demonstrated on postoperative MR scans. Histological and immunohistochemical findings confirmed the diagnosis of SFT (WHO Grade I). After a 6-month postoperative period, both patients neurologically improved and had no MR evidence of tumor recurrence. CONCLUSION: Intramedullary cervical exophytic SFTs are extremely rare. Although these solid tumors may present with hemorrhagic features and at surgery demonstrate significant adherence to the pial/cord surface, complete surgical resections are feasible resulting in good outcomes.

Is ABA involved in tolerance responses to salinity by affecting cytoplasm ion homeostasis in rice cell lines?

The ability of plant cells to maintain cytoplasm ion homeostasis under saline stress is among the main mechanisms involved in salt tolerance. To cope with excess Na(+), cells extrude it from the cytoplasm, which requires expenditure of metabolic energy, provided by H(+) gradients generated by membrane-bound H(+)-pumps. ABA is well-known to be involved in physiological processes elicited or enhanced by stresses causing cell dehydration. In this work we studied the possible implication of this plant hormone in the control of salt-induced cellular mechanisms conducting to Na(+) extrusion from the cytoplasm. We used rice (Oryza sativa L.) cell lines selected for their different tolerance to salinity to measure the response to ABA of H(+)-pumps and Na(+)/H(+)-antiporters associated to the plasma membrane and the tonoplast. Our results show that ABA generally enhances H(+)-pumping under salt stress but not under control conditions. This effect occurs to a higher extent across the tonoplast in the more tolerant lines (L-T). Na(+)/H(+) antiport activity is practically undetectable in calli under control conditions, pre-treated or not with ABA, but shows a strong activation under salinity across the tonoplast, particularly in L-T lines (cv Bahia) and also across de plasma membrane in cv Bomba. In these lines, prior treatments with ABA tend to reduce the NaCl enhanced activity of both antiporters. Overall, under saline conditions ABA seems to affect synergistically H(+) pumping and antagonistically Na(+) extrusion. A complex network of positive and negative regulatory signals seems involved in restoring ion cell homeostasis under salt stress.

Differential salinity-induced variations in the activity of H⁺-pumps and Na⁺/H⁺ antiporters that are involved in cytoplasm ion homeostasis as a function of genotype and tolerance level in rice cell lines.

The characterisation of cellular responses to salinity in staple crops is necessary for the reliable identification of physiological markers of salinity tolerance. Under saline conditions, variations in proton gradients that are generated by membrane-bound H⁺ pumps are crucial for maintaining cytoplasm homeostasis. We examined short (15 h) and longer term effects (4 days) of NaCl stress on the H⁺ pumping activities that are associated with the plasma membrane (P-ATPase) and the tonoplast (V-ATPase and V-PPase) in rice (Oryza sativa L.) callus lines that displayed different levels of NaCl tolerance and were established from two japonica rice cultivars. The applied stress conditions were based on those that were used in the induction of a stress-responsive polyubiquitin gene promoter (UBI1) in transgenic rice calli. The most remarkable effect of NaCl stress on H⁺ pumping was the rapid activation of tonoplast-bound pumps; this was particularly observed in cv. Bomba, in which the response of the P-ATPase was slower and showed a higher level of activity after 4 days of stress. The responses were cultivar-dependent; however, in general, a stronger activation occurred in the lines that had a higher tolerance (L-T) than in the less-tolerant (L-S) lines. Substrate hydrolysis was less affected than H⁺ pumping, and it yielded higher H⁺/substrate coupling ratios, which is indicative of an enhanced H⁺ pumping efficiency under saline conditions. The Na⁺/H⁺ antiport activity was generally limited to salt-stressed calli, and higher values and stronger activation of the tonoplast antiporter were observed in the L-T lines than in the L-S lines. The results that were obtained with the NaCl-stressed transgenic lines confirmed the close relationship between metabolic activity, H⁺ pumping and the induction of Na⁺/H⁺ exchange activities.

Optic neuritis with concurrent etanercept and isoniazid therapy.

OBJECTIVE: To report a case of optic neuritis associated with concurrent etanercept and isoniazid therapy. CASE SUMMARY: A 55-year-old man diagnosed as having rheumatoid arthritis had received treatment with nonsteroidal antiinflammatory drugs, sulfasalazine, oral methotrexate, leflunomide, and deflazacort. Four months prior to admission, he had a Disease Activity Score of 6.06; treatment with etanercept was considered. Three months prior to admission, because of evidence of latent tuberculosis, isoniazid 300 mg once daily and pyridoxine 50 mg once daily were prescribed. Treatment with subcutaneous etanercept 25 mg twice weekly was started 5 days after isoniazid was initiated. Two weeks prior to admission, the patient developed blurred vision in his left eye. Ten days later, his vision worsened and he was hospitalized. The visual acuity in both eyes was 0.7, and a campimetric examination was compatible with optic neuritis. Magnetic resonance imaging of the brain revealed lesions suggesting demyelinating lesions. The clinical course was consistent with bilateral optic neuritis. Etanercept was stopped, and isoniazid was replaced with rifampin 600 mg once daily. The patient was treated with intravenous methylprednisolone hemisuccinate 1 g/day for 5 days followed by oral prednisolone, resulting in a minor subjective improvement in left eye visual acuity. He then received oral prednisone for 3 weeks, slowly tapering to discontinuation. DISCUSSION: No physiologic factors could have predisposed this patient to develop optic neuritis. He was not diagnosed with a demyelinating disease or underlying systemic condition. The optic neuritis was unlikely to be an early manifestation of multiple sclerosis based on the clinical course and the negative results of the imaging tests. Furthermore, there was a close temporal correlation between the drug exposure and the onset of symptoms. After discontinuation of etanercept and isoniazid therapy, the patient's general condition improved. Use of the Naranjo probability scale indicated a possible relationship between optic neuritis and combined etanercept-isoniazid therapy. CONCLUSIONS: Patients initiated on etanercept and isoniazid should be closely monitored for the development of adverse neurologic signs and effects. If optic neuritis is determined, etanercept and isoniazid should be discontinued immediately.

Is hysterosalpingography able to diagnose all uterine malformations correctly? A retrospective study.

BACKGROUND: Mullerian duct anomalies are an uncommon but often a treatable cause of infertility. MATERIAL AND METHODS: From January 2002 until November 2003, a total of 705 hysterosalpingographies were realised of which 658 were analysed retrospectively in order to determine the importance of uterine malformations in infertile and sterile patients. In ten cases, the results of hysterosalpingography were compared with hysteroscopy and laparoscopy. RESULTS: The frequency of uterine malformations in infertile and sterile women was 10%. In this population, arcuate uterus (57.6%) was the most common malformation, followed by subseptate uterus (18.2%), uterus bicornis unicollis (10.6%), uterus bicornis bicollis (3.0%), septate uterus (6.1%), unicornuate uterus (3.0%) and unicornuate uterus with double vagina (1.5%). DISCUSSION: Our bibliographic research confirmed that arcuate uterus is the most frequent congenital malformation, but in gestations it does not show a significantly reduced live birth rate. Nevertheless, the septate uterus presents an important decrease of live birth rate that can be improved significantly by doing hysteroscopic metroplasty. As this is a completely different surgical intervention compared to bicornuate uterus, a correct diagnosis is very important. Differentiation of these two malformations is quite difficult by hysterosalpingographic exploration, wherefore an additional exploration by means of endovaginal or three-dimensional ultrasound is recommended.

Fracturas espontáneas múltiples: una forma de presentación excepcional del síndrome de Cushing / Multiple spontaneous fractures: an exceptional presentation of Cushing's syndrome

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