Simplified biplanar (0-90°) fluoroscopic puncture technique for percutaneous nephrolithotomy: the learning curve.

PURPOSE: To evaluate the learning curve of the simplified fluoroscopic biplanar (0-90º) puncture technique for percutaneous nephrolithotomy. METHODS: We prospectively evaluated patients with renal stones treated with percutaneous nephrolithotomy by a single institution's fellows employing the simplified bi-planar (0-90º) fluoroscopic puncture technique for renal access. The learning curve was assessed with the fluoroscopic screening time and the percutaneous renal puncture time. Data obtained were compared to a subset of patients operated by a senior surgeon. RESULTS: Eighty-nine patients were included in the study. Forty patients were operated by fellow-1, 39 by fellow-2, and 10 patients by the senior surgeon. Demographic data of all patients between groups were homogeneous, with no difference in gender (p = 0.432), age (p = 0.92), stone volume (p = 0.78), puncture laterality (p = 0.755), and body mass index (p = 0.365). The mean puncture time was 7.5, 4, and 3.1 min for fellow-1, fellow-2, and expert, respectively. The mean fluoroscopic screening time for the puncture was 10, 11, and 5.1 s for fellow-1, fellow-2, and the expert, respectively. Stone cases, both fellows needed to complete 10 procedures to match the senior surgeon in the mean puncture time (p = 0.046); meanwhile, the fluoroscopic screening time was equal even before to complete 10 procedures. CONCLUSION: This study suggests that with the simplified biplanar (0-90º) puncture technique, the fluoroscopic screening time used in the learning process is brief. A novice fellow could require to complete ten cases to flatten the learning curve treating complex stone cases, and a flat learning curve is seen since the beginning when treating simple renal stones.

Effects of cytomegalovirus infection in human neural precursor cells depend on their differentiation state.

Cytomegalovirus (CMV) is the most common cause of congenital infection in developed countries and a major cause of neurological disability in children. Although CMV can affect multiple organs, the most important sequelae of intrauterine infection are related to lesions of the central nervous system. However, little is known about the pathogenesis and the cellular events responsible for neuronal damage in infants with congenital infection. Some studies have demonstrated that neural precursor cells (NPCs) show the greatest susceptibility to CMV infection in the developing brain. We sought to establish an in vitro model of CMV infection of the developing brain in order to analyze the cellular events associated with invasion by this virus. To this end, we employed two cell lines as a permanent source of NPC, avoiding the continuous use of human fetal tissue, the human SK-N-MC neuroblastoma cell line, and an immortalized cell line of human fetal neural origin, hNS-1. We also investigated the effect of the differentiation stage in relation to the susceptibility of these cell lines by comparing the neuroblastoma cell line with the multipotent cell line hNS-1. We found that the effects of the virus were more severe in the neuroblastoma cell line. Additionally, we induced hNS-1 to differentiate and evaluated the effect of CMV in these differentiated cells. Like SK-N-MC cells, hNS-1-differentiated cells were also susceptible to infection. Viability of differentiated hNS-1 cells decreased after CMV infection in contrast to undifferentiated cells. In addition, differentiated hNS-1 cells showed an extensive cytopathic effect whereas the effect was scarce in undifferentiated cells. We describe some of the effects of CMV in neural stem cells, and our observations suggest that the degree of differentiation is important in the acquisition of susceptibility.

Avaliação do equilibrio estatico em individuos amputados de membros inferiores atraves da biofotogrametria computadorizada / Evaluation of the static balance lower limb amputers by means of computerized biophotogrammetry

Para que sejam realizadas atividades funcionais da vida diaria e primordial a manutencao do equilibrio estatico, possibilitando posturas, movimentos e respostas adequadas. Objetivos O presente trabalho teve como finalidade avaliar e comparar, atraves do teste de Romberg adaptado, as oscilacoes do equilibrio estatico de amputados protetizados de membros inferiores com individuos nao amputados. metodos Foram avaliados 33 individuoes do sexo masculino com idade media de 33,38 anos, divididos em tres diferentes grupos. O grupo A foi composto por 12 individuos amputados que utilizavam protese transfemural. O grupo B foi formado por 9 individuos amputados transtibias. O grupo C continua 12 individuos nao amputados. cada individuo foi filmado nos planos frontal e sagital, avaliado quadro a quadro para a selecao de momentos de maiores oscilacoes. As imagens selecionadas foram quantificadas atraves da Biofotogrametria computadorizada, utilizando-se o programa AL Cimage 2.1. Resultados Os resultados mostram diferencas significativas entre as oscilacoes anteriores para o grupo A (transfemural) e entre as oscilacoes para o lado esquerdo no grupo B. Conclusao A partir destes resultados, conclui-se que amputados de membros inferiores apresentam uma tendencia de oscilacao mais significativa em direcao anterior e para o lado contra-lateral a protese. com o avanco da idade, nota-se uma menor tendencia a oscilacao posterior

Validade e confiabilidade intra-individuo do cifolordometro na avaliacao da convexidade toracica / validity and intra-observer reliability of kyphosis-lordosis measurement for evaluating thoracic curve

O presente estudo teve por finalidade verificar a presenca ou nao de correlacoes existentes entre a cifolordometria e o metodo Cobb, exame radiografico, avaliando a sua validade e confiabilidade, estabelecendo criterios para avliar a curva toracica por meio de cifolordometro. Metodo: para avaliar a convexidade toracica foram utilizados dois metodos distintos: o exame radiografico e a avaliacao realizada no cifolordometro. Foram submetidos 30 pacientes com idade media de 39+-15,8 anos a uma radiografia da coluna toracica, incidencia perfil, e posteriormente a mesma curva foi mensurada no cifolordometro. A avaliacao da curva toracica no cifolordometro constou de tres medidas sucessivas, realizadas com o objetivo de verificar a validade intra-observatoria desse metodo. Resultados: Observou-se que ha correlacao positiva r significativa entre os dois metodos abordados (rs>0,72 e p<0,000). tambem foi estabelecida uma metodologia clara e de facil reproducao para avaliar a curva toracica no cifolordometro, e por meio da analise das tres medidas realizadas em cada elemento da amostra foi confirmada a confiabilidade intra-observada (p>0,02) do metodo em discussao. Conclusao: Os resultados deste estudo mostram que o cifolordometro e um metodo confiavel, de facil acesso, alta reproducao e de muita eficacia na mensuracao da curva toracica

[Standardization and evaluation of the modified vibriocidal assay]. / Estandarización y evaluación del ensayo vibriocida modificado.

The vibriocidal antibody test is a reliable and well-documented method to determine bacterial antibodies to Vibrio cholerae 01 antigens. It consists of mixing serum dilutions and a steady quantity of bacteria and supplement to cause cell lysis. Titer is determined by visual observation. In this paper, we implemented a change in the presented method where a pH and glucose indicator was added to the culture medium used to stop the reaction, which allowed a quicker reading by any person who are not very familiar with the carrying out of this test since the colour change in the plaque is quite evident.

Intestinal colonization of the infant mouse model by attenuated and virulent Vibrio cholerae strains.

BACKGROUND: Intestinal colonization of humans with virulent Vibrio cholerae stimulates substantial, lasting immunity against reinfection. The purpose of this study was to evaluate the colonizing capability of various Vibrio cholerae strains which are promising candidates to oral vaccine. METHODS: Infant mouse model modification was used. In order to standardize the method, several parameters were tested, such as culture medium and optimal time of incubation and appropriate number of cells to be inoculated. The following were tested: Vibrio cholerae strain 81, 413, and 251A, which were obtained at the Molecular Biology Department of the National Center for Scientific Research, Havana, Cuba. Their virulence cassettes which code for the main virulence factors were deleted. RESULTS: Good variance coefficient (VC) was obtained in repeated experiments. The colonizing properties of attenuated Vibrio cholerae strains evaluated by this method correlated well with those observed for parental strains. CONCLUSIONS: Genetically attenuated Vibrio cholera strains have the same intestinal colonization level as their parental strains in the infant mouse model; thus, genetic manipulation does not affect genes that encode for the synthesis of colonization factors.

[The excretion pattern and protective capacity in rabbits orally immunized with attenuated strains of Vibrio cholerae O1 biotype El Tor]. / Estudio del patrón de excreción y la capacidad protectora en conejos inmunizados de forma oral con cepas atenuadas de Vibrio cholerae O1 biotipo El Tor.

In order to study the excretion patterns, colonization and protective capacity of live attenuated strains of Vibrio cholerae O1. El Tor, rabbits were immunized in New Zealand with these strains and their corresponding parental strains. 2 doses were administered by the model of oral inoculation in adult rabbits. Rabbits were rotated 2 weeks after the second dose by the model of ligated intestine with highly virulent strains of V. cholerae O1 Ogawa and Inaba serotypes and O139 serogroup. It was proved that the genetically manipulated strains do not effect the excretion patterns when they are compared with their parental strains. It was observed in the challenge a decrease in the levels of colonization of virulent strains of both serotypes, not only among the rabbits immunized with the attenuated strains, but also among those immunized with the parental strains in comparison with control animals immunized with the strain of Escherichia coli K-12, which means that there was certain degree of protection. In the case of the animals challenged with the O139 strain it was demonstrated that the protection is specific for each serogroup, since in this case there was no reduction of the colonization.

[Night work and nurses health]. / Trabajo nocturno y salud en enfermeria.

A case study was carried out in a hospital to determine differences in health status, working environment, and spare-time activities among a group of nurses doing day and night shifts. 25% of the night shift nurses were selected for the study; an equal number of nurses of the same hospital who did not do night shifts were taken as controls. Health disorders due to night-shift working conditions as well as aspects that may or not influence personal satisfaction in this working activity are indicated.

[Characterization of monoclonal antibodies that recognize the thermolabile toxin of Vibrio cholerae]. / Caracterización de anticuerpos monoclonales que reconocen la toxina termolábil de Vibrio cholerae.

The obtention of two monoclonal antibodies which recognize a single epitope present in the subunit B of the thermolabile toxin of Vibrio cholerae and another which shows a cross-reaction with those produced by certain enteropathogenic toxins, is reported. The standardization of a solid phase indirect immunoenzymatic assay (ELISA) for the primary screening and selection of hybrids was performed; in addition, the isotype was determined.

Pigment gallstone composition in cirrhotic and noncirrhotic subjects.

The composition of pigment gallstones from patients with and without cirrhosis was compared. Carbonate-containing pigment stones were distinguished from noncarbonate stones by infrared spectroscopy. Calcium was the major cation of each stone group. The major anion in noncarbonate pigment stones was bilirubinate or phosphate, but was carbonate in carbonate stones. The composition of pigment stones from cirrhotic and noncirrhotic patients was similar except that significantly less carbonate was present in carbonate stones, and less pigment (bilirubinate) was present in noncarbonate stones from noncirrhotics. These data suggest that irrespective of the presence of cirrhosis, the formation of noncarbonate pigment stones involves the selective precipitation of calcium bilirubinate and phosphate, whereas carbonate stone formation involves the selective precipitation of calcium carbonate.

Pigment versus cholesterol cholelithiasis: identification and quantification by infrared spectroscopy.

We previously reported that 27% of 92 cholecystectomized patients had pigment stones (Am J Dig Dis 19:585-590, 1974). Using standard biochemical methods, we found that cholesterol accounted for an average of 77% of the dry weight of cholesterol stones, but that unconjugated bilirubin represented a mean of only 7% of pigment stones. This quantitation of pigment stones was limited because approximately 66% of their weight was insoluble. To characterize pigment and cholesterol stone composition further, we used infrared spectroscopy--a technique requiring neither crystallinity nor solubilization--to quantitate pigment, carbonate, and cholesterol in gallstones. Other organic and inorganic components of stones were measured by standard methods. By infrared spectroscopy, two types of pigment stones were identified: carbonate-containing and noncarbonate pigment stones. Carbonate pigment stones contained significantly more calcium, carbonate, and phosphate, but less pigment than noncarbonate stones. Compared to our initial report, the total measured components of all pigment stones were increased 6-fold from 10 to 63%. Cholesterol was the major component of cholesterol stones by chemical assay or infrared spectroscopy. Among five cholesterol stones with limited solubility, 80% of the insoluble residue was identified as cholesterol by infrared spectroscopy. This study extends our knowledge of pigment stone and cholesterol stone composition by the use of quantitative infrared spectroscopy in conjunction with standard biochemical methods; furthermore, it confirms that pigment and cholesterol stones differ in composition and form by different mechanisms.

Evaluation of radiographic lucency or opaqueness of gallstones as a means of identifying cholesterol or pigment stones. Correlation of lucency or opaqueness with calcium and mineral.

A major criterion for the selection of patients with gallstones for treatment with chenodeoxycholic acid is the radiographic demonstration of lucent gallstones. In this study, we sought to evaluate the degree of selectivity of that criterion for distinguishing patients with cholesterol stones from those with pigment stones and to define the determinants of stone lucency or opaqueness. Of 92 lucent stones, 14% were pigment stones; and of 18 of opaque stones, 33% were cholesterol. Thus, the criterion of stone lucency allows inclusion of a significant number of subjects (14%) with lucent pigment stones, which may account for about one-half of the reported 33% incidence of treatment failures with chenodeoxycholic acid. Conversely, of patients with opaque stones, the one-third with cholesterol stones would be excluded from chenodeoxycholic acid treatment. Calcium is the major metal of both types of stones. However, opaque stones contain 6 times more calcium than lucent stones, which accounts for the difference in radiographic appearance.