Influence of total hip arthroplasty and physicians advices in the sports activity performed after the surgery. / Influencia de la artroplastia total de cadera y el consejo médico en la actividad deportiva realizada después de la intervención.

BACKGROUND AND OBJECTIVES: There are no randomized prospective studies that evaluate sports activity after total hip arthroplasty (THA). The objective of this study is to assess the level and type of sports activity in patients undergoing THA and to assess the recommendations given by physicians. MATERIALS AND METHODS: We performed a descriptive study that analyzes 46 patients (the average age was 41 years, range 37 - 48) under 50 years of age who underwent THA (58 hips) in our center. The average follow-up was 7.5 (1 - 11) years. Age, sex, sports activity according to the UCLA scale, sports activities practiced before and after the intervention, complications and recommendations given by doctors were evaluated. RESULTS: The average time to resume sport activity after the surgery was 5 (3-10) months. There were no differences in the UCLA scale before and after the operation (P> 0.05). The most practiced sport before the surgery was swimming (17%). The 31% of patients did not receive advice from their physician and the 65.2% were dissuaded from playing sports after ATC. The recommended sports were swimming (44%) and the static bicycle (17.5%), correlating with the most practiced sports after the operation. CONCLUSION: The patients modified their sport activity after having undergone a total hip arthroplasty. The surgery and the physician's advice were the ones that influenced the choice of the sports activity performed after being operated on.

Finding the "odd one out": Memory color effects and the logic of appearance.

Can what we know change what we see? A line of research stretching back nearly a century suggests that knowing an object's canonical color can alter its visual appearance, such that objectively gray bananas appear to be tinged with yellow, and objectively orange hearts appear redder than they really are. Such "memory color" effects have constituted the strongest and most complete evidence that basic sensory processing can be penetrated by higher-level knowledge, and have contributed to theories of object perception in psychology, neuroscience, and philosophy. Are such phenomena truly perceptual? Or could they instead reflect shifts in judgments and responses without altering online color perception? Here, we take a novel approach to this question by exploiting a "logic" that is inherent in visual processing but that higher-level cognition often cannot follow. In four experiments spanning both classical and contemporary work, we exhaust the predictions of memory color theories, by exploring scenarios where memory color accounts generate tortuous and difficult-to-grasp hypotheses that should nevertheless be easily accommodated by visual processing. We show that such conditions eliminate or even reverse memory color effects in ways unaccounted-for by their underlying theories-especially in a novel "odd one out" paradigm that may help distinguish visual appearance from higher-level judgment in a powerful and general way. We suggest that prior knowledge can influence color judgments in real and robust ways, but that such influences may not truly reflect changes in visual appearance per se. We further discuss the general utility of this approach for isolating perception from judgment, both for memory color effects and beyond.

Simplicity and complexity preferences in causal explanation: An opponent heuristic account.

People often prefer simple to complex explanations because they generally have higher prior probability. However, simpler explanations are not always normatively superior because they often do not account for the data as well as complex explanations. How do people negotiate this trade-off between prior probability (favoring simple explanations) and goodness-of-fit (favoring complex explanations)? Here, we argue that people use opponent heuristics to simplify this problem-that people use simplicity as a cue to prior probability but complexity as a cue to goodness-of-fit. Study 1 finds direct evidence for this claim. In subsequent studies, we examine factors that lead one or the other heuristic to predominate in a given context. Studies 2 and 3 find that people have a stronger simplicity preference in deterministic rather than stochastic contexts, while Studies 4 and 5 find that people have a stronger simplicity preference for physical rather than social causal systems, suggesting that people use abstract expectations about causal texture to modulate their explanatory inferences. Together, we argue that these cues and contextual moderators act as powerful constraints that can help to specify the otherwise ill-defined problem of what distributions to use in Bayesian hypothesis comparison.

Rivaroxaban is as efficient and safe as bemiparin as thromboprophylaxis in knee arthroscopy.

PURPOSE: The aim of this study is to compare effectiveness and safety profile of rivaroxaban with bemiparin in 3-week extended prophylaxis after knee arthroscopy. METHODS: Four hundred and sixty-seven patients were included in this review divided in two groups. One followed prophylaxis with rivaroxaban and the other one with bemiparin. All patients were interviewed and explored at 1 and 3 months postoperatively, looking for symptomatic signs of deep-vein thrombosis (DVT). In case of suspicion, diagnostic tests were performed. Collected data were age, sex, gender, diagnosis, time with ischemia, body mass index, concomitant diseases, concomitant therapy, DVT signs, treatment satisfaction, minor and major complications, treatment adherence and tolerability. RESULTS: No thromboembolic events were observed in any of the groups. In one case treated with rivaroxaban, the drug had to be withdrawn due to epistaxis. CONCLUSIONS: Our study showed that extended prophylaxis with 10 mg of rivaroxaban once daily for 3 weeks resulted as effective as bemiparin in knee arthroscopy thromboprophylaxis.

Inferior Lateral Genicular Artery Injury during Anterior Cruciate Ligament Reconstruction Surgery.

We report a case of inferior lateral genicular artery (ILG) injury during anterior cruciate ligament (ACL) reconstruction surgery with lateral partial meniscectomy. This is a rare arthroscopy complication. A review of the literature has been made with the aim to define the anatomy of ILG across the lateral articular line and the risk of lesion during knee arthroscopy. We propose embolization as a good treatment option for this type of injuries.

Idiopathic osteonecrosis of the medial tibial plateau.

Osteonecrosis of the medial tibial plateau is characterized by acute pain on the medial aspect of the knee. Progression can lead to articular collapse and requires early diagnosis and treatment. We studied seven patients affected of idiopathic osteonecrosis of the tibial plateau. The mean age was 62 years and the mean follow-up 42 months. We performed roentgenograms in all patients, bone scans in three patients and magnetic resonance image (MRI) in five. MRI shows T1-weighted low-intensity signal and T2-weighted high-intensity signal with a surrounding area of intermediate low-intensity signal. An increased focal uptake was seen at bone scan. Histological findings showed necrotic bone with empty lacunae. Surgical treatment consisted of tibial subchondral drilling in four patients-two of them by failure of conservative treatment, and a total knee arthroplasty in other two. One patient had a satisfactory evolution with conservative treatment. Idiopathic osteonecrosis of the tibial plateau must be considered in elderly patients with knee pain over the medial tibial plateau. At early stages, decompression with tibial drilling must be considered. This procedure allows a prompt and effective relief of symptoms.

Effects of repetitive sevoflurane anaesthesia on immune response, select biochemical parameters and organ histology in mice.

Animal and technical models often require repeated anaesthetic administrations for surgical procedures. As there is evidence for immunomodulatory effects of anaesthesia, the effects of repeated exposure to sevoflurane anaesthesia on the immune response in mice were studied. Sevoflurane was administered in vivo under conditions that simulate those in clinical procedures. Adult male mice were anaesthetized with 3% sevoflurane in oxygen for 40 min weekly for 3 weeks. Untreated animals served as controls. After sevoflurane anaesthesia, peripheral blood leukocyte counts, the composition and in vitro function of spleen cells (lymphocytes and macrophages) and the in vivo immune response to a conventional T-dependent antigen were assessed. In addition, liver, spleen and kidney histopathology and also hepatic and renal function were studied. Three days after the latest anaesthetic procedure, the absolute number of both leukocyte and lymphocyte counts were reduced in peripheral blood. Splenic cell composition (LB, LTCD3(+), LTCD4(+) and LTCD8(+)), macrophage function and the mitogen-induced lymphoprolipherative response were preserved. Yet, the in vivo humoral response to a conventional antigen was augmented following the antigenic challenge. Assessment at day 9 after the last anaesthetic procedure revealed the persistence of the humoral response alteration. Nevertheless, sevoflurane-treated animals showed no evidence of histological changes or alteration in hepatic or renal function.

Positive culture in allograft ACL-reconstruction: what to do?

The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment-other than an antibiotic protocol-would be required when facing a case of positive culture of a graft piece after its implantation.

Communication challenges for science and religion.

How can the very different worlds of science and religion communicate effectively? Religion requires faith, belief without question. Science demands we take nothing on faith, reject any anecdotal evidence. How might these seemingly opposed disciplines collaborate to improve public understanding of science and impact pending policy making without undermining spiritual well being? Are scholars from both disciplines engineering the needed bridges?

Effects of sevoflurane general anesthesia: immunological studies in mice.

Based on the immunomodulatory effects of anesthesia and surgery, a study was undertaken to assess the effect of sevoflurane anesthesia on the immune system in a murine model without surgery. Adult male mice were anesthetized with 3% sevoflurane (1.2 minimal alveolar concentration, MAC) in oxygen for 40 min, whereas nontreated animals served as controls. After sevoflurane anesthesia, peripheral blood leukocyte counts, the splenic composition and in vitro macrophage phagocytic activity and lymphoproliferative response were assessed. The in vivo specific immune response to sheep red blood cells (SRBC), a conventional T-dependent antigen was determined. In addition, liver, spleen, thymus and kidney histopathology and also hepatic and renal functions after anesthesia were studied. Sevoflurane diminished the number of peripheral blood lymphocytes and splenic B-cell counts, enhancing CD4+ lymphocytes in spleen. The in vitro functionality of macrophages and the mitogen-induced lymphoproliferative response were preserved, while the in vivo immune response to SRBC was enhanced in treated animals. Microscopic studies revealed conserved architecture of the spleen, thymus, lymph node, liver and kidney, and there were no differences in serum parameters of hepatic and renal functions between treated and control groups. Our results suggest that 3 days after the anesthetic exposure, animals treated with sevoflurane modulated their peripheral blood leukocyte counts, splenic lymphoid composition and the characteristics of the specific response to SRBC, while there was no evidence of hepatic or renal toxicity.

[Levofloxacin. Clinical experience with long-term treatment of osteoarticular infections]. / Levofloxacino. Experiencia clínica en tratamientos de larga duración de infecciones osteoarticulares.

We evaluated the efficacy and safety profile of the long-term administration of levofloxacin in osteoarticular infections. For this purpose, 50 patients were included during the years 1999 to 2001 on an initial estimation to be under treatment with this antibiotic for at least 4 weeks. Forty six percent (46%) of patients were male and received treatment during a mean-time of 122.8 days. In forty one of a total of forty nine evaluable patients (83.7%) outcome was considered satisfactory with a total recovery or improvement of disease. Clinical and analytical series of examinations were performed, with no significant abnormalities being observed. Five (5) patients presented a total of 7 adverse events: gastrointestinal intolerance (3), oral mycosis (1), petechia (1), parestesia (1) and pruriginous rash(1). Only in three cases interruption of therapy was considered necessary. In conclusion, levofloxacin presents an adequate efficacy and is a well-tolerated therapy; both characteristics make it an appropriate treatment for those infections that require long-term therapy.

Improving the scientist/journalist conversation.

How well do scientists communicate to members of the mass media? A communication scholar reviews potential barriers to the essential dialogue necessary between those in the sciences and journalists who report science to the public. Suggestions for improving communication within this relationship, in spite of professional process differences, are offered, emphasizing adherence to shared ethical standards.

Development of a middle fossa arachnoid cyst. A theory on its pathogenesis.

The progression of congenital arachnoid cysts has seldom been documented. We report the case of a child who was diagnosed with arrested hydrocephalus at the age of 13 months. Neuroimaging studies performed when the girl was 22 months old showed the appearance of an arachnoid cyst in the right middle fossa, while the previously enlarged ventricles seemed to have decreased in size. To the best of our knowledge, the paradoxical expansion of an arachnoid pouch following a reduction in the size of the ventricular system has not previously been documented. We advance the hypothesis that the development of some cases of arachnoid cyst might be pathogenically related to impaired CSF dynamics associated with pre-existing hydrocephalus. We also briefly review the pertinent literature on the formation and evolution of congenital cerebral arachnoid cysts.

[Susac syndrome: clinical and diagnostic approach. A new case report]. / Síndrome de Susac: actitud diagnóstica y terapéutica. Presentación de un nuevo caso.

INTRODUCTION: The Susac syndrome is made up of the clinical triad: encephalopathy, visual and hearing defects. It is caused by microangiopathy of unknown origin affecting the small arteries of the brain, retina and cochlea. It is very uncommon. It mainly affects young women. The course of the illness is usually monophasic and self-limiting. The deficit of visual acuity is caused by occlusion of tributaries of the retinal artery. The auditory defect is bilateral and symmetrical, and particularly affects medium and low frequencies. NMR is of great diagnostic value, showing multiple lesions in the grey and white matter. Our case gives more data regarding the evolution of this condition and the contribution of cerebral SPECT to diagnosis, the results of systemic treatment, use of hyperbaric oxygen and reflections on the physiopathology of the process. CLINICAL CASE: We present the clinical case of a young woman who presented with psychiatric symptoms and migraine followed by clinical encephalopathy and acute/subacute coma. There were also visual and auditory deficits. Other types of systemic disease were ruled out. CONCLUSIONS: Findings on SPECT suggested the presence of a microangiopathic disorder of the brain. The patient responded to systemic treatment with cortico-steroids. The encephalopathy resolved in a few days and two months later she had resumed her former daily activities. Treatment with hyperbaric oxygen definitely reduced visual sequelae.

[Isotopic ventriculography in patients with obstructive hypertrophic cardiomyopathy treated with dual chamber stimulation]. / Ventriculografía isotópica en pacientes con miocardiopatía hipertrófica obstructiva tratados con estimulación bicameral.

BACKGROUND: Dual pacing stimulation improves symptoms and reduces intraventricular pressure gradient in obstructive hypertrophic cardiomyopathy. The mechanisms proposed for these effects are a change in ventricular contraction sequence, a paradoxical movement of the interventricular septum and a reduction in ventricular contractility. However, dual chambers pacing stimulation effects on systolic and diastolic function are unknown, and the study of this is the aim of this work. PATIENTS AND METHODS: We performed a radionuclide ventriculography in 10 patients with obstructive hypertrophic cardiomyopathy at 2 days and 1 and 6 months after placing a dual chamber pacemaker. The phase images, ventricular volumes, left ventricular ejection fraction and segmentary contractility were evaluated. Diastolic maximum peak-filling-rate and time to-peak-filling-rate were also studied. RESULTS: In DDD pacing stimulation, parametric phase images show a reversal up-down contraction sequence starting from the apical segment. At 6 months radionuclide ventriculography, a reduction in ejection fraction was found (60.9 +/- 12 vs 73.4 +/- 9.1; p < 0.05) which was attributed to apical, apical-septum and mainly basal-septum segmentary contraction decrease. A paradoxical mid-systolic septum movement was also found during DDD stimulation. No differences on diastolic parameters were noted. CONCLUSION: During dual chamber stimulation, a reversal ventricular contraction sequence, a paradoxical septum movement, hypokinesis of the septal ventricular segments and a reduction on left ventricular ejection fraction was observed.

Hemostatic markers in surgery: a different fibrinolytic activity may be of pathophysiological significance in orthopedic versus abdominal surgery.

Without prophylaxis, patients subjected to major abdominal surgery have a risk of deep vein thrombosis of approximately 30%, while the rate varies between 40% and 60% in orthopedic surgery. The reasons for this discrepancy are not completely understood. The present study was designed to compare the pre- and postoperative behavior of different coagulation and fibrinolysis parameters in patients undergoing both types of surgery, receiving low molecular weight heparin prophylaxis. Samples were taken before operation and on postoperative days 1, 3, and 7. The following parameters were assessed: prothrombin fragment 1 + 2, thrombin-antithrombin III complexes, fibrinopeptide A, tissue plasminogen activator, plasminogen activator inhibitor, plasmin-alpha 2-antiplasmin complexes, and fibrin degradation products. We found a significant increase in the clotting markers postoperatively compared with preoperative values (P < 0.05), both in abdominal and orthopedic surgery, indicating a marked hemostatic activation which remained until postoperative day 7. A significant increase in plasminogen activator inhibitor (P < 0.01) and a decrease in tissue plasminogen activator and plasmin-alpha 2-antiplasmin complexes was also observed early after operation. The plasminogen activator inhibitor activity decreased, while tissue plasminogen activator and plasmin-alpha 2-antiplasmin levels increased significantly on days 3 and 7 (P < 0.05). Fibrin degradation products significantly increased throughout the postoperative period (P < 0.01). Preoperatively, we found higher plasminogen activator inhibitor activity and lower tissue plasminogen activator and plasmin-alpha 2-antiplasmin complexes (P < 0.05) in patients undergoing hip replacement compared with abdominal surgery. Fibrin degradation products were also significantly lower on postoperative day 3 in patients undergoing hip replacement (P < 0.01). We suggest that the lower preoperative fibrinolytic activation observed in patients undergoing orthopedic surgery compared with abdominal surgery might have pathophysiological consequences. Our results also indicate that the hemostatic activation persists beyond the 7th postoperative day despite prophylaxis.

Use of wet mount to predict Chlamydia trachomatis and Neisseria gonorrhea cervicitis in primary care.

BACKGROUND AND OBJECTIVES: Cervicitis is associated with salpingitis, infertility, and complications of pregnancy. Universal screening has been recommended for high-prevalence populations but may not be appropriate in the family practice setting. Leukocytes on an endocervical gram stain have been associated with infectious cervicitis due to Chlamydia trachomatis and Neisseria gonorrhea. This study sought to determine whether the finding of leukocytes in a vaginal wet mount could be used to screen for infectious cervicitis in an urban family practice. METHODS: A consecutive sample of 357 women had cultures for C trachomatis and N gonorrhea and a standardized wet mount. RESULTS: All women with infectious cervicitis were under age 35. Thirty-six percent of infected women had more leukocytes than epithelial cells in the wet mount, compared with 23% of women without these organisms. CONCLUSIONS: Wet mount findings did not reliably predict infectious cervicitis. Study of a larger population is needed to confirm these findings.

[Detection of residual ischemia after acute anterior myocardial infarction using Thallium-201 SPECT]. / Detección de isquemia residual tras infarto agudo de miocardio de localización anterior mediante SPECT con talio-201.

OBJECTIVES: To assess the utility of single photon emission computed tomography (SPECT) with Thallium-201 after anterior myocardial infarction at predischarge time in the detection of; a) the prevalence of isotopic redistribution in the infarct area or at a distance; b) the correlation between peri-infarction ischemia and the angiographic state of the infarct-related artery, and c) the correlation between ischemia at a distance and the presence of multivessel disease. MATERIAL AND METHOD: Seventy-three survivors of an uncomplicated anterior myocardial infarction, 67 men and 7 women, with a mean age of 56 +/- 9 years (34-70 range), underwent T1-SPECT after stress test (62 exercise test and 11 pharmacological Dipyridamole test) as well as coronarographic studies before discharge. Peri-infarction ischemia was defined as redistribution presence in the distribution territory of the left anterior descending artery (LAD) and was assessed in a semi-quantitative way scoring both stress and rest images that allowed the calculation of a redistribution index R (Stress Score-Rest Score/Stress Score). Ischemia at a distance was defined as redistribution presence in the territories of circumflex and right coronary arteries as assessed both by visual analysis (VA) and bull's eye polar maps (BE) or by washout imaging (WO). RESULTS: Peri-infarction ischemia (R > 0) was found in 48 (65.7%) patients; 43 with and 5 without significant residual lesions in the LAD and the absence of peri-infarction ischemia (R = 0) was found in 25 (34.3%) patients, 19 with and 6 without significant residual lesions in the LAD. Sensitivity and specificity for multivessel disease detection by ischemia at a distance was 64% and 85% respectively, for VA; 60% and 77% for BE; and 95% and 65% for WO. Combinations of different analytical methods (multiparametric approach) showed a decrease in sensitivity but improved specificity and positive predictive value: 60%, 90% and 75%, respectively, for BE & WO; 44%, 90% and 69% for VA & BE and 60%, 92% and 79% for VA & WO. CONCLUSIONS: TI-SPECT imaging is a useful diagnostic method to detect both peri-infarction ischemia and ischemia at a distance at predischarge time following anterior myocardial infarction. Redistribution presence in the non infarct-area shows a fair sensitivity and a high positive predictive value to detect residual multivessel disease.

Thioctic acid protection against ethanol and indomethacin induced gastric mucosal lesions in rats.

BACKGROUND/AIMS: The gastric protective effect of thioctic acid, a sulfhydryl compound, against chemically induced mucosal lesions has not been reported. METHODS: Fasted Wistar rats (24 h) were treated (gavage administration) with graded doses of thiotic acid (12.5, 25, 37.5, 50 mg/kg) followed 0.5 h later by the gavage administration of 1 ml 96% ethanol or intraperitoneal administered indomethacin. The gastric mucosa was examined grossly and histologically for an evaluation of the lesions. RESULTS: Pretreatment of rats with thiotic acid has shown a significant decline in the mean number, size, incidence and severity of mucosal lesions induced by both ethanol and indomethacin. CONCLUSIONS: This is the first evidence that thiotic acid protects the rat gastric mucosa against chemically induced damage. Its is speculated that this finding may prove to be important in the development of improved therapies for the prevention and treatment of gastric ulcers in humans.