[Diagnostic errors and temporal stability in bipolar disorder]

INTRODUCTION

The diagnosis of bipolar disorder is frequently modified during the course of the illness.

MATERIAL AND METHODS

Diagnostic changes and associated errors are described for 1,153 patients diagnosed as bipolar disorder, aged over 18 years and with at least ten follow-up visits. Data was extracted from a clinical registry of out-patient care specialized in Psychiatry and psychiatric hospitalizations of 25,152 patients representative of an urban area of 240,000 inhabitants. Limit for diagnostic stability was established as the maintenance of the bipolar disorder diagnosis in at least 75% of the visits.

RESULTS

A total of 158 (46.1 %) out of 342 patients diagnosed as having a bipolar disorders in the first visit kept this diagnostic constant in subsequent evaluations. Infradiagnostic initial error was committed with 108 stable patients who were not diagnosed in the first visit. 184 patients diagnosed in the first visit with bipolar disorder had less than 75 % concordant diagnosis along the follow-up and could be considered as initial overdiagnosis. Two hundred and nine out of the 443 patients who were diagnosed as bipolar disorder in their last visit did not keep stability criteria in their follow-up and could be considered therefore as final overdiagnosis. Thirty two stable patients not diagnosed in their last visit could be considered as infradiagnosis final error. Diagnosis from schizophrenia spectrum (F2) appears in one of every four psychiatric visits of the patients included in this study. Overlap was seen in three other categories: anxiety disorders (F4), personality disorders (F6) and substance abuse disorders.

CONCLUSION

Initial course of bipolar disorder causes difficulties in the diagnosis.

[Assessment of agreement between anesthesiologists' location of anatomical landmarks]

OBJECTIVE

The main objective of this study was to evaluate agreement between anesthesiologists' location of specific anatomical landmarks in regional anesthesia.

MATERIAL AND METHODS

We administered an anonymous written questionnaire asking for the location of the T5 and T10 dermatomes, Tuffier's line (L3-L4 space), and the T7-T8 and C6-C7 spaces on an anatomical drawing. We asked about each anesthesiologist's number of years of experience and type of block most commonly performed and in what type of surgery, number of blocks performed per year, whether or not levels of sensory and motor blocks were assessed, and whether training had been received. Relative frequencies were then calculated. The relationships between years of experience and number of blocks performed and number of correct identifications of anatomical points were analyzed using the chi2 test.

RESULTS

We studied 100 doctors (66 residents and 24 staff anesthesiologists). The landmark for which agreement was highest was T10 (91.8%); agreement was lowest for T5 (38.1%). Forty-five percent of anesthesiologists performed between 100 and 250 neuraxial blocks per year. The most commonly performed procedure was a lumbar block (98% of the anesthesiologists). Level of sensory block was evaluated by 95% of the respondents and level of motor block by 83%. Response to heat and cold was used by 94.8%; the Bromage scale was used by 81%. The number of years of experience and the number of correctly located points appeared to be unrelated (P=.76). Nor was there a correlation between the number of blocks performed and number of correctly located points (P=.2).

CONCLUSIONS

T10 was the landmark correctly identified by the largest number of respondents; T5 was correctly identified by the fewest respondents, with answers differing by as much as 4 dermatomes.

Successful methotrexate treatment of an abdominal pregnancy in the pouch of Douglas

Abdominal pregnancy is a rare localization of ectopic pregnancy. Early diagnosis and treatment are advised and the choice of treatment is crucial. A successful case of conservative treatment with combined systemic and intra-amniotic methotrexate is presented. This treatment option should be considered in the management of this potentially life-threatening condition.

Layer spacing of montmorillonites modified with rigid rods

The dependence of the interlayer distance in modified montmorillonite clays on the length of rigid rod molecules used for clay organophilization is studied. Therefore, a series of fully aromatic compounds of different length functionalized with a terminal amine group has been synthesized and transformed into the corresponding ammonium salts. The interlayer distance is determined by X-ray diffraction, the quantity of the modifier incorporated in the clay is obtained by thermogravimetric analysis. It is shown that the distance between layers in the modified clay does not depend on the length of the modifier used. This fact leads to the conclusion that rigid rods must be oriented parallel to the clay layers. On the other hand, the molar percentage of modifier molecules incorporated in the clay structure depends on the length of the rigid rods in the sense that shorter molecules are considerably easier to incorporate than longer ones.

Successful treatment of childhood astrocytomas with cisplatin and irinotecan

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Background: Childhood astrocytomas are a heterogeneous group of neoplasms for which non-surgical management is controversial. After a pilot study suggesting that irinotecan/cisplatin (I/C) may be effective for spinal cord astrocytomas in children (Mora et al, Neuro-Oncol 2007), we initiated a phase II trial for progressing astrocytomas with the aim of avoiding radiation therapy for low grade's and improve outcome for high grade's. Methods: The indication for adjuvant therapy was based upon histology, the extent of surgical resection, and the presence of clinical or neuroradiological signs of progression. Weekly Irinotecan (50 mg/m2 and 65 mg/m2 the last 2 cycles) and Cisplatin (30 mg/m2) for four consecutive weeks (1 cycle), and a total of 4 cycles was used. Results: Since 2004, 17 children aged 7m-17y were treated including 5 WHO grade I, 6 grade II, 3 grade III, and 3 non biopsied tumors: 2 intrinsic brain-stem tumors (BST) and 1 optic-pathway (OP) tumor. No patient had clinical signs of neurofibromatosis. Primary sites included 4 supratentorial, 3 BST, 3 OP, 1 cerebellar, and 6 spinal tumors. Gross total resection was performed in 1 case, subtotal in 4 and only biopsy in 9. Six patients received chemotherapy and one radiotherapy prior to the I/C regimen. Vomiting was easily controlled except for patients with BST. All but 2 patients, because of C allergy, completed the protocol with no documented ototoxic, renal, or GI side effects. Eleven (65%) pts had a complete clinical response, including 1 BST and all the spinal cord cases. Remarkably all the clinical responses were rapid, within the first 1–2 weeks of treatment. Twelve (70%) pts had a <25 [O1] % reduction of the tumor size at the end of therapy including 2 spinal cord cases that achieved complete radiological responses 10 months after the end of therapy. One BST patient progressed on therapy. Thus far, none of the low grade cases have received radiotherapy, although median f/u is only 1 year. All pts are alive and well. Conclusions: Remarkable clinicoradiological responses and avoidance of radiotherapy was obtained using the I/C regimen for childhood astrocytoma.

No significant financial relationships to disclose.

Anterior tenoarthrolysis for severe flexion contracture of the fingers (the "TATA" operation): a review of 50 cases

The "hook finger", with both proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint flexion contractures, often after multiple previous operations, is difficult to treat. This paper reports the results of 50 fingers in 49 patients in which the TATA (Téno-Arthrolyse Totale Antérieure) salvage procedure, described by Saffar in 1978, was carried out. Thirty-seven of 50 (74%) of these fingers had had at least one previous operation, most on the flexor apparatus. The mean PIP and DIP extension deficit pre-operatively was 133 degrees with a mean PIP lag of extension of 83 degrees . With a mean follow-up of 7.8 years, 45 fingers were improved, five were not and none was worsened. The mean PIP and DIP extension deficit postoperatively was 47 degrees , with a mean PIP lack of extension of 31 degrees . The overall gain in extension deficit of both joints was 86 degrees and of the PIP was 52 degrees . One PIP joint developed septic arthritis immediately after surgery. The benefit of this salvage operation is mainly in the change of the active range of motion to a more functional arc.

Vanadium recovery from oil fly ash by leaching, precipitation and solvent extraction processes

In order to reduce the environmental impact due to land disposal of oil fly ash from power plants and to valorize this waste material, the removal of vanadium was investigated using leaching processes (acidic and alkaline treatments), followed by a second step of metal recovery from leachates involving either solvent extraction or selective precipitation. Despite a lower leaching efficiency (compared to sulfuric acid), sodium hydroxide was selected for vanadium leaching since it is more selective for vanadium (versus other transition metals). Precipitation was preferred to solvent extraction for the second step in the treatment since: (a) it is more selective; enabling complete recovery of vanadate from the leachate in the form of pure ammonium vanadate; and (b) stripping of the loaded organic phase (in the solvent extraction process) was not efficient. Precipitation was performed in a two-step procedure: (a) aluminum was first precipitated at pH 8; (b) then ammonium chloride was added at pH 5 to bring about vanadium precipitation.

Elenoside increases intestinal motility

AIM: To study the effects of elenoside, an arylnaph-thalene lignan from Justicia hyssopifolia, on gastro-intestinal motility in vivo and in vitro in rats.

METHODS: Routine in vivo experimental assessments were catharsis index, water percentage of boluses, intestinal transit, and codeine antagonism. The groups included were vehicle control (propylene glycol-ethanol-plant oil-tween 80), elenoside (i.p. 25 and 50 mg/kg), cisapride (i.p. 10 mg/kg), and codeine phosphate (intragastric route, 50 mg/kg). In vitro approaches used isolated rat intestinal tissues (duodenum, jejunum, and ileum). The effects of elenoside at concentrations of 3.2 x 10^-4, 6.4 x 10^-4 and 1.2 x 10^-3 mol/L, and cisapride at 10^-6 mol/L were investigated.

RESULTS: Elenoside in vivo produced an increase in the catharsis index and water percentage of boluses and in the percentage of distance traveled by a suspension of activated charcoal. Codeine phosphate antagonized the effect of 25 mg/kg of elenoside. In vitro, elenoside in duodenum, jejunum and ileum produced an initial decrease in the contraction force followed by an increase. Elenoside resulted in decreased intestinal frequency in duodenum, jejunum, and ileum. The in vitro and in vivo effects of elenoside were similar to those produced by cisapride.

CONCLUSION: Elenoside is a lignan with an action similar to that of purgative and prokinetics drugs. Elenoside, could be an alternative to cisapride in treatment of gastrointestinal diseases as well as a preventive therapy for the undesirable gastrointestinal effects produced by opioids used for mild to moderate pain.

Pathological findings in the lens capsules and intraocular lens in chronic pseudophakic endophthalmitis: an electron microscopy study

PURPOSE

The aim of this study was to describe the pathological findings in lens capsules and intraocular lens (IOL) studied by scanning and/or transmission electron microscopy (SEM and TEM, respectively) in a series of four eyes with chronic pseudophakic endophthalmitis (CPE).

PATIENTS AND METHODS

We performed a retrospective study of four patients presenting CPE in whom surgical treatment with pars plana vitrectomy, capsulectomy with extraction of the IOL, and intravitreous antibiotic therapy was thereafter performed. The extracted IOL and the capsular remains were studied by SEM and/or TEM and microbiologic analysis of aqueous humour and vitreous aspirate was also carried out in all the cases.

RESULTS

The presence of microorganisms was observed in the material analysed in all the cases studied. The use of TEM identified bacterial contamination by Staphylococcus spp and mixed contamination with microorganisms presenting a bacillar morphology suggestive of infection by Propionibacterium acnes in addition to the presence of cocci in the capsular remains. In another two cases, SEM localized colonies of Staphylococcus spp on the surface of the IOL in one case and mixed bacterial colonization with cocci plus filamentous bacteria in the other. The presence of macrophages associated with bacteria was observed in the capsular remains.

CONCLUSIONS

Microorganisms were found in the IOL or the capsular material in the four cases studied, thereby explaining the refractoriness and severity of infection. The possible presence of polymicrobial infections, especially in the cases with filamentous bacteria, also explains the recurrence of infection.

Correction of diffraction effects in confocal Raman microspectroscopy

A mathematical approach developed to correct depth profiles of wet-chemically modified polymer films obtained by confocal Raman microscopy is presented which takes into account scattered contributions originated from a diffraction-limited laser focal volume. It is demonstrated that the problem can be described using a linear Fredholm integral equation of the first kind which correlates apparent and true Raman intensities with the depth resolution curve of the instrument. The calculations of the corrected depth profiles show that considerable differences between apparent and corrected depth profiles exist at the surface, especially when profiles with strong concentration gradients are dealt with or an instrument with poor depth resolution is used. Degrees of modification at the surface obtained by calculation of the corrected depth profiles are compared with those measured by FTIR-ATR and show an excellent concordance.

Aspirin or Anticoagulants in Stenosis of the Middle Cerebral Artery:A Randomized Trial

BACKGROUND

We report the results of an open, randomized, multicenter trial that compared the efficacy of aspirin to oral anticoagulants (OA) for the prevention of vascular events in patients with symptomatic stenosis of the middle cerebral artery (MCA).

METHODS

Participants were randomly assigned to receive 300 mg/day of aspirin or a dose of OA (target INR 2-3). The MCA stenosis was demonstrated by conventional angiography or by at least two noninvasive examinations. Patients had either transient ischemic attack or cerebral infarct (CI) attributable to the MCA stenosis within 90 days before inclusion. The primary endpoint was: nonfatal CI, nonfatal acute myocardial infarct, vascular death and major hemorrhage. The patients were followed-up for a minimum of 1 year and a maximum of 3 years.

RESULTS

The study included 28 patients (14 in each treatment group); the average age was 67 +/- 9.9 years. Men constituted 68% of the patients. After a mean follow-up of 23.1 +/- 10.9 months, there were no recurrences of CI in both groups. No endpoint was reported in the aspirin group, but 2 patients in the OA group (14.3%) exhibited vascular events: 1 acute myocardial infarct and 1 intracerebral hemorrhage). However, this difference was not statistically significant (p = 0.48).

CONCLUSIONS

Our study suggests that aspirin is the treatment of choice for the prevention of vascular events in patients with symptomatic MCA stenosis.

A new de novo Notch3 mutation causing CADASIL

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is one of the most common hereditary forms of stroke, and migraine with aura, mood disorders, or dementia, are also frequently found in these patients. Missense mutations in the Notch3 gene that create or destroy cysteine residues, have been found in most cases with a family history of the disease, although a few sporadic cases harbouring Notch3 mutations have also been described. Here, we describe a 44-year-old patient with clinical features of CADASIL who was a carrier of a new Notch3 mutation: cys128-->gly. Both parents were alive and healthy, and negative for the mutation. This case illustrates the interest of analysing the Notch3 gene in cases with clinical features of CADASIL, even in the absence of a family history of the disease.

Resultados del tratamiento ortopédico del dedo en martillo por ruptura subcutánea del tendón extensor. Serie de 170 casos

Objetivo: El presente estudio tiene por objetivo demostrar que los pacientes con dedo en martillo por arrancamiento del tendón extensor o ruptura subcutánea, pueden beneficiarse del tratamiento ortopédico, reservando el tratamiento quirúrgico para casos con mala evolución.

Material y Método: Se realizó un estudio retrospectivo de un grupo 170 de pacientes que presentaban una deformación digital en martillo por ruptura subcutánea o arrancamiento del tendón extensor. Todos los casos fueron tratados ortopédicamente, ya sea en consulta precoz y hasta en casos con un retraso máximo de 8 semanas. El tratamiento utilizado fue una férula dorsal en forma de rejilla, moldeada a medida, inmovilizando sólo la articulación interfalángica distal en extensión por un período de tiempo medio de 54 días.

Resultados: Con un seguimiento medio de 5 meses, el déficit de extensión fue de 7° y la flexión alcanzó los 61°. Setenta y ocho pacientes de este grupo fueron evaluados después de un plazo medio de 5 años, obteniendo similares resultados, con un déficit de extensión medio de 5° y una movilidad en flexión media de 61°.

Conclusiones: La férula es pues el tratamiento de elección incluso en caso de consulta diferida; la cirugía sólo la utilizamos para casos de fracaso del tratamiento ortopédico y en pacientes exigentes ya sea por razones profesionales o de ocio.

Directly observed treatment for tuberculosis in pharmacies compared with self-administered therapy in Spain

OBJECTIVES

To compare directly observed treatment (DOT) of tuberculosis through pharmacy offices with self-administered treatment (SAT) in patients at risk for non-adherence.

METHODS

Prospective study for DOT (1999-2002) and retrospective study for SAT (1996-1998) in patients at risk for non-adherence (human immunodeficiency virus [HIV] infection, alcoholism, illicit drug use, immigrant or homeless status and/or previous failure to complete). Patients in the DOT programme received medication as out-patients twice a week in pharmacies that supervised adherence and provided socio-sanitary support to patients.

RESULTS

There were 101 and 112 patients in the DOT and SAT groups, respectively. Demographic and clinical characteristics were similar in both groups. Differences were observed in risk factors for non-adherence (more immigrants and fewer intravenous drug users in the DOT vs. the SAT groups; P < 0.05). In the DOT group, 76 patients (75.2%) completed treatment and were cured compared to only 30 patients (26.7%) in the SAT group (P < 0.001). Implementation of DOT increased the cost of treatment by 400 Euro per patient compared to SAT.

CONCLUSION

In patients at risk for non-adherence, DOT implemented through pharmacy offices was better than SAT; however, completion rates were still low.

Optimizing the use of anti-interleukin-6 monoclonal antibody with dexamethasone and 140 mg/m2 of melphalan in multiple myeloma: results of a pilot study including biological aspects

Interleukin-6 (IL-6) is a major survival factor for multiple myeloma (MM) cells preventing apoptosis induced by dexamethasone (DEX) or chemotherapy. In all, 24 consecutive patients with MM in first-line therapy received DEX for 4 days, followed by melphalan (HDM: 140 mg/m2) and autologous stem cell transplantation (ASCT). The anti-IL-6 monoclonal antibody (mAb) (B-E8) was given till haematological recovery, starting 1 day before DEX. Results were historically compared to MM patients treated with HDM 140 and 200 mg/m2. Our results show (1) that B-E8 was able to fully neutralize IL-6 activity in vivo before and after HDM as shown by inhibition of C reactive protein (CRP) production; (2) no haematological toxicity; (3) a significant reduction of mucositis and fever; (4) a median event-free survival of 35 months and an overall survival of 68.2% at 5 years with a median follow-up of 72 months; and (5) the overall daily IL-6 production progressively increased on and after 7 days post-HDM, with the increased serum CRP levels. In the 5/24 patients with uncontrolled CRP production, a large IL-6 production was detected (320 microg/day) that could not possibly be neutralized by B-E8. These data show the feasibility to neutralize IL-6 in vivo with anti-IL-6 mAb in the context of HDM.

Surface selectivities in wet chemically modified PVC films. Influence of reaction conditions

Wet chemical modification reactions of PVC films in solvent/nonsolvent mixtures were performed. Three thiol compounds of different size and reactivity were used varying the solvent quality, temperature, and reaction times. The evolution of the concentration gradients within the films was studied using confocal Raman spectroscopy and attenuated total reflectance Fourier transform infrared spectroscopy. Surface selectivities were calculated and discussed in terms of the different relative reaction rate constants.

IR and Raman study on the interactions of the 5'-GMP and 5'-CMP phosphate groups with Mg(II), Ca(II), Sr(II), Ba(II), Cr(III), Co(II), Cu(II), Zn(II), Cd(II), Al(III) and Ga(III)

The chief motive behind this research is the interest provoked by the presence of metal ions as necessary stabilizers of the negative charges of phosphate groups in nucleic acids. The effect that the presence of different metal ions produces on the band principally assigned to the nu(s) PO(3)(2-) mode has been studied using FT-IR and FT-Raman spectroscopy. The results obtained reveal the diagnostic capacity of these techniques in determining the type of metal ion interaction with respect to the mononucleotides that form DNA and RNA, providing a tool for improving the knowledge of the stabilizing or destabilizing effects of these ions on such macromolecules. The metal complexes of the ribonucleotides 5'-CMP and 5'-GMP with Mg(II), Ca(II), Sr(II), Ba(II), Cr(III), Co(II), Cu(II), Zn(II), Cd(II), Al(III) and Ga(III) were obtained in this study. After studying and analyzing the IR and Raman spectra of all these complexes and comparing them with the spectra of the corresponding disodium salts, it was verified that, independently of the type of nucleotide involved, the presence of the metal in the vicinity of the phosphate group produces an alteration in the aforementioned nu(s) PO(3)(2-) band. This effect is related to the type of interaction that the phosphate group has with the metal. Three components are observed: (1) one near 983-975 cm(-1) (detectable in IR and Raman), associated with phosphate groups in an electrostatic type of interaction with the metal ion, separated by two or more water molecules; (2) another near 989-985 cm(-1) (only in IR), associated with phosphate groups in indirect interaction through the water molecules of the coordination sphere of the metal ions; and (3) the IR and Raman bands near 1014-1001 cm(-1), which represent phosphate groups directly bonded to the metal ion. These results are supported by the behavior of 5'-CMP in aqueous solution in the presence of Mg(II) ions.

Copper sorption by chitosan in the presence of citrate ions: influence of metal speciation on sorption mechanism and uptake capacities

The presence of organic ligands in a solution containing metal ions modifies metal speciation, which in turn changes the sorption mechanism, optimum pH range and maximum sorption capacity. The present work investigates the sorption of copper by chitosan in the presence of citrate at different metal/ligand ratios. Copper uptake in acidic solution takes place through electrostatic attraction between the protonated amine groups of chitosan and anionic copper-citrate complexes (mainly Cu(OH)L2- but also a small fraction of CuL-). Sorption was negligible below pH 3 due to competition from dissociated anionic ligand and counter ions brought about by dissociation of the acid used for pH control. Actually, copper sorption begins to be significant when the fraction of anionic copper-complexes exceeds that of anionic copper-free ligand. So sorption capacity strongly increases up to pH 4.5-5.5. Above pH 5.5, the progressive decrease of amine protonation leads to a linear decrease in sorption capacity. An excess of ligand leads to an increase in the fraction of free dissociated (anionic) ligand that may compete for electrostatic attraction on protonated amine groups and therefore leads to a decrease in sorption capacities.

Analysis of biological phenotypes from 42 patients with inherited factor VII deficiency: can biological tests predict the bleeding risk?

BACKGROUND AND OBJECTIVES

Inherited factor VII (FVII) deficiency is a rare bleeding disorder characterized by a poor relationship between reported FVII clotting activity (FVII:C) and bleeding tendency. Our study was aimed at defining biological parameters that are possibly predictive for bleeding risk in this condition.

DESIGN AND METHODS

Forty-two FVII-deficient patients (FVII:C <30%) were classified into two opposite clinical groups defined as severe and non-or-mild bleeders. For each patient, plasma samples were collected and then investigated for FVII:C (using a sensitive method and human recombinant thromboplastin as the reagent), FVII antigen, activated FVII coagulant activity (FVIIa:C) and the free-form of tissue factor pathway inhibitor.

RESULTS

None of these tests could be used as highly accurate predictors of bleeding. Nevertheless, both FVII:C and FVIIa:C differed significantly between the two clinical groups. Using ROC-curve analysis, two critical values of 8% and 3mIU/mL for FVII:C and FVIIa:C, respectively, could be proposed to discriminate between severe bleeders and non-or-mild bleeders.

INTERPRETATION AND CONCLUSIONS

A highly accurate diagnostic test for predicting bleeding tendency in inherited FVII deficiency still eludes definition, highlighting the fact that factors other than FVII itself interfere with the expression of bleeding phenotypes in this condition. Nevertheless, potential critical values using sensitive FVII:C and FVIIa:C methods may be useful in clinical laboratories for FVII-deficient patients. Those patients with FVII:C levels higher than 8% FVII:C or FVIIa:C higher than 3 mIU/mL, with no other hemostatic defect, seem to have a minimal risk of severe bleeding. Extended clinical studies are needed to support these findings.

Aerobiology as a tool to help in episodes of occupational allergy in work places

Over 80% of weekday time is spent indoors and the air quality of this environment may affect the incidence of symptoms in allergy sufferers. However, indoor/outdoor measurements have been jointly considered only in a few studies. The objective of this paper is to analyse indoor/outdoor biological and non-biological particle content togeher with other factors affecting the severity of symptoms during working periods in an Aerobiology Lab during the most troublesome period of the year for allergy sufferers. For this purpose, indoor/ outdoor air samples were taken using standard portable particle traps at the National Coordinating Centre of the Spanish Aerobiology Network, University of Cordoba. The analysis differentiated between biological and non-biological material, and the allergy symptoms suffered by workers were quantified and correlated accordingly. An inventory of the incoming and outgoing sources of emissions was done in order to identify agravating co-factors. The results showed that since there was very little air movement between indoors and outdoors, there was a significant difference in the amount of biological material present in the two areas. The presence of some indoor source of emissions, such as the Plant Collections property of the Department, the Air Conditioned System and the volatile compounds of the copying machine was responsible of high particle content. External factors such as weather conditions or human activities contributed exacerbating symptoms. As Conclusion, the knowledge of airborne biological particle content could be a useful tool in minimising allergy symptoms when environmental conditions render them inevitable.

Percutaneous needle aponeurotomy: complications and results

Recently French rheumatologists have repopularized fasciotomy using a percutaneous needle technique. This blind approach has been claimed to be plagued by numerous complications. We reviewed the charts of 211 patients treated consecutively on 261 hands and 311 fingers to assess the rate of postoperative complications. The first 100 patients were evaluated with a mean follow up of 3.2 years to assess the rate of recurrences and extension of the disease. In the whole group the mean age was 65 years and delay between onset and treatment was 6 years. Division of the cords were performed only in the palm in 165 cases, in the palm and finger in 111 and purely in the finger in 35. Complications were scarce without infection or tendon injury but one digital nerve was found injured during a second procedure. Postoperative gain was prominent at metacarpophalangeal joint level (79% versus 65% at interphalangeal level). The reoperation rate was 24%. In the group assessed at 3.2 years follow up, the recurrence rate was 58% and disease "activity" 69%. Fifty nine hands need further surgery. The ideal indication for this simple and reliable technique is an elderly patient with a bowing cord and predominant MP contracture.

Consequences of polymorphism of 5'-GMP.Na2 in the vibrational spectra of metal complexes and isotopic derivatives

The commercial mononucleotides are frequently used to obtain metal complexes and isotopic derivatives. Normally, the spectra of these new compounds are compared with the spectra of the commercial mononucleotides. Nevertheless, important variations in the vibrational spectra of the disodium 5'-guanosine monophosphate, 5'-GMP, have been observed in this work produced by submitting the commercial salt to the same general laboratory process that the obtained compounds, i.e., solving the commercial salt in water and subsequent recrystallization. These changes have been analyzed and interpreted. The variations are not significant in disodium 5'-cytosine monophosphate, 5'-CMP. It is important to take this information into account before carrying out vibrational studies with this type of molecules, since some bands attributed to isotopic substitutions or to the metal attack may be a result of manipulation of the nucleotide (solving and recrystallization) instead of the studied effect. Thus, before any work in which the nucleotide salt is manipulated (deuteration, synthesis of other isotopic derivatives or metal-nucleotide complexes), it should be noted that the process to which the sample is submitted on its own is enough to modify the vibrational spectrum. Then, attention should be paid to the changes observed in the vibrational spectra of recrystallized mononucleotides, since recrystallization may lead to a considerable phase change, and this can notably alter the vibrational spectra.