Preliminary evaluation of medical outcomes (including quality of life) and costs in incident RA cases receiving hospital-based multidisciplinary management

A six-month, prospective descriptive study of medical outcomes (including quality of life) and costs was conducted in 20 incident cases of rheumatoid arthritis (RA). Multidisciplinary management was started during an inpatient stay at the beginning of the study. Patients were evaluated on a day-hospital basis three and six months later. The following parameters were studied: quality-of-life scores on a generic scale (the Nottingham Health Profile [NHP]) and two specific scales (Health Assessment Questionnaire [HAQ] and the short-form Arthritis Impact Measurement Scale [AIMS]), pain severity, disease activity assessed by the patient and physician, painful and swollen joint counts, erythrocyte sedimentation rate, and C-reactive protein level. The following costs were evaluated: laboratory tests, plain radiographs, other investigations, physician care (by rheumatologists or other specialists), second-line drug therapy and monitoring for its side effects, care by nurses, physical therapy, and occupational therapy. All patients showed significant improvement three months after initiation of multidisciplinary management. This effect was sustained through the sixth month. Quality-of-life scores improved, with the exceptions of the social isolation subscore on the NHP and the psychological impact, social activity, and occupational activity subscores on the short-form AIMS. Mean total cost for the six-month period was 3429 +/- 880 euros (1 euro = 6.6 FF). Laboratory tests contributed the largest portion of the total cost (39%), followed by rheumatologist care (16%); the other costs accounted for 7.6 to 9.2% of the total cost. This prospective medical and economic study is preliminary. Comparative studies are needed.

[Comparative analysis of the clinical history and polysomnography in sleep disorders. Diagnostic relevance of polysomnography]

INTRODUCTION

The incidence of associate pathologies has been studied during the sleep, as well as the diagnostic efficiency of the clinical history.

PATIENTS AND METHODS

Patients (n = 136) remitted by diverse services, have been studied. It has been carried out a complete polysomnography, as well as other supplementary studies (anxiety and depression tests, excessive daytime sleepiness Epworth's test, EEG and sleep notebook).

RESULTS

The most common symptom turned out to be the primary snores, followed by the excessive daytime sleepiness and apneas. The results of the excessive daytime sleepiness Epworth's test and the anxiety and depression tests were not useful to differ among pathologies, not even between pathologies and patients with normal sleep. The percentage of diagnosis of suspicion confirmed by the polysomnography was of 39.7%, while in 11% of the total of patients it was observed the existence of more than a pathology of the sleep. In 49.3% of the cases the polysomnographic diagnosis was completely different from the diagnosis of suspicion. Among the patients with clinic suspicion of apnoea, in 48.3% of the cases the existence of the same one was verified, although in 14.6% it was associated with other pathologies. In 51.7% of the patients it was not possible to confirm this pathology.

CONCLUSIONS

The clinical history is not enough for the diagnosis of the pathologies of the sleep. On the other hand, the existence of associate pathologies diminishes the value of several 'screening-methods'. Therefore, it is fundamental to carry out a complete polysomnography in all the patients that present any sleep disorder on the part of doctors that approach the problem of the sleep in a global way and not only thinking in the possible existence of syndrome of sleep apnoea.

Immunoglobulin G class identification from wild ungulates by cross-reactivity with antisera to domestic animals

Seven species of Spanish ungulates were tested for the presence of homologous immunoglobulin G (IgG) with a gel-diffusion test using bovine, ovine, caprine and porcine IgG antisera. Homologous ovine and caprine IgG were detected in sera from chamois (Rupicapra pyrenaica), Spanish ibex (Capra pyrenaica hispanica), mouflon (Ovis orientalis musimon), red deer (Cervus elaphus), fallow deer (Dama dama) and roe deer (Capreolus capreolus). Homologous porcine IgG was detected in wild boar (Sus scrofa) serum. Immunoelectrophoretic assays were performed to compare the electrophoretic mobility of IgG from domestic and wild species.

Hematologic and serum chemistry values of the captive European wildcat

Hematologic and serum chemistry values were determined for 20 adult captive European wildcats (Felis silvestris) in Lleida (Catalonia, Spain). Seven wildcats (4 females and 3 males) were captured in the wild and 13 (4 females and 9 males) were born and raised in captivity. Samples were collected between September and December from 1993 to 1998. Blood was obtained by jugular venipuncture after administration of either ketamine and xylazine or ketamine and medetomidine. Females had significantly higher mean eosinophil counts, albumin concentration, (and A/G ratio) and lower mature neutrophil counts, although these differences were not clinically relevant. Results for many of the blood parameters fall within the reference range for domestic cats. Mean values for alanine aminotransferase, aspartate aminotransferase, creatine phosphokinase, and lactate dehydrogenase activities as well as blood urea nitrogen, glucose, and sodium concentrations were higher than the upper limit of the reference range for domestic cats.

Electrically induced blink reflex and facial motor nerve stimulation in beagles

Electrophysiologic assessment of the blink reflex test and the muscle-evoked potentials evoked by stimulation of the facial nerve were performed in 15 healthy adult Beagles before and after supraorbital (trigeminal) and facial anesthetic nerve blocks performed by lidocaine injections. Unilateral electrical stimulation of the supraorbital nerve elicited 2 ipsilateral (R1 and R2) and a contralateral (Rc) reflex muscle potential in orbicularis oculi muscles. Electrical stimulation of the facial nerve elicited 2 muscle potentials (a direct response [D] and a reflex faciofacial response [RF]) in the ipsilateral orbicularis oculi muscle. Anesthetic block of the left supraorbital nerve resulted in bilateral lack of responses upon left supraorbital nerve stimulation, but normal responses in right and left orbicularis oculi muscles upon right supraorbital stimulation. Right facial anesthetic block produced lack of responses in the right orbicularis oculi muscle regardless the side of supraorbital nerve stimulation. Results of this study demonstrate that the blink reflex can be electrically elicited and assessed in dogs. Reference values for the blink reflex responses and for the muscle potentials evoked by direct facial nerve stimulation in dogs are provided. The potential usefulness of the electrically elicited blink reflex test in the diagnosis of peripheral facial and trigeminal dysfunction in dogs was demonstrated.

[Lhermitte-Duclos disease associated with tuberous sclerosis. A case report and review of literature]

INTRODUCTION

Lhermitte-Duclos disease is a rare disorder of the cerebellum of unknown origin in which dysplasic thickening of the cerebellar convolutions is seen. It usually occurs in young adults. Currently it is included in the phacomatosis group of disorders.

CLINICAL CASE

A 19 year old woman attended the Emergency Department complaining of progressive orthostatic headache for the previous three months. On examination there were striking facial micronodular lesions suggestive of angiofibromas, a hypo-pigmented macula in the inframammary region and a hyperpigmented 'café-au-lait' macula in the right hypochondrium. On computerized tomography there was tetraventricular hydrocephalia. Cerebral magnetic resonance showed significant descent of the tonsils, hypertensive hydrocephalia and a lesion in the left cerebellum, apparently laminar hyperintensity in DP and T2, with thickening of some folia, not enhanced by intravenous contrast and suggestive of a dysplasic gangliocytoma. Laboratory investigations showed subclinical hypothyroidism. Other investigations were normal. The patient was treated by implanting a ventriculo-peritoneal shunt which has relieved the symptoms to date.

CONCLUSIONS

Lhermitte-Duclos disease is probably not a single anatomo-clinical condition, assuming that it may be a cerebellar hamartoma associated with a phacomatosis with few clinical signs, whether it be Cowden's disease, tuberous sclerosis as in this case or an 'overlapping' syndrome. The magnetic resonance findings are necessary and sufficient for the diagnosis of Lhermitte-Duclos disease.

Finite resolution effects in the analysis of the scaling behavior of rough surfaces

We investigate the influence of finite spatial resolution in the analysis of the scaling behavior of rough surfaces. We analyze such an effect for two usual measurement methods: the local width and the height-height correlation function. We show that while the correlation function is insensitive to finite resolution effects for practical purposes, the local width presents correction terms to the scaling law, leading to an effective value of the local roughness exponent smaller than the theoretically expected. We also show that a functional scaling relation can only be properly formulated in terms of the height-height correlation function.

[Biophysical foundations of the neuronal activity]

OBJECTIVE

It is sought to expose in a simple but rigorous way the fundamental basis of the classical biophysics.

DEVELOPMENT

I start from the basic properties of a simple system (two solutions separated by a semipermeable membrane) in order to analyze the process of development of differences of potential. It is analyzed with special interest the development of the Nernst and Nernst-Planck equations. Then it is studied how this difference potential can originate, with different ionic species, the resting potential (Goldman, Hodgkin and Katz model). The next step consists in to analyze how the action potential arises. To do this, it will be of capital importance the mathematical model developed by Hodgkin and Huxley in the fifties; for it will be analyzed it thoroughly. Finally, some properties of the ionic channels will be commented that symbolize the biological implementation of the previous model.

CONCLUSION

The fundamental property of the nervous system that constitutes its biological sense is the handling of the information in a quick and sure way. This information codes it basically in form of potentials and its changes. For it, it would be important for clinical neurophysiologists, neurologists, neurosurgeons and psychiatrists to understand the mechanisms that underlie into the behavior of the nervous system.

Biotic indices based on soil nematode communities for assessing soil quality in terrestrial ecosystems

Nematode communities offer several advantages for assessing the quality of soils. Diversity and maturity indices as well as trophic structure defining parameters based on the composition of soil nematode communities have been used to detect various kinds of man-induced disturbances and monitor ecological recovery. In the present paper we examined the response of these indices in herbaceous Mediterranean ecosystems. Incipient soils, which were developed on the top of waste dumping sites were compared with agricultural soils under fallow. Grasslands and old-fields were considered as reference systems. Either diversity or maturity indices were shown to be very sensitive to changes in soil system caused by waste dumping. However, they were less useful for the categorisation of perturbation in agroecosystems. Trophic composition related parameters were more meaningful for this aim. Plant parasite index (PPI) may be a good generic indicator of recovery processes after perturbation in these annual herbaceous ecosystems.

Back-scattered electron imaging of a non-vertebral case of hypervitaminosis A in a cat

We describe a clinical case of hypervitaminosis A in a cat. The main lesions were bony fusions of both the hip and stifle joints, without spinal involvement. A post-mortem study using back-scattered scanning electron microscopy (BEI-SEM) revealed that exostoses had formed around the joints without articular surface involvement. The more recently formed areas of bony proliferation were composed mainly of chondroid tissue surrounded by different degrees of woven bone. As the bony reaction occurred, remodelling of the trabeculae was observed which lead to progressive substitution of chondroid tissue by woven bone surrounded by apposition of lamellar bone. No traces of calcified cartilage were observed in any of the bone sections evaluated.

Effects of sarcoptic mange on serum proteins and immunoglobulin G levels in chamois (Rupicapra pyrenaica) and Spanish ibex (Capra pyrenaica)

Three groups of chamois (Rupicapra pyrenaica) and three groups of Spanish ibex (Capra pyrenaica) were established to study the effects of sarcoptic mange on serum proteins and immunoglobulin G (IgG) levels. The first group of chamois consisted of 22 healthy Pyrenean chamois (R. pyrenaica pyrenaica) from a non-infested area, the second group consisted of 20 healthy Cantabrian chamois (R. p. parva) from an area where sarcoptic mange has been reported since 1994 and the third group consisted of 16 Cantabrian chamois from the same area but naturally infested by Sarcoptes scabiei. The first group of Spanish ibex was 39 healthy animals from a sarcoptic mange non-infested area, the second group was 23 healthy animals from a sarcoptic mange infested area and the third group consisted of 20 animals from the same area but naturally infested with the parasite. Blood samples were taken after killing the animals as part of hunting programmes. Values for total proteins, gamma-globulin and IgG were higher in infested and healthy chamois from the infested area compared to healthy chamois from the non-infested area, and IgG levels were higher in infested chamois compared to healthy-exposed chamois. Values for alpha2-globulin were higher in healthy Cantabrian chamois. In Spanish ibex, albumin, alpha2-globulin and IgG levels were lower in the healthy Spanish ibex from the non-infested area than in healthy animals from an infested area. The differences found in the chamois were indicative of the establishment of a humoral antibody response in the animals in contact with the disease. As the IgG levels were not significantly different between healthy and infested Spanish ibex from the same area, a different pattern of chronic infection with humoral response to the disease was suggested.

[Small-cell nonanaplastic bronchogenic carcinoma. The new stage I]

OBJECTIVE

To validate updated guidelines for stage I classification of patients with differentiated small-cell bronchogenic carcinoma.

METHODS

Seven hundred seventeen tumors of differentiated small-cell bronchogenic carcinoma were resected in our hospital and given a TNM classification of stage I based on guidelines recently issued by the Spanish Society of Pneumology and Chest Surgery (SEPAR). Survival was calculated using the Kaplan-Meier method and curves were compared with a log-rank test. The Cox proportional hazards model was used to analyze multiple variables.

RESULTS

One hundred forty-two cases were classified as stage IA and 575 as stage IB. Survival was significantly longer for stage IA than for stage IB (p = 0.0021). The prognosis was significantly better for stage IA patients who were asymptomatic (p = 0.0380) or who had tumors < or = 2 cm in diameter (p = 0.0431). In stage IB, histologic grade (p = 0.0104) and tumor diameter (p = 0.0002) significantly affected survival. A noteworthy finding was the 82% survival at five years in a group of 66 patients with a maximum tumor diameter of 3 cm classified as T2N0M0 due to invasion of the visceral pleura or to proximal involvement of a lobar bronchus at a site > 2 cm from the carina; that survival rate was not significantly different from survival for stage IA (p = 0.1573). Multivariate analysis showed that tumor diameter (p = 0.0272) was of prognostic importance in stage IA, while tumor diameter (p = 0.0005) and histologic grade (p = 0.0092) were relevant in stage IB.

CONCLUSION

The new staging guidelines for differentiated small-cell bronchogenic carcinoma are nearer to prognostic reality given that survival for stage IA patients is significantly longer than for stage IB patients. However, the method continues to have shortcomings in that it fails to achieve one of its main objectives, namely prognostic homogeneity for each subgroup, as indicated by problems related to variables of tumor extension such as diameter, involvement of the visceral pleura or bronchial location, apart from other factors that affect survival.

Information processing in large-scale cerebral networks: the causal connectivity approach

Today, cognitive functions are considered to be the offspring of the activity of large-scale networks of functionally interconnected cerebral regions. The interpretation of cerebral activation data provided by functional imaging has therefore recently moved to the search for the effective connectivity of activated regions, which aims at understanding the role of anatomical links in the activation propagation. Our assumption is that only causal connectivity can offer a real understanding of the links between brain and mind. Causal connectivity is based on the anatomical connection pattern, the information processing within cerebral regions and the causal influences that connected regions exert on each other. In our approach, the information processing within a region is implemented by a causal network of functional primitives, which are the interpretation of integrated biological properties. Our choice of a qualitative representation of information reflects the fact that cerebral activation data are only the approximate view, provided by imaging techniques, of the real cerebral activity. This explicit modeling approach allows the formulation and the simulation of functional and physiological assumptions about activation data. Two alternative models explaining results of the striate cortex activation described by Fox and Raichle (Fox PT, Raichle ME (1984) J. Neurophysiol 51:1109-1120; Fox PT, Raichle ME (1985) Ann Neurol 17:303-305) are provided as an example of our approach.

[The prognosis following surgical resection of small-cell nonanaplastic bronchogenic carcinoma according to the new staging guideline: an analysis of 1433 patients]

OBJECTIVE

To validate current guidelines for staging bronchogenic lung carcinoma.

METHODS

Between 1969 and 1996, small-cell non-anaplastic tumors of bronchogenic carcinoma classified by the recently proposed TNM guidelines of the Spanish Society of Pneumology and Chest Surgery (SEPAR) were resected from 1,433 patients. We used the Kaplan-Meier method to calculate survival and compared the curves using a log-rank test.

RESULTS

A stage IA classification was given to 142 patients and IB to 575. Thirty-seven cases were classified IIA and 336 were IIB. Of the latter, 177 were T2N1M0 and 159 were T3N0M0. Two hundred forty-eight patients were in stage IIIA, 54 T3N1M0, 23 T1N2M0, 120 T2N2M0 and 51 T3N2M0. Ninety-five stage IIIB patients were classified as follows: 37 T4N0M0, 35 T4N1M0, and 23 T4N2M0. Five-year survival for IA patients, at 75% was significantly better than the 60% rate for IB patients (p = 0.0021). Likewise, the prognosis for stage IIA, where five-year survival was 57%, was significantly better than for IIB at 39% (p = 0.0434). The prognosis for patients classified as T1NM0 was better than for those classified as T2N1M0, which was 38% (p = 0.0320). The survival of those classified as T3N0M0 (42%) was not significantly different from that of T1N1M0 (p = 0.1754) or T2N1M0 (p = 0.5360) patients. We found no significant difference between T1N1M0 and stage IB (p = 0.3847) patients. Among stage III patients, we observed no difference in survival between stage IIIA and IIIB (p = 0.1914). In stage IIIA, patients classified as T3N2M0 had a significantly lower rate of survival (p = 0.0399). The presence of mediastinal ganglia in stage IIIB was associated with a lower survival rate (p = 0.0328).

CONCLUSION

The new guidelines for staging non-small cell anaplastic lung carcinoma do not provide consistent prognoses for homogeneous groups of patients, at least not in certain categories.

[Reflex benign myoclonic epilepsy of childhood. Apropos of a new case]

INTRODUCTION

Recently a series of cases has been reported characterized by myoclonic crises similar to those occurring in benign myoclonic epilepsy of childhood. However, these crises only occurred after unexpected tactile or auditory stimuli. These clinical conditions represent a new epileptic syndrome, which is age-dependent and has been called benign myoclonic epilepsy of childhood.

CLINICAL CASE

We present the case of a 12 month old girl with myoclonic crises which occurred only after auditory or tactile stimuli. The myoclonia could be set off whilst awake or asleep. No other types of crises or neurological changes were seen. A brother of the patient had had febrile convulsions. The EEG recorded during the crises showed generalized brief spike-and-wave discharges at 3 cycles/second. The intercritical EEG was normal whilst awake, but during sleep showed brief generalized discharges. After treatment with valproate was started the crises became less frequent.

CONCLUSIONS

The case we describe is similar to those described by Ricci et al in 1995. We, therefore, consider it to fit the concept of reflex myoclonic epilepsy of childhood of benign character. We consider that this condition should be differentiated from other reflex epilepsies and epileptic syndromes with a predominance of myoclonia, including benign myoclonic epilepsy of childhood.

[Resection of bronchogenic carcinoma invading the diaphragm]

The prognosis for survival when small cell non-anaplastic bronchogenic carcinoma (SCN-ABC) invades the diaphragm has not been clearly established because the diagnosis is rare. We report a series of eight patients who underwent full resection of SCN-ABC with diaphragm invasion. One died during the postoperative period. Mean survival was eight months for the remaining seven and no patient lived five years. All died as a result of remote metastasis. Given these results, we question whether surgery is the most appropriate treatment for these patients.

ERP correlates of phoneme perception in speech and sound contexts

To address the question of the existence of a phonetic module for speech perception, event-related potentials were recorded using a 32 channel system in subjects performing a detection task where the target was the ambiguous, noise-like phoneme /f/ presented either among syllables (speech context) or among environmental sounds (non-speech context). Significant context effects were observed on the N2/P3 complex elicited by the target. In particular, a well localized N2b (250-280 ms) appeared at the left temporoparietal sites on the difference wave between contexts as the result of an enhanced negativity when the target was presented among non-speech stimuli. These findings suggest the involvement of the left temporoparietal region in autonomous, modular processes of speech perception.