Differential recovery ability from infections by two blood parasite genera in males of a Mediterranean lacertid lizard after an experimental translocation

Different blood parasites can co-infect natural populations of lizards. However, our knowledge of the host's ability to recover from them (i.e., significantly reduce parasitemia levels) is scarce. This has interest from an ecological immunology perspective. Herein, we investigate the host recovery ability in males of the lizard Psammodromus algirus infected by parasite genera Schellackia and Karyolysus. The role of lizard hosts is dissimilar in the life cycle of these two parasites, and thus different immune control of the infections is expected by the vertebrate host. As Schellackia performs both sexual and asexual reproduction cycles in lizards, we expect a better immune control by its vertebrate hosts. On the contrary, Karyolysus performs sexual reproductive cycles in vectors, hence we expect lower immune control by the lizards. We carried out a reciprocal translocation experiment during the lizards' mating season to evaluate both parasitemia and leukocyte profiles in male lizards, being one of the sampling plots close to a road with moderate traffic. These circumstances provide a combination of extrinsic (environmental stress) and intrinsic factors (reproductive vs. immune trade-offs) that may influence host's recovery ability. We recaptured 33% of the lizards, with a similar proportion in control and translocated groups. Karyolysus infected 92.3% and Schellackia 38.5% of these lizards. Hosts demonstrated ability to significantly reduce parasitemia of Schellackia but not of Karyolysus. This suggests, in line with our predictions, a differential immune relationship of lizards with these parasites, at time that supports that parasites with different phylogenetic origins should be analyzed separately in investigations of their effects on hosts. Furthermore, lizards close to the road underwent a stronger upregulation of lymphocytes and monocytes when translocated far from the road, suggesting a putative greater exposure to pathogens in the latter area.

Cross-cultural adaptation of the Genetic Counseling Outcome Scale (GCOS-24) for use in Canada: A qualitative study

The Genetic Counselling Outcome Scale (GCOS)-24 is a patient-reported outcome measure (PROM) developed and validated in the United Kingdom (UK). The aim of this study was to cross-culturally adapt GCOS-24 to Canadian Clinical Genetic Services (CGS). This was achieved through a qualitative study exploring whether the existing GCOS-24 maintains its intended meaning in a Canadian population and assessing whether GCOS-24 items could be better worded to meet the needs of members of families affected by genetic conditions in Canada. Thirteen participants were recruited from Canadian Patient Organizations supporting people and families affected by genetic conditions. Data were collected through semi-structured cognitive interviews, as these allow exploration of participants' comprehension, opinions, thoughts, and feelings regarding GCOS-24's instructions, response options, and the meaning/relevance of each item. Thematic analysis was utilized for data analysis, and an inductive approach to coding was followed to allow for themes to emerge from the data. Themes were organized in respect to their questionnaire item and further classified into their respective Empowerment dimension. The GCOS-24 instructions were found easy to understand by all thirteen participants. Although the response options were also found to be straightforward, the data suggest the questionnaire would benefit from the addition of a "non-applicable" option. Semantic validation of the GCOS-24 showed that items within the Cognitive Control and Emotional Regulation dimensions were found easy to understand by participants. However, items within the Decisional Control, Behavioural Control and Hope dimensions presented semantic difficulties. Participants provided feedback on syntactic changes to support understanding, and this feedback was used to develop a final Canadian-adapted version of GCOS-24, GCOS-Canada. This study provides the first step towards a valid, culturally adapted PROM for use in Canadian CGS service evaluation and research. GCOS-Canada would benefit from psychometric validation to ensure validity, reliability, responsiveness, minimal clinically important difference and internal consistency.

Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia

INTRODUCTION

The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system's bottlenecks from a territorial point of view.

METHODS

Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15-May 2, 2020) and an immediate prepandemic period (January 26-March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days.

RESULTS

Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = -0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05-2.4], p 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4-0.9], p 0.015) during the pandemic period.

CONCLUSION

During the COVID-19 pandemic, Catalonia's stroke system's weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system's analysis is crucial to allocate resources appropriately.

Discovery of Homobivalent Bitopic Ligands of the Cannabinoid CB2 Receptor*

Single chemical entities with potential to simultaneously interact with two binding sites are emerging strategies in medicinal chemistry. We have designed, synthesized and functionally characterized the first bitopic ligands for the CB2 receptor. These compounds selectively target CB2 versus CB1 receptors. Their binding mode was studied by molecular dynamic simulations and site-directed mutagenesis.

Effectiveness and safety of perampanel as early add-on treatment in patients with epilepsy and focal seizures in the routine clinical practice: Spain prospective study (PERADON)

OBJECTIVE

Perampanel (PER) has been shown to be effective as an adjunctive therapy for controlling refractory focal-onset seizures (FOS). However, the information as early add-on for the treatment of FOS in the clinical practice is still scarce and must be further assessed.

METHODS

An observational prospective study was conducted to evaluate the effectiveness of early add-on PER, assessed as 50% responders (seizure frequency reduced by at least 50% during the last 3 months as compared with baseline) rate at 6 and 12 months, in patients with FOS in the routine clinical practice of Spain.

RESULTS

One hundred and thirteen patients (mean age: 40.3 years, 51.3% male) with FOS received PER as early add-on (1st add-on: 37.2% and 2nd: 62.8%) for a mean exposure of 11 months (mean PER dose: 6.3 mg/day at month 12). At 6 months, 50.4% and 20.4% of the patients were responders and seizure-free (respectively) relative to baseline (3 months prior to PER initiation), and at 12 months, 68.1% and 26.5% of the patients were responders and seizure-free (respectively), relative to baseline (3 months prior to PER initiation). The retention rate at 6 and 12 months was 83.2% and 80.5%, respectively. The percentage of seizure-free patients at 12 months was significantly (p = 0.033) higher when PER was added as first vs. second add-on. The number of concomitant antiepileptic drugs (AEDs) was significantly reduced from baseline to 6 and 12 months (p = 0.001). Treatment was simplified in 23.9% of patients at the end of the observation period. Drug-related adverse events (AEs), most mild or moderate, were reported in 30.1% of patients, with irritability (8%) and dizziness (7.1%) as the most frequent ones.

CONCLUSIONS

This is the first observational, prospective study to evaluate efficacy and safety of early adjunctive treatment with PER in patients with focal epilepsy at 12 months. Perampanel demonstrated a good efficacy and safety profile when used at a median dose of 6 mg/day, regardless of the combination with other AEDs. Adverse events were mild or moderate, with dizziness being the most frequent one.

Usefulness of the Trabecular Bone Score for assessing the risk of osteoporotic fracture

INTRODUCTION AND OBJECTIVES

The trabecular bone score (TBS) is an imaging technique that assesses the condition of the trabecular microarchitecture. Preliminary results suggest that TBS, along with the bone mineral density assessment, could improve the calculation of the osteoporotic fracture risk. The aim of this study was to analyse TBS values and their relationship with the clinical characteristics, bone mineral density and history of fractures of a cohort of posmenopausal women.

MATERIAL AND METHODS

We analysed 2,257 posmenopausal women from the FRODOS cohort, which was created to determine the risk factors for osteoporotic fracture through a clinical survey and bone densitometry with vertebral morphometry. TBS was applied to the densitometry images. TBS values ≤1230 were considered indicative of degraded microarchitecture. We performed a simple and multiple linear regression to determine the factors associated with this index.

RESULTS

The mean TBS value in L1-L4 was 1.203±0.121. Some 55.3% of the women showed values indicating degraded microarchitecture. In the multiple linear regression analysis, the factors associated with low TBS values were age, weight, height, spinal T-score, glucocorticoid treatment, presence of type 2 diabetes and a history of fractures due to frailty.

CONCLUSIONS

TBS showed microarchitecture degradation values in the participants of the FRODOS cohort and was associated with anthropometric factors, low bone mineral density values, the presence of fractures, a history of type 2 diabetes mellitus and the use of glucocorticoids.

A meta-analytic review of the MMPI validity scales and indexes to detect defensiveness in custody evaluations

Background/Objective: In child custody disputes, one of the remit of the forensic psychologist is to evaluate parental attributes while suspecting defensiveness. The instrument of choice for undertaking this double task is the MMPI. Method: As to establish the state of the art on this, a meta-analysis was undertaken with a total of 32 primary studies from which 256 effect sizes were assessed. A meta-analysis was undertaken, effect sizes were corrected for sampling error and criterion unreliability. Results: The results revealed a positive, significant, large and generalizable mean true effect size for the L, K, S and MP scales, and the L + K and L + K-F indexes. The Wsd was positive, significant and large, but not generalizable. A negative and significant, but not generalizable mean true effect size was found for the F and generalizable for F-K index. The effect sizes for the L, K, S and MP scales, and the L + K and L + K-F indexes were equal. Both the gender of parents (father vs. mother) and the context of evaluation (parent child custody disputes vs. parenting capacity) were assessed as moderators. Conclusions: The results are discussed in relation to forensic practice.

[Comparison of FRAX Score without bone mineral density determination and the criteria proposed by the Argentine Osteoporosis Society for the use of antiresorptive therapy in postmenopausal women]

To identify patients at high risk of fracture using clinical risk factors could reduce health costs arising from the realization of a bone densitometry. The aim of this study was to compare the FRAX score without bone mineral density (BMD) with the criteria proposed by the Argentine Society of Osteoporosis (SAO) to consider starting antiresorptive treatment. We conducted an observational, cross-sectional study where 330 postmenopausal women between 40 and 90 years of age were included. The number of treatments given if the FRAX tool without BMD had been followed was compared with the number of treatments indicated using the SAO criteria. Using the SAO criteria, 85 (25.8%) patients would initiate antiresorptive treatment compared with 15 (4.5%) using the FRAX without BMD (p = 0.0019). Among the 67 patients with a diagnosis of osteoporosis by BMD determination, all of them (100%) would have received treatment by using the SAO criteria compared with 10 (15%) using the FRAX score (p = 0.011). The use of FRAX without BMD significantly underestimates the number of patients who should receive antiresorptive treatment. In patients diagnosed with osteoporosis by BMD, the FRAX score underestimates the number of patients to be treated.

Asymptomatic presence of Nosema spp. in Spanish commercial apiaries

Nosemosis is caused by intracellular parasites (Nosema apis and Nosema ceranae) that infect the midgut epithelial cells in adult honey bees. Recent studies relate N. ceranae to Colony Collapse Disorder and there is some suggestion that Nosema spp., especially N. ceranae, induces high mortality in honey bees, a fact that is considered as a serious threat for colony survival. 604 samples of adult honey bees for Nosema spp. analysis were collected from beekeeping colonies across Spain and were analysed using PCR with capillary electrophoresis. We also monitored 77 Andalusian apiaries for 2 years; the sampled hives were standard healthy colonies, without any special disease symptoms. We found 100% presence of Nosema spp. in some locations, indicating that this parasite was widespread throughout the country. The two year monitoring indicated that 87% of the hives with Nosema spp. remained viable, with normal honey production and biological development during this period of time. The results of these trials indicated that both N. ceranae and N. apis could be present in these beehives without causing disease symptom and that there is no evidence for the replacement of N. apis by N. ceranae, supporting the hypothesis that nosemosis is not the main reason of the collapse and death of beehives.

[Psychogenic tremor: a positive diagnosis]

Psychogenic movement disorders are a daily challenge for the neurologist. A mistake in its recognition may have important consequences for the patients. As a result, the diagnosis must be considered very carefully in clinical practice. However, psychogenic movement disorders are not unusual, are mainly tremors, and a wrong diagnosis is common. Psychogenic is an unspecific term that usually masks the real mental disorder, and should be called somatoform disorders, factitious disorders, malingering, depression, anxiety and histrionic personality disorder, although the absence of a psychiatric diagnosis does not preclude a psychogenic cause. The diagnosis may often be difficult and should be made by an expert neurologist. Organic movement disorders must be excluded after a detailed neurological history, examination, and appropriate diagnostic studies. Psychogenic tremor is not only a diagnosis of exclusion, it can be diagnosed positively by its neurological signs, mainly: variability in frequency and amplitude, bilateral and sudden onset, non-progressive with frequent remissions, absence of finger, tongue or face tremor and coactivation of antagonistic muscles. Several tests can be useful in diagnosis, such as: accelerometry, EMG and response to placebo or suggestion. The treatment requires close cooperation between the medical team and patient. The problem must never be minimised and early diagnosis and treatment must be attempted.

Modification of pepsinogen I levels and their correlation with gastrointestinal injury after administration of dexibuprofen, ibuprofen or diclofenac: a randomized, open-label, controlled clinical trial

OBJECTIVE

To assess the effect of a 2-week treatment with dexibuprofen, in comparison with ibuprofen and diclofenac, on pepsinogen plasma concentrations and gastrointestinal mucosa, as well as the correlation of these changes with gastrointestinal mucosal injury.

METHODS

60 patients with rheumatologic disease in chronic therapy with NSAID, were included. After a 7-day run-in period patients were randomly assigned to receive a 14-day treatment with dexibuprofen (Group A; Day 1 - 3 = 400 mg t.i.d; Day 4 - 14 = 400 mg b.i.d.), ibuprofen (Group B; Day 1 - 3 = 800 mg t.i.d; Day 4 -14 = 800 mg b.i.d.) or diclofenac (Group C; Day 1 - 3 = 50 mg t.i.d; Day 4 - 14 = 50 mg b.i.d.). Upper gastrointestinal endoscopy (Day 15), capsule-endoscopy (Day 16, 7 patients of each group) and determination of pepsinogen plasma concentrations were performed (basal and Day 15). A semiquantitative scale was designed for the assessment of the gastrointestinal mucosa.

RESULTS

No differences in plasma pepsinogen were found between treatment groups or gastrointestinal injury grades or between basal and post-therapy determinations. Dexibuprofen showed gastroduodenal mucosal injury in fewer patients (42.1%) than was the case with ibuprofen (5%; p = 0.003) and diclofenac (30%; p = N.S.). Dexibuprofen administration was also associated with more patients having no intestinal mucosal damage (42.86% vs. 28.7% in the diclofenac group and 14.29% in the ibuprofen group; p = 0.0175). The rate of clinical adverse events was similar in Groups A, B and C (28%, 38% and 34%).

CONCLUSIONS

Dexibuprofen showed a lower rate of gastroduodenal and intestinal mucosal injury. This effect was not mediated by modifications of plasma pepsinogen levels.

Intestinal anti-inflammatory activity of dietary fiber (Plantago ovata seeds) in HLA-B27 transgenic rats

BACKGROUND & AIMS

Dietary fiber has been proven to be beneficial in maintaining remission in human ulcerative colitis, an effect related with an increased luminal production of short-chain fatty acids (SCFA). The aim of the present study was to further investigate the mechanisms involved in the intestinal anti-inflammatory effects of dietary fiber in an experimental model of rat colitis.

METHODS

HLA-B27 transgenic rats (8-10 weeks old) were fed a fiber-supplemented diet (5% Plantago ovata seeds) for 13 weeks before evaluation of the colonic inflammatory status, both histologically and biochemically. The luminal colonic production of SCFA was quantified. In vitro studies were also performed to test the interaction between two SCFA (butyrate and propionate) as inhibitors of cytokine production in THP-1 cells.

RESULTS

Dietary fiber supplementation ameliorated the development of colonic inflammation in transgenic rats as evidenced by an improvement of intestinal cytoarchitecture. This effect was associated with a decrease in some of the pro-inflammatory mediators involved in the inflammatory process: nitric oxide, leukotriene B(4), tumor necrosis factor alpha (TNFalpha). The intestinal contents from fiber-treated colitic rats showed a significant higher production of SCFA, butyrate and propionate, than non-treated colitic animals. In vitro studies revealed a synergistic inhibitory effect of butyrate and propionate on TNFalpha production.

CONCLUSIONS

Dietary fiber supplementation ameliorated colonic damage in HLA-B27 transgenic rats. This effects was associated with an increased production of SCFA, which can act synergistically in inhibiting the production of pro-inflammatory mediators.

[HIV related Foix-Chavany-Marie syndrome]

Automatic-voluntary motor dissociation of the face and lower cranial nerves of brainstem is the hallmark of Foix-Chavany-Marie syndrome (biopercular syndrome). It is commonly caused by ischemic strokes. We present a biopercular syndrome associated with HIV. A 41 year old female who presents a progressive automatic- voluntary motor dissociation of face and lower cranial nerves with later involvement of limbs. She was immunodepressed as a result of HIV. MRI showed bilateral lesions in opercular areas and ventrolateral thalamic nucleus, likely as a result of retrograde neuronal degeneration. Automatic-voluntary dissociation occur after biopercular lesions with sparing of motor pathway proceeding from the cingulate cortex.

[Cardiovascular disease and pregnancy]

Cardiovascular disease is the most important non-obstetric cause of disability and death in pregnant women, occurring in 1% of pregnancies. The added hemodynamic burden of pregnancy, labor and delivery can aggravate symptoms and precipitate complications in women with pre-existent cardiac disease. Additionally, it can reveal an underlying unknown pathology. The authors present three cases of pregnant women with mechanical prosthetic valve, cyanotic congenital heart disease and intracardiac shunt. Antenatal, labor and postpartum obstetric management is subject of debate.

[Correlation between reaction time and bradykinesia in Huntington's disease]

BACKGROUND

Bradykinesia is the clinical feature of Huntington's disease most closely related to functional discapacity and stage, probably as a consequence of spreading of neuronal injury. The aim of the present article is to verify whether a choice reaction time could be considered an estimate measurement of clinical bradykinesia, and its possible relationships with other evolutive parameters such as functional discapacity, clinical stage and prefrontal executive dysfunction.

METHODS

Fifteen patients were studied (9 in advanced stage and 6 initials), equal number of controls and 3 asymptomatic gene carriers. We used clinical bradykinesia and functional capacity scales, an extensive prefrontal battery and a computerized paradigm of reaction time.

RESULTS

Clinical bradykinesia and reaction time are closely related. The associations between reaction time with those parameters indicatives of prefrontal dysfunction, functional discapacity and clinical stage are closer and more significatives than those that could be established with clinical bradykinesia.

CONCLUSIONS

Reaction time is an objective measurement of global motor slowness that allow us assigning each subject to a specific stage, and avoid possible errors derived from interobserver bias in clinical scales.

Effects of silymarin MZ-80 on hepatic oxidative stress in rats with biliary obstruction

This study was designed to evaluate the effects of three pharmaceutical forms of silymarin (silymarin MZ-80, silybinin-beta-cyclodextrin, and silybinin) on the liver oxidative status in vitro and after oral administration to rats with extrahepatic biliary obstruction (EBO) and sham-operated animals. We evaluated thiobarbituric acid-reactive substances (TBARS), glutathione (GSH + GSSG) and their related enzyme activities (GSH peroxidase, GSSG reductase and GSH transferase). All three compounds inhibited the in vitro production of TBARS (IC(50) 56-533 micromol/l). These compounds, mainly silymarin MZ-80, also increased GSH peroxidase and GSH transferase activities. In EBO rats we found increases in TBARS production which was inhibited by 50-70% after treatment. Glutathione was reduced by 55% and elevated by silymarin MZ-80. GSH transferase increased in the group given silymarin MZ-80. We conclude that all three derivatives of silymarin show a clear ability to reduce lipid peroxidation in the liver. Silymarin MZ-80 was the only compound that enhanced the glutathione antioxidant system.

[Parkinson disease of juvenile onset with systemic lupus erythematosus in a pre-symptomatic stage]

INTRODUCTION

Parkinson's disease of juvenile onset is known to be rarely seen in clinical neurology. Occasionally it may be secondary to other pathological processes which have to be excluded by investigation of such cases, since the clinical, therapeutic and prognostic significance varies considerably depending on whether the condition is idiopathic or secondary.

CLINICAL CASE

We present the case of a patient whose illness started when she was 16 years old. She complained of rigidity, tremor and akinesia. Her condition was studied to find whether the syndrome was secondary. Thus, on four occasions, at annual visits during a period of five years, immunological changes suggestive of systemic lupus erythematous were observed. Neuroimaging, magnetic resonance and computerized axial tomography studies were completely normal on all four occasions over the five years during which the patient had annual follow-up reviews.

CONCLUSION

We considered whether the rigidity-akinesia-tremor syndrome might have been secondary to systemic lupus erythematous, due to a probable pathological focus of cerebral vasculitis, in this clinical case which we report.

[The bent spine syndrome: a focal axial myopathy of late onset]

The bent spine is a rare syndrome appearing at an advanced age which shows a posture of anterior flexion of the trunk, which is reducible and is often hereditary. It is caused by a paresia of the extensor musculature of the trunk by a focal axial myopathy of late onset. We herein describe the case of a 72-year-old woman with a progressive bent spine initiated at the age of 55. Family questioning showed vertical transmission of the process. On exploration paresis of the paravertebral musculature and to a lesser extent of both girdles was observed. Serum CK levels were normal. Vertebral CT showed atrophy with fatty substitution of the paravertebral musculature. EMG of the scapular and paravertebral muscles demonstrated a myopathic pattern. Deltoid muscle biopsy found atrophy of type II fibers and isolated broken red fibers. This case corroborates the myopathic nature of this syndrome. A review of the nosology of the syndrome is also presented.

[Myotonic dystrophy: DNA instability in monozygotic twins]

INTRODUCTION

Myotonic dystrophy is an autosomal dominant hereditary disorder with variable expression, associated with expansion of the CTG triplet on the gene which codifies myotonia situated on chromosome 19q. We present an unusual case of myotonic dystrophy in a pair of monozygotic twin sisters, determination of CTG expansion in lymphocytes of members of their family and in their father's spermatozoids.

CLINICAL CASE

The patients presented the phenomenon of anticipation of paternal transmission with an expansion of triplet CTG of lymphocyte DNA in a range of 300-1,400 identical repetitions in both. DNA of the paternal lymphocytes and spermatozoids showed a similar expansion of 75 repetitions.

CONCLUSIONS

CTG expansion is not due to previous expansion of DNA in the paternal gametes but to instability of DNA in the cellular mitoses following formation of the zygote.

[Lymphocytic meningitis by mumps virus: epidemiologic, clinical, serologic and evolutive analysis of 28 cases]

BACKGROUND

Mumps is a viral infection which is particularly found in children and adolescents and one of its manifestations is as lymphocytary meningitis. The aim of this study was to analyze the clinical, epidemiologic and serologic characteristics of the cases of meningitis by the mumps virus (MMV) observed during an epidemic of mumps.

SUBJECTS AND METHODS

Twenty-eight cases of MMV diagnosed from December 1, 1994 to August 31, 1995 during an epidemic of mumps in the south of the province of Badajoz (Spain) were analyzed. Demographic, clinical, analytical and evolutive data were obtained.

RESULTS

Cases predominated in the winter and summer in adolescents and youths (mean age 16.9 years) with a male:female relationship of 3:1. On admission most patients presented fever, headache, and parotid hypertrophy. Orchitis was observed in half of the males. No case of encephalitis was seen. Hyperproteinorrhachia was observed in the cephalorrhachidian fluid of 79% of the cases and hypoglucorrhachia was found in only two patients (7%). The course was benign, except in four patients (14%) who had sequelae (headache, unilateral hyperacusia and testicular discomfort).

CONCLUSIONS

The epidemiologic and liquoral data of MMV in adolescents agree with those described in series of children. Nonetheless, the absence of encephalic involvement and the high proportion of orchitis is of note.

[Post-traumatic tics]

Secondary tics are those in which an aetiology justifying them can be found, as compared to idiopathic tics, which make up the majority, and the Gilles de la Tourette syndrome (SGT), which is, at the moment, of unknown origin. Of the possible aetiologies described as causing tics, craneo-encephalic trauma has been mentioned on very few occasions. We present a case of post-traumatic tics (verbal and neck) in a young man of 24, and review the published cases which can be considered to be of post-traumatic tics. We have found six cases of tics secondary to traumas, all craneo-encephalic, like ours (the one under study). The time interval between the blow and the appearance of the tic or tics varied between 2 weeks and 3 months. The absence of significant lesions seen in the complementary investigations make it impossible for us to discover the site of the lesion caused by the trauma. However, the presence in some cases of other tics before the trauma, and of family histories of tics, supports the idea of a genetic basis or predisposition to suffer this disorder.

[Symptomatic chronic hemichorea of a vascular lesion in the contralateral putamen]

We present a case of chronic multifocal choreform dyskinesia with evident anatomical and temporal relationship with a contralateral putamen lesion of ischaemic origin after embolism originating in a partially thrombosed intracavernous caratid aneurysm. Isolated putamen lesions are associated with abnormal dystonic type involuntary movements, bilateral to Parkinsonisms, sometimes associating both these types of movements, and lesions involving the cauda giving rise to choreic movements. Given the rarity in the literature of this entity, chorea associated with unilateral ischaemic putamen lesion, and the absence of pathogenic mechanisms which might satisfactorily explain it, we propose a series of possibilities which could underlie this type of chorea. If putamen macroscopic lesions are really more associated with dystonic manifestations, it is possible that, in some cases they might selectively alter base ganglia circuits and bring on chronic choreas rather than dystonia.

Histologic effects of different suture materials in microsurgical anastomosis of the rat uterine horn

OBJECTIVE

To evaluate the histologic effects and permeability rate of different suture materials in microsurgical anastomosis of the left uterine horn in Wistar rats.

STUDY DESIGN

In this histologic study, 81 female Wistar rats were used. A transverse section and anastomosis were performed using three surgical techniques. The rats were divided into 15 experimental groups based on evaluation of three variations in microsurgical technique: (1) one-layer transmucosal anastomosis, (2) one-layer extramucosal anastomosis, and (3) two-layer transmucosal anastomosis. With each technique, five suture materials were used: 7/0 polyglycolic acid, 6/0 polyglactin, 7/0 polydioxanone, 7/0 silk and 7/0 polypropylene.

RESULTS

The permeability rate was 86%. Polydioxanone persisted in 41% of cases at 90 days. Abnormal proliferation of mucosal epithelium was verified in 10% of cases. Polypropylene was responsible for the majority of foreign-body granulomas. Polydioxanone produced the smallest inflammatory reaction.

CONCLUSION

The type of suture material did not influence the permeability rate. Use of nonabsorbable suture material altered the histologic structure the most and produced the greatest tissue reaction. The best results were obtained with polydioxanone. Monofilial sutures gave rise to fewer structural alterations than did multifilament sutures.

[Effects of the administration of vitamin K on the activity of Factor II, VII and X in healthy newborns]

The study was designed to know the effect of oral vitamin K (VK) treatment, on clotting factors II-VII-IX-X and the protein induced by VK absence from factor II (PIVCA II) on full term infants. Seventy healthy newborns were studied and each was randomly placed in one of two groups: Group A, newborns that received human milk and milk formula (mixed feeding)and group B, newborns that were exclusively breast fed. These groups were also divided in two subgroups: I received 2mg of VK1 orally and II (control) did not receive VK. Clotting activity of the coagulation factors and PIVCA II was determined from blood plasma obtained immediately after birth and 48 hours after VK administration. Basal activity of the factors analyzed was similar in all groups with values ranging from 25% to 40%. After 48 hours a significant increase in all factors studied and a decrease of PIVKA II was observed in those children who received oral VK. The results suggest that oral VK effectively increases VK dependent factors and prevents the risk of hemorrhagic disease in the newborn, with the advantage of being less traumatic and less risky to the infant than intramuscular VK.