Influence of Traditional Management and Environmental Variables on Mediterranean Saproxylic Beetle Assemblages

Mediterranean oak forests of the Iberian Peninsula host a great diversity of saproxylic beetles. For centuries, humans have carried out traditional management practices in this area, at both habitat and tree level, causing changes in forest structure. The aim of this study was to evaluate the anthropic effect of these traditional practices on saproxylic beetle diversity by measuring a set of environmental variables related to forest structure at both plot and tree level. Fauna was collected using window traps over a period of 12 mo. Multiple regression procedures showed which variables significantly affected the diversity of the studied assemblage. Our results demonstrated that the different metrics used to assess the diversity of assemblages responded variably depending on the management strategies applied and the level at which they were carried out. Certain management practices that disrupted the landscape from its natural state, such as the introduction of livestock or the local removal of particular trees, maximized species richness but, nevertheless, had a negative effect on the rest of diversity metrics analyzed. However, other practices such as pollarding, which involves the suppression of the main branch of the tree, had a positive effect on all diversity metrics evaluated as it promoted the formation of potential microhabitats for saproxylic fauna. We concluded that not all types and degrees of traditional forest management favor saproxylic beetle diversity and that different diversity metrics should be taken into consideration in future strategies for the protection and conservation of this fauna.

Nursing involvement in risk and patient safety management in Primary Care

Patient safety and quality of care in a highly complex healthcare system depends not only on the actions of professionals at an individual level, but also on interaction with the environment. Proactive risk management in the system to prevent incidents and activities targeting healthcare teams is crucial in establishing a culture of safety in centres. Nurses commonly lead these safety strategies. Even though safety incidents are relatively infrequent in primary care, since the majority are preventable, actions at this level of care are highly effective. Certification of services according to ISO standard 9001:2008 focuses on risk management in the system and its use in certifying healthcare centres is helping to build a safety culture amongst professionals.

Saproxylic Beetle Assemblage Selection as Determining Factor of Species Distributional Patterns: Implications for Conservation

The knowledge of the distributional patterns of saproxylic beetles is essential for conservation biology due to the relevance of this fauna in the maintenance of ecological processes and the endangerment of species. The complex community of saproxylic beetles is shaped by different assemblages that are composed of species linked by the microhabitats they use. We evaluate how different the species distribution patterns that are obtained can be, depending on the analyzed assemblage and to what extent these can affect conservation decisions. Beetles were sampled using hollow emergence and window traps in three protected areas of the Iberian Peninsula. Species richness, composition, and diversity turnover were analyzed for each sampling method and showed high variation depending on the analyzed assemblage. Beta diversity was clearly higher among forests for the assemblage captured using window traps. This method collects flying insects from different tree microhabitats and its captures are influenced by the forest structuring. Within forests, the assemblages captured by hollow emergence traps, which collect the fauna linked to tree hollows, showed the largest turnover of species, as they are influenced by the characteristics of each cavity. Moreover, the selection of the forest showing the highest species richness strongly depended on the studied assemblage. This study demonstrates that differences in the studied assemblages (group of species co-occurring in the same habitat) can also lead to significant differences in the identified patterns of species distribution and diversity turnover. This fact will be necessary to take into consideration when making decisions about conservation and management.

A modified device to facilitate flow measurements during voiding cystometry studies in infants

INTRODUCTION

Urodynamic studies (UDS) in infants are traditionally hampered by technique and flow collection; both are difficult and have not yet been standardized.

METHODS

A very simple device has been developed to collect urine during the voiding phase in UDS. It is based on a urine-collection adhesive bag, which is connected to a tube that conducts the urine to a flowmeter.

RESULTS

Eleven infants (4-23 months) were selected and a complete UDS was performed on all of them. A diagnosis was obtained for all of the infants.

DISCUSSION

This device is easily available in every pediatric clinic; it is also disposable and inexpensive. It enables UDS in infants to be complete and achievable.

Sjögren-Larsson syndrome: optical coherence tomography and a novel mutation

CASE REPORT

A case is presented of a thirty year-old male with ichthyosis, mental retardation, epilepsy and spasticity. Ocular examination showed a best-corrected visual acuity of 0.5 and bilateral crystalline maculopathy. Optical coherence tomography (OCT) revealed focal hyperreflective spots and intrafoveal microcystoid spaces. The diagnosis of Sjögren-Larsson syndrome (SLS) was made, and confirmed by genetic analysis.

DISCUSSION

SLS is caused by mutations in the ALDH3A2 gene. A previously unreported novel mutation was identified, c.681-14T>G. Macular OCT makes it possible to find even funduscopy invisible changes. Its use is important because the OCT features of SLS are specific and, therefore, it can help to diagnose this rare systemic disease.

[Subretinal neovascular membrane in angioid streaks treated with intravitreal bevacizumab]

INTRODUCTION

Angioid streaks are breaks in Bruch's membrane that may be associated, among others, with pseudoxanthoma elasticum. Its most common complication is the development of subretinal neovascular membranes (SRNVM) and the decreased vision this entails.

CASE REPORT

A 28 year old woman with angioid streaks and SRNVM in the left eye, who received 3 injections of intravitreal bevacizumab, with rapid improvement in vision and stability during 11 months follow up. The finding of angioid streaks led to the diagnosis of pseudoxanthoma elasticum.

CONCLUSION

Intravitreal bevacizumab should be considered as an effective treatment option for choroidal neovascularization associated with angioid streaks.

Importance of tuberculosis screening before inhibiting tumour necrosis factor-alpha therapy

INTRODUCTION

There has been an increase in the incidence of tuberculosis infection in recent years, due to the increasing use of drugs inhibiting tumour necrosis factor-alpha (anti-TNFα) in the treatment of inflammatory diseases.

CASE REPORT

We report the case of a male patient being treated with infliximab (anti-TNFα) who developed disseminated tuberculosis with ocular involvement.

CONCLUSION

It is very important to conduct a proper screening to detect patients at risk for tuberculosis before starting treatment with these drugs. For this purpose, the QuantiFERON®-TB Gold in Tube (Interferon Gamma Release Assay, IGRA) is presented as an alternative screening test with high sensitivity and specificity.

Subthreshold symptoms and time to relapse/recurrence in a community cohort of bipolar disorder outpatients

BACKGROUND

Researchers have previously found that persistent subthreshold symptoms increase the risk and shorten the time until an affective relapse in bipolar disorder (BD) patients. Research has mainly focused on patients from tertiary Care Centers in USA. We tested the hypothesis that even in a different setting, BD outpatients with subsyndromal affective symptoms would re.turn to a subsequent major affective episode significantly faster than completely asymptomatic at baseline. Secondarily, we analysed other variables related to time and risk to relapse.

METHODS

A community cohort of BD outpatients from Madrid (Spain) followed-up in a systematic prospective follow-up protocol for up to five years were evaluated. Patients in clinical euthymia at baseline were included and evaluated quarterly.

RESULTS

Initially, 225 patients were included in the survival analysis. Of them, according to predefined psychometric criteria, 163 were in euthymia (72.4%) and 62 (27.6%) suffered subsyndromal symptoms. Median follow-up was 157.6 weeks (95% CI, 78.14 to 111); 57.3% of patients experienced at least one affective episode during their follow-up. Median survival time to first affective episode was 109 weeks for patients in euthymia at baseline, versus 35 weeks for those with subsyndromal symptoms (p<0.0001). Psychosocial stress (p=0.003; HR 2.20; 95% CI 1.31-3.68) and the affective mood baseline state, subsyndromal vs. euthymic (p=0.046; HR 1.74; 95%CI 1.009-3.020), were related to time to first affective episode.

LIMITATIONS

Naturalistic study, some of the data collected were necessarily retrospective.

CONCLUSIONS

In Spanish non-tertiary psychiatric outpatients, subsyndromal BD symptoms and psychosocial stress at baseline predict earlier episode relapse/recurrence.

Sampling methods for assessing syrphid biodiversity (Diptera: Syrphidae) in tropical forests

When assessing the species richness of a taxonomic group in a specific area, the choice of sampling method is critical. In this study, the effectiveness of three methods for sampling syrphids (Diptera: Syrphidae) in tropical forests is compared: Malaise trapping, collecting adults with an entomological net, and collecting and rearing immatures. Surveys were made from 2008 to 2011 in six tropical forest sites in Costa Rica. The results revealed significant differences in the composition and richness of syrphid faunas obtained by each method. Collecting immatures was the most successful method based on numbers of species and individuals, whereas Malaise trapping was the least effective. This pattern of sampling effectiveness was independent of syrphid trophic or functional group and annual season. An advantage of collecting immatures over collecting adults is the quality and quantity of associated biological data obtained by the former method. However, complementarity between results of collecting adults and collecting immatures, showed that a combined sampling regime obtained the most complete inventory. Differences between these results and similar studies in more open Mediterranean habitats, suggest that for effective inventory, it is important to consider the effects of environmental characteristics on the catchability of syrphids as much as the costs and benefits of different sampling techniques.

Syndromal and subsyndromal illness status and five-year morbidity using criteria of the International Society for Bipolar Disorders compared to alternative criteria

BACKGROUND

Subsyndromal symptoms have been recognized as relevant in the course and outcome of bipolar disorder (BD) patients. Nevertheless, their definition and cutoff points on current depression and mania scales are uncertain. The recently defined International Society for Bipolar Disorders (ISBD) operational criteria for the assessment of the course and outcome of bipolar illness have never been tested until now.

METHODS

A naturalistic longitudinal follow-up study of up to 5 years included a cohort of 317 DSM-IV-TR BD outpatients. For the first time, we assessed the proportion of visits in different affective states using the ISBD criteria. Secondarily, we compared the results with those obtained applying other cutoff points.

RESULTS

Patients were symptomatic in 39.1% (95% CI 35.3-42.9) of the visits. Subsyndromal symptoms, primarily subsyndromal depression, were present in 15.9% of patients (95% CI 13.4-18.4). No significant differences were found between bipolar I patients and bipolar II patients. There were differences in the total percentage of visits in euthymia depending on the cutoff points (p < 0.05).

CONCLUSIONS

Applying ISBD criteria, bipolar patients have significant clinical morbidity and are often symptomatic, both with threshold symptoms and with subthreshold symptoms, especially with depression. The chosen cutoff points modify the apparent results.

LIMITATIONS

The cutoff points used have not been validated. Psychopharmacologic treatments were naturalistic.

Treatment of fibrous dysplasia of the proximal femur by means of pedicled iliac crest bone graft: a case report

In this report, we present a case of treatment of fibrous dysplasia (FD) of the proximal femur with the pedicled iliac crest bone graft. An 18-year-old patient presented with hip pain and polyostotic dysplasia with involvement of the proximal femur and a history of pathological fracture. The patient was operated on using vascularized bone graft from the iliac crest and osteosynthesis with Dynamic Hip Screw (DHS®). With vascularized bone graft, we found an improvement on X-ray with no reabsorption, and with osteosynthesis, we controlled the pain and prevented pathological fracture and progression of the deformity. Several other studies where the pedicled iliac crest bone graft has been successfully used for the management of defects in the proximal femur (osteonecrosis of the femoral head and pseudarthrosis of the femoral head) can be found in the medical literature. However, the pedicled iliac crest bone graft in a patient with FD of the proximal femur is unique.

Endocrine and milt response of Senegalese sole, Solea senegalensis, males maintained in captivity

Improving fertilization success in captive Senegalese sole broodstocks has been a challenge in the last years. Recent reports suggest that low sperm volume and quality could be one of the reasons leading to poor fertilization rates, although further studies are needed to reach a conclusive explanation. Here, we report on several experiments focused on this issue. Seasonal profiles of plasma androgen levels (testosterone and 11-ketotestosterone) and sperm production and quality parameters were assessed, although no statistical correlations among them were identified. The response of males to female presence/absence was also analyzed. Long-term isolation from females decreased male androgen levels at the peak of the reproductive period, suggesting some kind of disrupting effects on the endocrine system. On the other hand, short-term exposure of previously isolated males to ripe females decreased androgen levels, possibly reflecting a rapid steroidogenic shift promoting final maturation of spermatozoa, and increased sperm viability, motility and velocity, thus, supporting the concept of positive effects of female contact on male sole performance. Further evidence sustaining the relevant female-to-male communication in sole reproduction was obtained after treating the females with progestagen 17α,20β-dihydroxy-4-pregnen-3-one (regarded as pre-ovulatory pheromone in fish) and registering a significant increase in sperm viability, velocity and motility in surrounding males. Finally, we found that a single administration of a 20 μg/kg GnRH analogue in males was effective in stimulating androgen release and sperm quality, although the effects were transient and thus, the use of sustained hormone delivery methods were suggested for improving efficiency. Our results point to velocity, viability, and motility as the most sensitive parameters in sole sperm, although further studies will have to evaluate whether these parameters have any relation with fertilization success in captive broodstocks of this important aquaculture species.

Lectin-binding pattern of Senegalese sole Solea senegalensis (Kaup) testis

The localization and characterization of oligosaccharide sequences in the testis of Senegalese sole Solea senegalensis was investigated using 12 lectins in combination with KOH saponification and sialidase digestion (K-s). The interstitial compartment contained all the sugar residues investigated, those bearing oligosaccharides terminating with sialic acid (Neu5Ac) alpha2,3Galbeta1,4GlcNAc, Neu5AcGalNAcalpha1,3(LFucbeta1,2) Galbeta1,3/4GlcNAcbeta1 and GalNAcalpha1,3(LFuc1,2) Galbeta1,3/4GlcNAcbeta1 being more abundant in the medullar region than in the cortex. The melano-macrophage centres found in the interstitial compartment displayed glycans terminating with Galbeta1,3GalNAc. The basal lamina separating the germinal and interstitial compartments exhibited glycans with terminal/internal mannose, internal betaGlcNAc, and terminal Neu5Acalpha2,6Gal/GalNAc, and Neu5AcGalbeta1,3GalNAc, Galbeta1,3GalNAc (PNA), Galbeta1,4GlcNAc, GalNAc, alphaGal, and alphaL-Fuc. In the germinal compartment, the Sertoli cells expressed only glycans terminating with Neu5Acalpha2,3Galbeta1,4GlcNAc in the apical and supra-nuclear lateral surface of the spermatonial cysts located in the distal part of the seminiferous lobules. Primary spermatocytes exhibited oligosaccharides terminating with Galbeta1,3GalNAc and alphaGalNAc in the cytoplasm and nucleus, respectively. The spermatids contained highly mannosylated glycans terminating with GalNac, alphaGal, and alphaL-Fuc. The head of spermatozoa expressed a more complex glycosylation pattern characterized by the additional presence of oligosaccharides terminating with Neu5Acalpha2,3Galbeta1,4GlcNAc, Neu5AcGalbeta1,3GalNAc, Neu5AcGalNAcalpha1,3(LFuca1,2)Galbeta1,3/4GlcNAcbeta1, GalNAcalpha1,3(LFucalpha1,2)Galbeta1,3/4GlcNAcbeta1. The comparison with previous lectin histochemical studies carried out in other fish species reveals a specific glycosylation pattern of Senegalese sole testicular structures and spermatozoa head.

Sex steroids and metabolic parameter levels in a seasonal breeding fish (Sparus aurata L.)

The gilthead seabream is a protandrous hermaphrodite seasonal breeding teleost with a bisexual gonad that offers an interesting model for studying the two first reproductive cycles (RCs), in which the specimens develops as males. During the first RC (RC1), 11-ketotestosterone (11-KT) and testosterone (T), the main androgens in fish, play different and specific roles in the testicular physiology as they peak at different stages of RC1. Moreover, the profiles of T serum levels during the second RC (RC2) demonstrated that this androgen is not essential in the testicular regression process that occurs during this cycle. However, changes in serum levels suggest that 17beta-estradiol (E2) orchestrates this process during both RCs. Moreover, the E2 serum levels recorded during RC2 indicate that there is a threshold level that determines the initiation of ovarian development during this cycle without promoting complete feminization. We analysed triglyceride, protein, glucose and lactate serum levels in order to establish a relationship between the mobilization and transfer of nutrients, the hormonal changes that take place during the RC and body composition, finding that in vivo serum levels of metabolites change significantly throughout the first two RCs, although the physiological relevance of such changes is still unknown. Triglyceride levels seem to be affected by the beginning of ovary development during RC2 but not by testicular recrudescence during RC1. Moreover, glucose and lactate might be important sources of energy during the resting and testicular involution stages.

Effect of sex-steroid hormones, testosterone and estradiol, on humoral immune parameters of gilthead seabream

The role of sex-steroid hormones, testosterone (T) and 17beta-estradiol (E2), on the humoral immune parameters of the teleost gilthead seabream Sparus aurata was studied attempting to deepen on the knowledge of the immune-reproductive system interactions. Fish were injected intraperitoneally with coconut oil containing different dosages of T (0, 2, or 5 microg g(-1) body weight [bw]) or E2 (0, 1, or 2 microg g(-1) bw) and sampled 1, 3, and 7 days later. Hormonal levels and immune parameters (complement, peroxidase and antiprotease activities and IgM levels) were determined in plasma. Plasma hormone levels peaked at 1 day post-injection decreasing thereafter. Treatment with T significantly increased both complement and peroxidase activities after 3 days of injection but antiprotease activity and IgM levels remained unchanged. Treatment with E2 enhanced complement activity 1 day post-injection while decreased it after 3 and 7 days. However, peroxidase activity increased at 3 and 7 days post-injection while total IgM levels decreased. Implications of T and E2 in the immune-reproductive system interactions were discussed.

17Beta-Estradiol Triggers Postspawning in Spermatogenically Active Gilthead Seabream (Sparus aurata L.) Males1

The testis is a tightly controlled dynamic tissue. In mammals, there is growing evidence that estrogen plays a role in the regulation of testicular functions. In teleosts, high levels of 17beta-estradiol (E2) in serum correlate with the end of spermatogenesis, spawning, and the initiation of postspawning stages when spermatogonia are the main cell types in the testis. Moreover, E2 modulates leukocyte functions in several teleost species. We hypothesized, therefore, that E2 would induce the infiltration of acidophilic granulocytes and cause a resumption of testicular cell proliferation in spermatogenically active gilthead seabream males. Several studies of this species have reported that supraphysiological doses of E2 are needed to induce histological and developmental changes in males. In fact, as gilthead seabream is a protandrous hermaphrodite teleost, long exposures (6-14 wk) to high doses of E2 result in feminization of the males. Taking all this into account, we sharply increased E2 levels during short times by i.p. injecting E2 diluted in coconut oil as the vehicle and sampled the fish after 7, 13, and 18 days to assess the effects that E2 had on spermatogenesis. It was observed that E2 levels in plasma increased, while 11-ketotestosterone (11-KT) and testosterone (T) levels remained unaltered. However, 11-KT and T levels strongly increased in control fish 18 days postinjection. The most relevant result of our study was that E2 accelerates the final events of spermatogenesis, inhibits the proliferation of spermatogonia in early stages, and induces some of the processes that usually occur during postspawning, such as the infiltration of acidophilic granulocytes and the apoptosis of primary spermatogonia. Strikingly, neither the shedding of spermatozoa nor an increase in the proliferative rate of spermatogonia stem cells was observed, probably because of the lack of other necessary stimuli, such as the increase in T levels that takes place during normal postspawning.

Testicular development and plasma sex steroid levels in cultured male Senegalese sole Solea senegalensis Kaup

Testicular development and plasma levels of sex steroids (11-ketotestosterone (11-KT), testosterone (T) and 17,20beta-dihydroxy-4-pregnen-3-one (17,20beta-P)) were investigated for the first time in cultured male Senegalese sole Solea senegalensis. The germ cell dynamics and gonadosomatic index (IG) were monitored. Based on the relative abundance of the different types of germ cells present, the spermatogenetic cycle was divided into five stages: early (I; spermatogonia (SPG)), mid (II; SPG, spermatocytes (SPC) and spermatids (SPD)), and late spermatogenesis (III; SPC, SPD, and spermatozoa (SPZ)), functional maturation (IV; SPD and SPZ), and recovery (V; SPD, SPZ, and SPG). During summer, fish had stage I and V testes and the lowest values in plasma levels of sex steroids and IG. Testicular recrudescence seemed to begin in autumn, as denoted by the first increase in IG and in the levels of 11-KT and T, and the appearance of testes at stage II and III. During winter, the levels of 11-KT and T peaked and soon began to decrease, the IG slightly declined and the proportion of running males (RM) gradually increased. In spring, levels of 11-KT and T continued to decline, the IG slightly increased and the proportion of RM peaked concomitantly with the occurrence of stage IV testes. Plasma levels of 17,20beta-P did not change significantly throughout testicular development. Transformation of SPD into SPZ followed a group-synchronous fashion, a phenomenon which parallels asynchronous oocyte development reported in females. This mechanism would be consistent with the observed small quantity of sperm that can be manually stripped at any one time and other aspects of S. senegalensis reproductive biology.

Male reproductive system in Senegalese sole Solea senegalensis (Kaup): anatomy, histology and histochemistry

Despite the fact that the Senegalese sole Solea senegalensis is a target species for the aquaculture industry in Spain and Portugal, very little is known about its gametogenesis and especially about testicular development. Therefore, the male reproductive system in adult S. senegalensis was described using a histological and histochemical approach. Mean gonadosomatic index was very low (0.094+/-0.004%) and suffered slight changes throughout the experimental period. In transverse sections, the testis presents a reniform structure with two main regions, a cortical one with seminiferous lobules where germ cells proliferate in spermatocysts (germ/Sertoli cells units), and a medullar one with spermatic ducts that collect and store the produced sperm. The germinal compartment is organized into branching lobules of the unrestricted spermatogonial type, although the majority of type A spermatogonia are located at the distal part of the lobules. Spermatogenesis seems to be semi-cystic, since spermatids are released into the lobule lumen, where they are transformed into spermatozoa. Proteins in general, especially those rich in arginine, and carboxylated mucosubstances/glyco-proteins increased from spermatogonia to spermatozoa. 3beta-Hydroxysteroid dehydrogenase enzymatic activity was exclusively observed in Leydig cells. The present study provides the first precise description of male reproductive apparatus in S. senegalensis.

[Musculoskeletal manifestations in allogenic hematopoietic stem cell transplantation]

INTRODUCTION

Few studies have examined musculoskeletal manifestations after allogenic hematopoietic stem cell transplantation (AHSCT).

OBJECTIVE

To investigate the musculoskeletal symptoms observed after AHSCT for distinct hematological and non-hematological diseases.

MATERIAL AND METHODS

We performed a retrospective, observational study through review of medical records.

RESULTS

There were 123 patients who underwent AHSCT from 1996 to 2000: 34 children (aged 5 months-14 years) and 81 adults (aged 15-55 years). There were 48 women (39%) and 75 men (61%). Of these patients, 43 (34.90%) had acute graft-versus-host disease (aGVHD). Thirty-three out of 106 patients (31.1%) had chronic GVHD (cGVDH) and 50 patients (40.65%) died during follow-up. Musculoskeletal manifestations were found in 14 patients (13.2%): aseptic necrosis in six (5.6%), scleroderma in five (4.7%), arthralgia and bronchiolitis obliterans in one, polyarthralgia in one, and knee monoarthritis in one.

CONCLUSIONS

Musculoskeletal manifestations after AHSCT cannot be attributed to a single cause. Inflammatory and fibrosing manifestations can be due to the inflammatory process of cGVHD or to the treatments administered during transplantation.

Results of the cemented SR trapeziometacarpal prosthesis in the treatment of thumb carpometacarpal osteoarthritis

PURPOSE

The purpose of this study was to analyze our experience in the treatment of trapeziometacarpal (TMC) osteoarthritis with a cemented surface replacement arthroplasty.

METHODS

We did a retrospective study of 19 patients with 20 hands operated on with this technique, with a follow-up evaluation of 33 months. We analyzed the preoperative stage, the postoperative clinical results, measured the radiographic changes found at the end of the study, and correlated all these data with a statistical study. For statistical analysis chi(2) test and Student t-test were used. The level of significance was set at a p value of.05 or less.

RESULTS

With an average follow-up period of 33 months (range, 24-45 mo) the following rates were obtained: 55% loosenings and 15% ankylosis owing to periprosthetic calcifications (70% of failures of the technique). Four patients (20%) needed a revision surgery (a salvage procedure with a dynamic ligament reconstruction arthroplasty). In the subjective functional evaluation only 8 cases of 19 patients (40%) maintained an excellent/good result at the end of the study.

CONCLUSIONS

In our group of patients the cemented surface replacement TMC prosthesis was not an adequate surgical option for the treatment of TMC osteoarthritis. Further studies are necessary to clarify the role of this surgical technique in this pathology.

The buccal fat pad flap in oral reconstruction

BACKGROUND

The aim of this study is to describe the surgical technique, indications, advantages, and possible complications of the buccal fat pad flap and to report our clinical experience with this flap for intraoral reconstruction after tumor removal.

METHODS

The flap has been used to reconstruct oral defects after tumor resection in 32 patients, who have been retrospectively analyzed.

RESULTS

Adequate closure of the defect was achieved during surgery in all cases. In one case, there was partial loss of the flap; this was treated conservatively. In five cases there was some retraction in the reconstructed area.

CONCLUSIONS

Buccal fat pad as a flap offers an adequate reconstructive option to be born in mind when reconstructing small to medium defects in the oral cavity. It is a simple and quick surgical technique with a low incidence of complications.

The use of Mitek pins in the mandibular lingual releasing approach to oral and/or oropharyngeal carcinomas: a technical note

Resection of carcinoma of the oral cavity and oropharynx requires adequate exposure. The purpose of this paper is to demonstrate the approach employed (mandibular lingual releasing approach) for resection of some oral cavity or oropharyngeal carcinomas and to point out the indications, advantages, complications, and refinements of this technique. The technique was carried out on 23 patients with oral cavity or oropharyngeal squamous cell carcinomas. A lingual floor-of-mouth flap was created allowing delivery of the tongue and floor of mouth without lip splitting, mandibulotomy, or mandibulectomy. After resection of the tumour and repair of the defect, the musculature of the floor of the mouth was reattached to the lingual cortex of the mandible using Mitek minianchors. There was adequate exposure in all the patients. Wound margin dehiscence occurred in four patients resulting in an orocervical fistula in three patients. Mandibular osteotomy and subsequent osteosynthesis were avoided. Thus instability and infection of the osteotomy site were avoided. However, additional mandibular osteotomy is feasible.

[Effectiveness of lithium in the prophylaxis of affective disorders]

Lithium effectiveness in manic depressive illness is still controversial. Recent naturalistic trials on lithium effectiveness as a mood stabilizer offer poorer results than previous controlled studies. These previous studies have methodological deficiencies.

OBJECTIVE

To determine the effectiveness of lithium treatment as a mood stabilizer under real clinical conditions.

METHODOLOGY

An intervention study in a case series of all patients treated at least for two years at two Affective Disorders ambulatory Units was conducted to evaluate the incidence of episodes by year, before and during lithium therapy.

RESULTS

152 patients were included. (91% were bipolar patients). Most of them were in monotherapy. The average time of illness before lithium treatment was 13 years, and cases were followed up a media of 8 years. Only 33% of the sample had no relapses during lithium therapy. An average of 1.38 (+/- 2.89) episodes/person year was estimated previous to lithium therapy and was decreased to 0.35 (+/- 0.47) phases/person year during lithium therapy.

CONCLUSIONS

Although the total absence of relapses is not attained in most of the patients, our results support the lithium effectiveness to reduce the relapses in bipolar patients.

Actinomycotic ulcer of the oral mucosa: an unusual presentation of oral actinomycosis

Although the oral mucosa is often the site of entry of actinomyces into the deeper tissues, actinomycosis in the oral mucosa is extremely rare. Actinomycotic lesions are usually described as either single or multiple abscesses or indurated masses with hard fibrous walls and soft central loculations. Actinomyces israelii is the principal cause of human actinomycosis. We present a rare case of actinomycosis caused by Actinomyces odontolyticus; it presented primarily as a long-standing ulcer of the oral mucosa mimicking a squamous cell carcinoma.

The predictive value of the HLA shared epitope for severity of radiological joint damage in patients with rheumatoid arthritis. A 10 year observational prospective study

OBJECTIVE

To evaluate the clinical importance of the RA "shared epitope" (SE) as a prognostic marker of radiological severity and extension of the disease to large joints in patients with rheumatoid arthritis (RA).

METHODS

Eighty-two patients who met the American College of Rheumatology criteria for RA with a disease duration < 2 years at presentation were included in the study. Radiographs of hands, wrists, feet, shoulders, elbows, hips, and knees were taken at study entry and 8-10 years later. HLA-DRB1 genotypes were determined by polymerase chain reaction-sequence-specific oligonucleotide probes. Radiological severity was assessed in small joints of hands, wrists, and feet. Extension of the disease to large joints was evaluated in radiographs of shoulders, elbows, hips, and knees.

RESULTS

At the end of the study, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF) titer, and percentage of maximum radiological score at baseline were significantly associated with RA severity (p < 0.01, p < 0.01, p < 0.05, respectively). Extension of RA to large joints was related to a higher ESR (p < 0.001) and a lower hemoglobin level (p < 0.01) at baseline. Neither at entry nor at the end of the study was the RA shared epitope predictive for radiologic severity or extension of disease to large joints (p = 0.8, p = 0.3, respectively).

CONCLUSION

Presence of the SE in patients with RA is not a good prognostic marker of radiological severity after a mean followup period of 9 years.

Unreamed intramedullary locking nailing for open tibial fractures

We reviewed the results of the treatment of 24 cases of open tibial fractures using unreamed intramedullary locking nailing. The fractures were classified, following the Gustilo system as grade I-7, grade II-7 and grade III-10. The average time to achieve bony union was 22 weeks with a 26% incidence of pseudoarthrosis. There were no cases of deep infection. Five cases healed with shortening of over 1 cm, but we did not observe angular deformity in any of the patients. In 2 fractures with associated articular lesions, joint motion was limited at final follow up. The nail broke in 2 cases and the screws in 5. The surgical procedure is well tolerated by patients, allows good management of soft tissue lesions and rehabilitation with low rate of infection and malunion. The main disadvantages have been the relative high incidence of nonunion and breakage of metal.

Cardiopulmonary and haemodynamic changes during total hip arthroplasty

We report a prospective study of 30 patients who underwent total hip arthroplasty for osteoarthrosis in order to investigate the haemodynamic and respiratory changes which occur during operation. Cement was used in 17 cases and the implants were not cemented in 13. Pulmonary and cardiac function, blood levels of methylmethacrylate monomer, intramedullary pressure and transoesophageal echocardiography were recorded. Two well differentiated echogenic patterns appeared consistently during the operation. The intramedullary pressure became raised as the cement was inserted. The following changes occurred within seconds and continued for some minutes: elevation of mean arterial pressure and mean pulmonary artery pressure; decrease of arterial oxygen tension and of mixed venous PO2, and greater tissue consumption of oxygen. Although we recorded raised concentration of methylmethacrylate monomer in venous blood after the cement was inserted, there is no evidence that the monomer is responsible for the haemodynamic changes which take place.

Comparison of tenoxicam and bromazepan in the treatment of fibromyalgia: a randomized, double-blind, placebo-controlled trial

Fibromyalgia is a painful syndrome of non-articular origin, predominantly involving muscles, and the commonest cause of chronic widespread musculoskeletal pain. The diversity of therapeutic programs for patients with fibromyalgia reflects both the lack of a known pathophysiology for this disorder and the low efficacy of the current therapies. We studied the efficacy of tenoxicam and bromazepan in the treatment of patients with fibromyalgia. One hundred and sixty-four patients from our Rheumatology Outpatient Clinic fulfilling the American College of Rheumatology criteria for the classification of fibromyalgia, with widespread pain at study entry. Each of the 164 patients was randomly assigned to 1 of 4 treatment groups: double placebo (P), tenoxicam (20 mg) + placebo (T), bromazepan (3 mg) + placebo (B)m or tenoxicam (20 mg) + bromazepan 3 mg (TB). Patient global assessment of disease, pain, sleep quality, morning stiffness, and number of tender points were evaluated at baseline and 8 weeks afterwards. At the end of the trial, 17%, 10%, 12%, and 29% of the P, T, B, and TB patients, respectively, had clinical improvement. A statistically significant difference was found only between the T and TB groups. Our data indicate that treatment with tenoxicam + bromazepan can be effective for some patients with fibromyalgia, but the differences with the placebo group were neither clinically nor statistically significant.

Bilateral Smith fracture of the radius caused by airbag deployment

A passenger-side occupant of a car involved in a collision suffered bilateral Smith's fracture after extending both arms for protection and being hit by the deploying airbag.