Delayed full-thickness autografting of cryopreserved avulsed skin in degloving injuries of the extremities.
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Biomedical subjects
Publications and source records attributed to A Nogueira.
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In the present study, the authors investigated and defined development stages of Daphnia magna eggs that could be potential endpoints for sublethal toxicity tests with in vitro parthenogenetic egg cultures. Such an "egg test" could be a cost-effective alternative to the classic 21-day test with D. magna. Three main stages of embryonic development were considered: release of the egg external membrane, release of the internal membrane, and separation of the caudal spine. The first embryonic stage was attained approximately 30 h after transfer of eggs from ovaries to the brood chamber (considered as time zero), the second stage at 48 h, and the third stage at 68 h. Embryonic development was considered completed with the caudal spine separation. Thereafter, juveniles were able to swim in the water column. Egg mortality, duration of each egg stage, egg diameter, and egg abnormalities were investigated as potential endpoints. In vitro tests were carried out with several toxicants (DBS, 3,4-DCA, cadmium, and copper) and with acid mine drainage, sensitivity generally being higher than with the accepted chronic 21-day test with D. magna.
Defective innervation of the neuromuscular junctions (NMJ) was recently described in intestinal neuronal dysplasia type B (IND B). The aim of the present study was to correlate the alterations in NMJs to other classically described parameters in dysganglionoses and to determine the relationship between NMJ abnormalities in IND B and clinical symptoms. The rectal biopsies and full-thickness colonic biopsy specimens of 17 patients were studied applying histochemical (acetylcholinesterase [AChE], lactic dehydrogenase [LDH], and succinic dehydrogenase [SDH] reactions) and immunohistochemical (neuronal-cell adhesion molecule [NCAM] and SY antibodies) methods. Thirteen patients had Hirschsprung's disease (HD). IND B was diagnosed in 11 (associated with HD in 8 cases, isolated in 2, and associated with hypoganglionosis in 1). In the aganglionic segment of HD there was very intense AChE activity; in contrast, NCAM- and SY-immunoreactive nerve fibers were markedly decreased. A spectrum of abnormalities was observed in IND B, usually more severe in the most distal segments: giant and immature ganglia in the submucous plexus were observed in all cases; heterotopic myenteric ganglia were frequent (72.7%); hyperganglionosis was observed in 6 (54.5%) and was not related to the patients' age; thick and tortuous NCAM- and SY-immunoreactive nerve fibers, irregularly distributed in the colonic wall, were observed in 81.8% of the cases. No relationship was observed between abnormalities of NCAM- and SY-immunoreactive nerve fibers and AChE activity, ganglion-cell maturity, heterotopy, or the clinical symptoms presented by the patients with IND B. In hypoganglionism, low AChE activity and a slight decrease in NCAM- and SY-immunoreactive nerves were observed. Thick and tortuous, irregularly-distributed intrinsic NCAM- and SY-immunoreactive nerves were observed in every colon layer in IND B. Our results do not support IND B as a NMJ disorder.
The present work describes a coke oven soil treatability study by land-farming, conducted on-site in a field scale facility covering 100 m2. The soil contamination was mainly due to high concentrations of polynuclear aromatic hydrocarbons (PAHs) up to 1,140 mg/Kg dry weight (sigma EPA). Along the treatment process the soil was characterised at the chemical, microbiological and ecotoxicological levels. After 3 months a reduction of 63% in total PAHs concentration was observed, being detected a more pronounced reduction for PAHs with 2, 3 and 4 rings (79%). Concomitantly, a change in the composition of the microbial population was observed with a significant increase in the PAHs degrading and total heterotrophic colonies. Concerning the ecotoxicity and genotoxicity data no effect was detected in the treated soil samples eluates.
The concept of left ventricular aneurysm has been a subject of controversy and it's not yet completely settled. This has some implications on the patients selection for surgery and explains the various non-invasive methods so far developed for the clinical assessment of patients with ventricular aneurysms. Seventy-one patients with ischemic heart disease, 65 with recent myocardial infarction, were studied by equilibrium radionuclide angiography (ERNA) in order to define left ventricular wall motion abnormalities. One hundred ERNA were undertaken, through the usual erytrocites in vivo labelling technic, employing a GE 400 T Gama-Camera GP. Image acquisition was through 400 cardiac cycles, on LAO (30 and 60 degrees) and left lateral. PAGE protocol was employed. Fourier transform was used in the present work to obtain phase and amplitude images, which actually became the main criteria to define aneurysmatic areas. Global ejection fraction, regional wall motion and regional ejection fraction were other parameters investigated. Wall motion abnormalities have been identified in all the 65 patients having suffered a myocardial infarction. Extensive areas of akinesia or localized dyskinesia were present in 40 patients (16.5%), while remainder 25 had just localized hypoakinesia. Phase image enabled the selection of LV areas of contraction delay in 19 of the 40 patients with extensive wall motion abnormalities (Group I). In such Group I we could identify an LV area with contrasting colour, defining the aneurysmatic LV portion. In the order 21 patients with extensive akinesia, no significant changes of colour were present on ventricular phase image (Group II) meaning absence of aneurysm. No phase disturbances were seen in the remainder 25 patients with MI (Group III) and the 6 patients with CAD without MI had normal phase images (Group IV). The percentage of akinetic segments was 39.1 and 35.4 in Group I and II, respectively (p = .53) while it was significantly lower in Group III 17.9%; p < .0001). LV ejection fraction was statistically different in the four groups considered (I = 30.0% +/- 3.7; II = 39.9% +/- 2.9; III = 49.0% +/- 2.5; IV = 62.0% +/- 3.2). The degree of phase delay in aneurysmatic zones was quantified by the phase histogram. Average value of phase for the left ventricle was 129.7 +/- 8.4 degrees, and for the aneurysm it was 238.0 +/- 5.0 with an average phase delay of 104.8 +/- 4.1 degrees. The association of phase and amplitude images and the measurements of phase and amplitude values on the histograms allowed the distinction of akinetic aneurysm (phase delay and low amplitude) from the dyskinetic aneurysms (phase delay and high amplitude). Half of the isotopic diagnosis of aneurysms have been confirmed by classic contrast angiography, and a third of then have undergone surgery. The two dyskinetic aneurysms that have been submitted to aneurysmectomy had pos-operative improvement of LV function. On summary, phase and amplitude analysis by the Fourier method, which is independent of LV geometry, showed that LV regions with high phase values are associated with severe regional wall motion abnormalities and low ejections fractions. The definition of the sequence and amplitude of ventricular contraction allows the distinction of akinetic and dyskinetic aneurysms, anticipating the method as a valid contribution for the screening of patients likely to benefit from aneurysmectomy.
Prurigo nodularis of Hyde is an unusual disorder of unknown aetiology characterized by extremely pruritic nodules with well defined clinical and histopathological aspects. The literature on this disease is reviewed, focusing on the historical background, aetiology, pathogenesis, histopathology and ultrastructure, clinical aspects, differential diagnosis and therapeutic alternatives.
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We report on two brothers, aged four and six years-old, evidencing the Van Der Knaap syndrome. Clinical and radiological aspects are discussed as well their peculiarities. Data are compared with related literature, as etiopathogenic mechanisms possibly involved.
The authors have shown in a recent paper that survival with amyotrophic lateral sclerosis (ALS) can be increased by the use of non-invasive methods of assisted ventilation (Bipap). However, the progression of muscle weakness was not affected and the quality of life was not positively enhanced. In ALS, reduced physical activity may partially be secondary to alveolar hypoventilation syndrome. This leads to deconditioning of ALS/motor neuron disease (ALS/MND) patients. The authors decided to investigate the possibility of reducing motor decline by exercising these patients to the anaerobic threshold, but simultaneously compensating the respiratory insufficiency with the Bipap STD. We conducted a controlled single blind study, exercising eight consecutive ALS/MND patients and used a control group of 12 ALS/MND patients. The patients were all evaluated during a 1 year period. Respiratory function tests (RFT) were performed at entry and then at 6 month intervals. Barthel, Functional Independent Mobility scale (FIM) and Spinal and Bulbar Norris scores were recorded every 3 months. There was a significant difference between the two groups with respect to FIM scores (P<0.03), but not Barthel scores (P<0.8). A slower clinical course (Spinal Norris score P<0.02) and a significant difference in the slope of the RFT (P<0.008) were observed in the treated group, suggesting that exercise may be beneficial in ALS patients once Bipap is used to control peripheral and muscle oxygenation.
Reflex sympathetic dystrophy (RSD) is a syndrome characterised by severe distal pain and vasomotor changes. It is believed to be caused by sympathetic nervous system overactivity. Trauma is the most frequent precipitant event. An association with amyotrophic lateral sclerosis (ALS) has been reported only once. We report three patients with ALS in whom the occurrence of RSD, in one of them at a very early clinical stage, seemed to have precipitated a more rapid clinical evolution. New sprouting re-innervating fibres have abnormal ion channels which might increase the risk of RSD. On the other hand, motor changes have been described in RSD, as well as motor strength improvement after RSD treatment. The complex relation of ALS with RSD is discussed. In all ALS patients pain followed by further loss of function should prompt a search for RSD.
BACKGROUND AND PURPOSE: Large within-country variations have been described in stroke management and there have been a few studies of between-country variation (in the USA and the UK). We designed a study to examine stroke management across a wide range of countries representing different stages of economic development. Large variations would suggest the need to explore methods of increasing the uptake of evidence-based stroke practice. METHODS: Members of the International Clinical Epidemiology Network (INCLEN) from 14 centres in ten countries agreed to review the records of the last 50 patients admitted to hospital with a clinical diagnosis of stroke. Information on demographic variables, the clinical diagnosis of stroke type, investigations performed and treatments given and the discharge destination of the patient were recorded and sent to the coordinating centre in Australia for analysis. RESULTS: There were statistically significant between-centre differences in the proportions of patients cared for by a neurologist, staying in hospital for at least ten days and having CT or MRI scans. Significant between-centre differences were also seen for treatment, for example, the use of aspirin in non-haemorrhagic stroke varied from 11 to 79%. The variation (for all interventions studied) was no longer statistically significant when examined within strata according to availability of facilities. CONCLUSIONS: The large variation between centres in the management of stroke is largely 'explained' by the availability of resources, even for interventions that do not depend on resource availability. It will be important to develop management guidelines that reflect evidence-based practice of relevance across a range of economic settings.
A new case with 14-year follow-up of an extremely rare variety of congenital hand macrodactyly is presented. The disease characteristically presents a diffuse proliferation of fibrofatty tissue, but in this special type, osteocartilaginous deposits around the joints can also be found. The case presented included the troublesome feature of a lipofibromatous hamartoma in the median nerve at the wrist and its branches producing carpal tunnel syndrome. The patient obtained benefit from carpal tunnel release and epineurolysis. The hyperostotic development was managed with conservative resection of the periarticular osteochondromas. The literature reviewed suggests that the hyperostotic cases of macrodactyly do not differ from general cases of this congenital condition, except for the osteochondral deposits. These tumours develop during adulthood or after previous trauma, before epiphyseal closure.
The authors present the case of a 53-year-old woman suffering from synovial osteochondromatosis of her right elbow responsible for ulnar and median nerve entrapment neuropathy. This condition is characterised by the formation of multiple cartilaginous nodules in the metaplastic synovium of otherwise normal joints, bursae or tendon sheaths. Treatment consisted of partial synovectomy, removal of loose bodies and microscopic nerve release. Synovial osteochondromatosis complicated by nerve compression syndromes has been rarely reported, usually with ulnar tunnel syndrome at the elbow. The literature on this subject is reviewed.
A 4-year-old girl sustained a longitudinal shaft fracture of the proximal phalanx of the ring finger. The fracture was irreducible by closed manipulation and required open reduction. The fragments were separated by both flexor tendons near the level of Camper's chiasma, which caused a "pinching" phenomenon when manipulative reduction was attempted. The case presented reveals that an irreducible fracture should be suspected in hyperextension injuries with severe angulation when rubbery resistance is noted at the time of closed manipulation.
A case of partial trisomy 2(q21q33) detected by cordocentesis at 27 weeks' gestation in a polymalformed fetus is described. This is the second case of a prenatally detected de novo duplication of 2q and the first involving the region referred to above.
A newborn male with the characteristic phenotype of classic rhizomelic chondrodysplasia punctata (RCDP) and with the usual and severe radiographic skeletal abnormalities is described. The parents were young, healthy, and not consanguineous; the mother had not used licit or illicit drugs, alcohol, or tobacco during pregnancy and had not been exposed to radiation or teratogenic chemicals. The clinical phenotype led us to study peroxisomal function. Plasmalogen content in erythrocytes, membrane, and fibroblasts; dihydroxyacetone phosphate acyltransferase (DHAP-AT), alkyldehydroxyaceton phosphate synthetase (a gift from Professor Henk van der Boch, Utrech) in fibroblasts; and phytanic and pristanic acids in plasma showed normal values. Immunocytofluorescence study with antibodies against peroxisomal membrane showed normal organelles. We found no reference in the literature of a case of RCDP with normal peroxisomal functions, but non-CDP has been described with peroxisomal dysfunction. This phenotype (RCDP) may be due to other metabolic error.
INTRODUCTION: Inflammatory changes are relatively frequent findings in cervical smears and are generally believed to be a consequence of genital infection. However, clinical signs of infection are frequently absent and no consensus exists on the management of these patients. The objective of this study was to assess whether or not inflammatory smears are exclusively a consequence of genital infection. For this purpose, the prevalence of genital infection in a group of women with inflammatory cells in the cervical smear and a control group with normal smears was compared. MATERIAL AND METHODS: Sixty-two regularly menstruating women aged 17 to 48 years, attending the outpatient Gynaecology sector of S. João Hospital, were prospectively evaluated. Cervical smears were analysed by the same cytologist who chose 10 inflammatory cells per high power field (400x) as the cut-off value for normality. Infection by Candida spp., Trichomonas vaginalis, Neisseria gonorrhoeae, Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis and bacterial vaginosis was investigated. Human Papillomavirus infection was evaluated by colposcopy and biopsy of abnormal colposcopic findings. RESULTS: Thirty-four women and inflammatory cells on their cervical smear and 15 of these (44%) had a genital infection. Of the 28 women with normal smears, 12 (43%) had a genital infection. No statistically significant difference in the prevalence of infection was found between the two groups. CONCLUSIONS: Our results suggest that the presence of inflammatory cells in cervical smears is not necessarily due to infection and other causes may be responsible for their appearance.
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