Ultrasonography and stimulating perineural catheters for nerve blocks: a review of the evidence

Purpose: This narrative review summarizes the evidence derived from randomized controlled trials (RCTs) offering blinded assessment and sample size justification, in order to determine the benefits associated with adjunctive ultrasonography (US) and stimulating perineural catheters for nerve blocks. Source: The literature search for this review was conducted during the second week of December 2007 using the MEDLINE (January 1950 to November 2007) and EMBASE (January 1980 to November 2007) databases. For US-guided peripheral and neuraxial blocks, the following medical subject heading (MeSH) terms were searched: “nerve block”, “epidural anesthesia”, “epidural analgesia”, “epidural injection”, “epidural space”, “spinal anesthesia”, and “spinal injection”, the results were combined with “ultrasonography” (MeSH term) and “ultrasound” (key word). For stimulating perineural catheters, the following MeSH terms were cross referenced with the MeSH term, “nerve block”: “peripheral catheterization”, “indwelling catheterization”, “catheterization”, and keywords, “nerve catheter” and “continuous”. Subsequently, the result of this search was combined to “stimulating” (key word). Fifteen RCTs, offering blinded assessment and sample size justification, were retained for analysis. Principal findings: For axillary blocks, US guidance yields a higher success rate than a double-injection, transarterial and a triple-injection, neurostimulation-guided technique. Compared to a quadruple-stimulation technique, no major differences can be found. The addition of nerve stimulation to US guidance offers no clear benefits for axillary blocks. For femoral blocks, compared to neurostimulation, echoguidance is associated with a local anesthetic (LA) sparing effect (up to 42%). In children, US guidance yields a LA sparing effect and a longer duration of action for lower extremity nerve blocks. Compared to their blind counterparts, stimulating catheters seem to offer limited clinical benefits. Despite providing a sparing effect on LA and opioid consumption, stimulating catheters are not associated with a decrease in side effects or analgesia-related expenditures. Conclusions: Published reports of RCTs provide evidence to formulate limited recommendations regarding the use of adjunctive US and stimulating perineural catheters. Further well-designed and meticulously executed RCTs are warranted.     

Lubricin immunohistochemical expression in human temporomandibular joint disc with internal derangement

J Oral Pathol Med (2011) 40 : 587–592 Lubricin is a chondroprotective, mucinous glycoprotein which contribute to joint lubrication, especially to boundary lubrication and maintains joint integrity. The present investigation aimed to study the immunolocalization of lubricin in TMJ discs from patients affected by anterior disc displacement with reduction (ADDwR) ADDwoR. Eighteen TMJ displaced disc affected by ADDwoR were processed immunohistochemically, with a polyclonal anti‐lubricin antibody, used at 1:50 working dilution. The percentage of lubricin immunopositive cells (extent score = ES) and the extent of lubricin staining of the disc extracellular matrix (ECM), were evaluated. Each sample was scored for histopathological changes. Percentage of immunostained surface disc cells was the same (ES = 4) in both control and ADDwOR cells, being this data not statistically significant (P < 0.05). In pathological specimens the percentages of lubricin‐stained cells was very high with an ES of 4 respect to control specimen, and this difference was statistically significant different (P > 0.05). The extracellular matrix (ECM) of discs at the disc surfaces of both pathological and normal specimens was very heavily stained (++++). Both the ES and ECM staining were not statistically correlated to the TMJ degeneration score according to the Spearman’s rank correlation coefficient. According to our findings, a longstanding TMJ disc injury, affects lubricin expression in the TMJ disc tissue and not its surfaces, moreover, lubricin immunostaining is not correlated to TMJ disc histopathological changes.     

Handling-habituation prevents the effects of diazepam and alprazolam on brain serotonin levels in rats.

In two different experiments, serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) levels were measured in rats, using HPLC with electrochemical detection, in 3 brain regions (hippocampus, cerebral cortex and hypothalamus) after acute i.p. treatment with diazepam (4 mg/kg), alprazolam (1.25 mg/kg) or vehicle. In the first experiment, rats received the acute treatment 30 min before they were sacrificed. In the second, the animals were previously habituated to handling (involving the maneuvers of injecting and sacrificing at the guillotine) daily for 15 days, before the acute administration of the drugs. Results of the acute treatment alone showed a significant increase in 5-HT levels in hippocampus and cerebral cortex, and a decrease in hypothalamus, but not differences in 5-HIAA levels, for the diazepam- and alprazolam-treated groups. After handling-habituation, no effect in the monoamine or metabolite levels appeared when the rats were treated with diazepam or alprazolam. The results are discussed in relation to the emotional changes induced by the handling procedure, and for possible connections between the mechanisms of action of handling-habituation and benzodiazepine treatments at CNS level.     

Differential expression of two ICAM-1 epitopes and LFA-1 chains in B-cell non-Hodgkin's lymphomas

Abstract: B-cell non-Hodgkin's lymphomas (B-NHL) and B-cell areas of reactive lymphadenopathies were investigated immunohistochemically for expression of two distinct ICAM-1 epitopes, Me14/D12 and P3-58, and the LFA-1 α and β chains. Partial or total loss of expression of one or both epitope(s) and/or chain(s) was evident in all B-NHL in function of increasing Working Formulation (WF) malignancy grade, with most defects in the high-grade tumors, namely the lowest detectability of the ICAM-1 Me14/D12 and LFA-1 α chain, the lowest co-expression of ICAM-1 epitopes and LFA-1 chains, and the most frequent simultaneous loss. The ICAM-1 and LFA-1 profiles overlapped within the low- and intermediate-grades, whereas striking differences between the high-grade subtypes were detected. Specifically, Burkitt's and lymphoblastic tumors always lost both epitopes and both chains. Large cell, immunoblastic tumors occasionally did so, and also showed either uncoordinated expression or co-expression of these constituents. It is suggested that expression defects of this type may help differentiate malignant from benign lymphoproliferations, and also be involved in the progression of B-NHL, since most are observed in high-grade tumors, whose ICAM-1 and LFA-1 profiles indicate that their subtypes are the expression of distinct normal B-cell differentiation stages.     

Hepatitis C virus antibodies in dialysis pediatric patients.

A new 4-antigen recombinant immunoblot assay (4-RIBA) for confirmation of hepatitis C virus (HCV) C-100 enzyme-linked immunosorbent assay (ELISA) reactivity was tested in serum samples of 11 pediatric patients on dialysis. Of 6 HCV C-100 ELISA-positive samples, all were 4-RIBA positive. The 2nd generation ELISA picked up 1 additional case confirmed by 4-RIBA. The 2nd generation tests increased the prevalence of HCV-positive cases.     

Conservative treatment of caustic esophageal injuries in children: 20 years of experience

The authors present their experience in the medical treatment of 1,296 caustic esophageal injuries in children over the last 20 years in two study groups, one comprising the period up to 1989 and the other 1990 to 1996, comparing the different treatments used in each group. The treatment was based fundamentally on dilatations with anterograde mercury bougies, Savary bougies, or retrograde thread-guided bougies with gastrostomy. Pneumatic balloons or stenting procedures have also been employed in the last 3 years. Early fiberendoscopy was used systematically in the second group, which provides a more accurate evaluation of the esophageal lesions. Antibiotic coverage was done systematically during the first 10 days in all serious cases, while steroids were employed routinely only in the last 3 years. The results were similar in both groups, with a dilatation average of 32 in the first and 30 in the second group and an initial dilatation interval of 3 to 4 weeks in both. Using updated exploration and dilatation techniques, we drastically reduced the number of gastrostomies needed for retrograde thread-guided dilatations from 51 in the first group to 5 in the second, consequently improving the patients' life quality. There was no mortality and only five esophageal perforations, which did not require surgical treatment. Accepted: 5 January 1999     

Homozygosity for MECP2 gene in a girl with classical Rett syndrome

We report a 21 year-old girl with classical Rett syndrome (RS) based on clinical diagnosis. The molecular testing of MECP2 gene revealed that the patient is homozygous for a de novo 473C > T mutation, causing the T158M amino acid change. Chromosome analysis showed a normal karyotype, and the haplotype analysis ruled out the possibility of parental disomy or microdeletion in MECP2 gene. Cultured fibroblast analysis reveals a mosaic for the mutation. This is a documented case of a homozygous female with RS.     

Ingesta de flúor a través del consumo de agua de abastecimiento público en la cohorte INMA-Gipuzkoa

Objective

To estimate fluoride intake through consumption of water from the municipal network in pregnant women and their children from the INMA-Gipuzkoa cohort and to compare these intakes with recommended levels. In Euskadi (Spain), fluoridation of drinking water is compulsory in water supplies for more than 30,000 inhabitants.