Effects of Hydrofluoric Acid Concentrations, Commercial Brands, and Adhesive Application on the Bond Strength of a Resin Luting Agent to Lithium Disilicate Glass Ceramic

OBJECTIVES

To evaluate the surface topography/roughness and bond strength of a resin luting agent to a lithium disilicate glass ceramic after etching with different concentrations of hydrofluoric acid (HF) and commercial brands.

METHODS

For bond strength evaluation, 260 lithium disilicate glass ceramic (EMX) discs were randomly distributed into 13 groups based on concentrations of HF and commercial brands (n=20): 5% and 10%, Lysanda (LY5 and LY10); 5% and 10%, Maquira (MA5 and MA10); 5% and 10%, FGM (FG5 and FG10); 4.8%, Ivoclar Vivadent (IV5); 5% and 10%, PHS do Brasil (PH5 and PH10); 5% and 10%, BM4 (BM5 and BM10); 9%, Ultradent Inc (UL10); and Dentsply (DE10). A further random distribution (n=10) was made based on the application (+) or absence (-) of an adhesive layer. Resin luting agent cylinders (1 mm in diameter) were added on EMX surfaces, light-cured, and stored for 24 hours in deionized water at 37°C. On a universal testing machine (DL 500, EMIC), specimens were submitted to a microshear bond strength test at a crosshead speed of 1 mm/min until failure. A representative etched EMX disc from each group underwent surface topography analysis using field-emission scanning electron microscopy (n=1), and five (n=5) etched EMX discs from each group were tested for surface roughness. Data were statistically analyzed using analysis of variance and Tukey test (α=0.05).

RESULTS

A less conditioned and smoother surface was observed for 5% HF compared to 10%. Additionally, commercial brands of HF were shown to affect bond strength. When the adhesive layer was not used (-), a 10% concentration promoted higher bond strengths to EMX. However, when adhesive was applied (+), the concentrations of HF and commercial brands had no effect on bond strength results.

CONCLUSIONS

A 10% concentration of HF results in higher bond strength than a 5% concentration. If an adhesive layer is applied, neither this distinction nor the influence of commercial brands is observed.

Indomethacin attenuates mechanical allodynia during the organization but not the maintenance of the peripheral neuropathic pain induced by nervus ischiadicus chronic constriction injury

The neurochemical mechanisms underlying neuropathic pain (NP) are related to peripheral and central sensitization caused by the release of inflammatory mediators in the peripheral damaged tissue and ectopic discharges from the injured nerve, leading to a hyperexcitable state of spinal dorsal horn neurons. The aim of this work was to clarify the role played by cyclooxygenase (COX) in the lesioned peripheral nerve in the development and maintenance of NP by evaluating at which moment the non-steroidal anti-inflammatory drug indomethacin, a non-selective COX inhibitor, attenuated mechanical allodynia after placing one loose ligature around the nervus ischiadicus, an adaptation of Bennett and Xie's model in rodents. NP was induced in male Wistar rats by subjecting them to chronic constriction injury (CCI) of the nervus ischiadicus, placing one loose ligature around the peripheral nerve, and a sham surgery (without CCI) was used as control. Indomethacin (2 mg/kg) or vehicle was intraperitoneally and acutely administered in each group of rats and at different time windows (1, 2, 4, 7, 14, 21, and 28 days) after the CCI or sham surgical procedures, followed by von Frey's test for 30 min. The data showed that indomethacin decreased the mechanical allodynia threshold of rats on the first, second, and fourth days after CCI (P<0.05). These findings suggested that inflammatory mechanisms are involved in the induction of NP and that COX-1 and COX-2 are involved in the induction but not in the maintenance of NP.

Rheumatology telephone advice line - experience of a Portuguese department

BACKGROUND

Telephone helplines for patients are tool for information and advice. They can contribute to patient's satisfaction with care and to the effectiveness and safety of treatments. In order to achieve this, they need to be adequately adapted to the target populations, as to incorporate their abilities and expectations.

AIMS

a) Evaluate the adherence of patients to a telephone helpline managed by nurses in a Portuguese Rheumatology Department, b) Analyse the profile of users and their major needs, c) Analyse the management of calls by the nurses.

MATERIAL/METHODS

The target population of this phone service are the patients treated at Day Care Hospital and Early Arthritis Clinic of our department. Nurses answered phone calls immediately between 8am and 4pm of working days. In the remaining hours messages were recorded on voice mail and answered as soon as possible. Details of the calls were registered in a dedicated sheet and patients were requested permission to use data to improve the service, with respect for their rights of confidentiality, anonymity and freedom of decision.

RESULTS

In 18 months 173 calls were made by 79 patients, with a mean age of 47.9 years (sd=9.13). Considering the proportions of men and women in the target population, it was found that men called more frequently (M= 32.7% vs F= 20.4%, p=.016). The reasons for these calls can be divided into three categories: instrumental help, such as the request for results of complementary tests or rescheduling appointments (43.9% of calls); counselling on side effects or worsening of the disease/pain (31.2 %); counselling on therapy management (24.9%). Neither sex nor patient age were significantly related to these reasons for calling. Nurses resolved autonomously half (50.3%) of the calls and in 79.8% of the cases there was no need for patient referral to other health services.

CONCLUSIONS

About a quarter of patients adhered to the telephone helpline.. Patients called to obtain support in the management of disease and therapy or to report side effects and/or symptom aggravation in addition to reasonable instrumental reasons. This suggests that this service may provide important health gains, in addition to comfort for the patient.

Barriers associated with frequency of leisure-time physical activity among Brazilian adults of different income strata

This study aimed to estimate the prevalence of the main perceived barriers to leisure-time physical activity (LTPA) and their associations with the frequency of LTPA in a representative sample of industrial workers from Brazil (n = 47,477), according to their income strata (low income: ≤$US280, middle income: $US281-$US1400, and high income: ≥$US1401). Data were collected between 2006 and 2008 via questionnaires about the main perceived barrier to LTPA and the frequency of LTPA. Multinomial logistic regression was performed to evaluate differences among groups. There was a lower prevalence of regular practice of LTPA in the low- (15.8%) and middle-income strata (18.2%) than among the individuals of the high-income stratum (27.6%). A large proportion of workers who regularly participated in LTPA reported no barriers (low: 43.1%; middle: 46.8%; high: 51.6%). Additional obligations and fatigue were the two most common perceived barriers in all family income strata among participants who engaged in different frequencies of LTPA. The odds for all perceived barriers showed a positive trend related to frequency of LTPA (from regular to no LTPA), with higher values according to income. In summary, the ordering of the main perceived barriers to LTPA differed according to workers' income stratum and frequency of engaging in LTPA.

Musculoskeletal ultrasound in Paediatric Rheumatology: a retrospective analysis

OBJECTIVES

Musculoskeletal Ultrasound (MSK-US) has become increasingly important in the diagnosis and follow-up of children with rheumatic diseases. We describe the experience of a large Portuguese centre and study the added value of MSK-US in the clinical assessment of paediatric rheumatic diseases.

MATERIAL AND METHODS

Patients were observed by assistant Rheumatologists, a clinical diagnosis was assigned and MSK-US requested. 330 MSK-US exams were performed to 222 children with rheumatic inflammatory diseases. The children's ages were between 1 and 18 years (mean=11.7±4.7 years) and 67.6% were female. Synovial membrane proliferation, intra-articular effusion, cartilage abnormalities, erosions and periarticular affections were searched in each joint. Clinical and ultrasonography data were compared.

RESULTS

MSK-US detected synovitis in 100 of 194 exams (51.5%) of patients with that clinical information and in 36 of 136 exams (26.5%) of patients who presented other clinical findings. In those in which MSK-US did not confirm the clinical information of synovitis (94; 48.5%), we detected tenosynovitis/tendinopathy in 13 cases (13.8%) and synovial cyst in four (4.3%). The remaining patients had no ultrasonography changes and MSK-US helped to exclude synovitis. The sensitivity for arthritis clinical assessment was good (73.5%), with modest specificity (51.5%), an accuracy of 60.6% and precision of 51.5%. Ultrasonography synovitis was mostly found in the knee (37.5%), followed by the ankle (22.8%) and hip (10.3%). Overall, 39 exams showed ultrasonographic tenosynovitis/tendinopathy, 15 of which had the same clinical diagnosis. Tenosynovitis/tendinopathy was mostly found in the ankle (59.0%) and knee (23.1%) areas.

CONCLUSIONS

MSK-US is an important aid to clinical evaluation, allowing both the detection and exclusion of joint pathology in children, contributing to a better assessment.

Acute effect of alcohol intake on sine-wave Cartesian and polar contrast sensitivity functions

The aim of this study was to assess contrast sensitivity for angular frequency stimuli as well as for sine-wave gratings in adults under the effect of acute ingestion of alcohol. We measured the contrast sensitivity function (CSF) for gratings of 0.25, 1.25, 2.5, 4, 10, and 20 cycles per degree of visual angle (cpd) as well as for angular frequency stimuli of 1, 2, 4, 24, 48, and 96 cycles/360°. Twenty adults free of ocular diseases, with normal or corrected-to-normal visual acuity, and no history of alcoholism were enrolled in two experimental groups: 1) no alcohol intake (control group) and 2) alcohol ingestion (experimental group). The average concentration of alcohol in the experimental group was set to about 0.08%. We used a paradigm involving a forced-choice method. Maximum sensitivity to contrast for sine-wave gratings in the two groups occurred at 4 cpd sine-wave gratings and at 24 and 48 cycles/360° for angular frequency stimuli. Significant changes in contrast sensitivity were observed after alcohol intake compared with the control condition at spatial frequency of 4 cpd and 1, 24, and 48 cycles/360° for angular frequency stimuli. Alcohol intake seems to affect the processing of sine-wave gratings at maximum sensitivity and at the low and high frequency ends for angular frequency stimuli, both under photopic luminance conditions.

[Nurses' professional prestige: estimate of magnitudes and expanded categories]

The prestige of professionals such as social workers, biologists, dentists, nurses, engineers, pharmacists, physicists, physical therapists, speech-language pathologists, physicians, psychologists, chemists and sociologists was scaled by the psychophysical methods of estimation of magnitudes and expanded categories. Results showed that: 1) when we increase the limited amplitude of categories, this method has the same characteristics as those of the estimation of magnitudes. 2) the relationship between the estimations of magnitudes and estimations of expanded categories is a power function with an exponent that is not significantly different from 1.0. These data enabled the following conclusions: 1--The nursing profession is in the seventh or eighth position regarding the prestige of the 13 professions whereas physicians are in the first position in the scale obtained by the used methods; 2--the orders resulting from the methods produce positions of prestige that highly agree for the different professions.

Influence of sex, age, and menopausal state on the course of early rheumatoid arthritis

OBJECTIVE

To investigate the influences of the menopausal state, sex, and age on the course and outcome of rheumatoid arthritis (RA).

METHODS

A cohort of patients with early RA (209 female, 123 male) was studied. Sex, age, and menopausal state at baseline, and disease activity, radiographic joint destruction, and physical disability during 6 years of followup were assessed.

RESULTS

The Disease Activity Score (DAS) was significantly higher in female compared to male patients at any time point except at the time of inclusion. This was mainly due to postmenopausal patients. Radiographic joint destruction (RJD) was significantly worse in female patients compared to males at the time of inclusion. Postmenopausal patients had significantly higher RJD than premenopausal patients at the time of inclusion and 3 years thereafter. Older male patients showed worse RJD than younger male patients at all time points measured. Physical disability was significantly worse in female compared to male patients, as well as in postmenopausal compared to premenopausal patients, and older male compared to younger male patients. Stepwise regression analysis revealed that at 3 years higher age and female sex were the best predictors for a worse DAS. Higher age and the interaction term between menopausal state and age best predicted higher RJD. Higher age and the interaction term between menopausal state and age best predicted Health Assessment Questionnaire (HAQ) score.

CONCLUSION

Higher age at presentation of RA leads to a more severe disease course in terms of DAS, RJD, and HAQ. Although female sex has a deteriorating effect on the DAS, the menopausal state is responsible for the major part of the differences in outcome between men and women. Postmenopausal state in early RA influences future disability and damage, especially in older patients.

Vanadium haloperoxidases from brown algae of the Laminariaceae family

Vanadium haloperoxidases were extracted, purified and characterized from three different species of Laminariaceae--Laminaria saccharina (Linné) Lamouroux, Laminaria hyperborea (Gunner) Foslie and Laminaria ochroleuca de la Pylaie. Two different forms of the vanadium haloperoxidases were purified from L. saccharina and L. hyperborea and one form from L. ochroleuca species. Reconstitution experiments in the presence of several metal ions showed that only vanadium(V) completely restored the enzymes activity. The stability of some enzymes in mixtures of buffer solution and several organic solvents such as acetone, ethanol, methanol and 1-propanol was noteworthy; for instance, after 30 days at least 40% of the initial activity for some isoforms remained in mixtures of 3:1 buffer solution/organic solvent. The enzymes were also moderately thermostable, keeping full activity up to 40 degrees C. Some preliminary steady-state kinetic studies were performed and apparent Michaelis-Menten kinetic parameters were determined for the substrates iodide and hydrogen peroxide. Histochemical studies were also performed in fresh tissue sections from stipe and blade of L. hyperborea and L. saccharina, showing that haloperoxidase activity was concentrated in the external cortex near the cuticle, although some activity was also observed in the inner cortical region.

Essential oils from Azorean Laurus azorica

The essential oils isolated from leaves of ten and from unripe berries of eight populations of Laurus azorica (Seub.) Franco, collected on five islands of the Azorean archipelago, were analysed by GC and GC-MS. All oil samples were dominated by their monoterpene fraction (60-94%), alpha-pinene (15-37%) and 1,8-cineole (12-31%) being the main components of the leaf oils, while trans-beta-ocimene (27-45%) and alpha-pinene (12-22%) were the main components of the oils from the berries. The sesquiterpene fractions of the oils ranged from 3 to 17% and the main components were beta-caryophyllene (traces-8%) and beta-elemene (traces-3%) both in the leaf and berry oils. Some phenylpropanoid components were also present, in total amounting to 17%, trans-cinnamyl acetate (215% of the leaf oils) being the main component of this fraction. Cluster analysis of the enantiomeric composition of alpha- and beta-pinene in the oils from the leaves clearly showed two groups, one constituted by the two populations growing on the island S. Jorge, and the other constituted by the remaining populations.

Arthropathy of genetic hemochromatosis: a major and distinctive manifestation of the disease

Genetic hemochromatosis is not a rare disease and represents a frequently underestimated cause of arthropathy. Joint involvement is one of the most frequent manifestations of the disease and presents typical clinical and radiological features that strongly suggest the diagnosis. Joint complaints are often the first clinical manifestation of GH. Their identification may be crucial to establish the diagnosis in the pre-cirrhotic phase and to institute appropriate therapy to prevent organ damage and associated mortality. Recent identification of the genetic defect responsible for the disease is leading to new insights into the pathogenesis of GH and the associated arthropathy.

Histology of the synovial tissue: value of semiquantitative analysis for the prediction of joint erosions in rheumatoid arthritis

OBJECTIVE

Routine histologic techniques are still the main procedure in the study of the synovial biopsy. The relationship between the typical histological changes of rheumatoid synovium and clinical manifestations has not been studied in detail.

METHODS

With the aim of determining whether a simple semiquantitative method of evaluating the changes in closed synovial biopsies was of clinical value in assessing both the diagnosis and prognosis of rheumatoid arthritis (RA) patients, we evaluated retrospectively 72 synovial biopsy specimens (26 RA patients, 30 patients with other inflammatory diseases and 16 osteoarthritis patients). Scores (0-10) were assigned to each biopsy specimen for each of 6 histologic features: synoviocyte hyperplasia; fibrosis in the subsynovial layer; proliferating blood vessels; perivascular infiltrates of lymphocytes; focal aggregates of lymphocytes; and diffuse infiltrates of lymphocytes. Scores were compared between the 3 groups and also between the RA subgroups with early and late disease; positive and negative rheumatoid factor; with and without joint erosions; and with and without systemic disease.

RESULTS

Significant differences in the mean global score (mean of the 6 scores) were found both between RA and osteoarthritis and between other inflammatory diseases and osteoarthritis (p < 0.01). The mean global score for RA was higher than the mean global score obtained for the other inflammatory diseases, but the difference was not significant. We found a significantly higher mean global score in the RA patients with erosions in comparison to the RA patients without erosions, this difference being particularly evident for the lymphocyte perivascular infiltrate (p < 0.05). There were no significant differences between the other RA subgroups.

CONCLUSION

In this study we have identified differences, using routine histologic techniques, between the rheumatoid synovial membrane of patients with and without erosions. Based on our present observations we suggest that the intensity of inflammatory histological features and, in particular, a high percentage of vessels with perivascular lymphocyte infiltrate might be of prognostic value in RA.

[Comparison of two psychophysical methods for the estimation of the severity of illness]

In this study, 15 diagnoses were selected and evaluated by the methods of estimation of magnitudes and estimation of categories. These methods were performed by 46 subjects (10 physicians, 20 nurses and 16 psychologists). The results show that the non-metric continuum of seriousness of an illness exhibits prosthetic characteristics and the variability of estimates is a linear function of the magnitude estimation, thus confirming that Ekman's law is also valid for non-metric continua.

[Estimation of the number of minimum salaries attributed to professions in function of their prestige]

The purpose of this study was to verify the relationship between professional prestige scaled through estimations and the professional prestige scaled through estimation of the number of minimum salaries attributed to professions in function of their prestige in society. Results showed: 1--the relationship between the estimation of magnitudes and the estimation of the number of minimum salaries attributed to the professions in function of their prestige is characterized by a function of potence with an exponent lower than 1,0,2--the orders of degrees of prestige of the professions resultant from different experiments involving different samples of subjects are highly concordant (W = 0.85; p < 0.001), considering the modality used as a number (estimation of magnitudes of minimum salaries).

A complex case of hepatitis in a patient with systemic lupus erythematosus

Liver involvement in patients with systemic lupus erythematosus (SLE) is considered rare. Previous treatment with potentially hepatotoxic drugs or viral hepatitis have usually been implicated as the main causes of liver disease in SLE patients. On the other hand, even after careful exclusion of these aetiologies, the problem remains whether to classify the patient as having a primary liver disease with associated autoimmune clinical and laboratory features resembling SLE, such as autoimmune hepatitis, or as having liver disease as a manifestation of SLE. We report the case of an elderly woman who presented with acute hepatitis, who had been diagnosed with SLE 14 years ago and who also had Sjögren's syndrome and anti-phospholipid's syndrome for several years. The histology depicted chronic active hepatitis and, after drug-induced hepatitis and viral hepatitis were excluded, the serological and clinical features were shown to be typical of liver damage caused by SLE. The patient was treated with azathioprine 100 mg/d and prednisone 30 mg/d. The clinical symptoms resolved in 10 days and the laboratory values were normal at the end of the first month of therapy. Prednisone was progressively reduced, during a period of 4 months, to 10 mg/d but azathioprine was kept to the same dose. One year after the diagnoses the patient is still in remission. Although uncommon, hepatic involvement is well recognised in SLE. The interest of this case lies in the differential diagnosis and recognition of this condition, which deserves an aggressive treatment.

Statistical aspects of genetic mapping in autopolyploids

Many plant species of agriculture importance are polyploid, having more than two copies of each chromosome per cell. In this paper, we describe statistical methods for genetic map construction in autopolyploid species with particular reference to the use of molecular markers. The first step is to determine the dosage of each DNA fragment (electrophoretic band) from its segregation ratio. Fragments present in a single dose can be used to construct framework maps for individual chromosomes. Fragments present in multiple doses can often be used to link the single chromosome maps into homologous groups and provide additional ordering information. Marker phenotype probabilities were calculated for pairs of markers arranged in different configurations among the homologous chromosomes. These probabilities were used to compute a maximum likelihood estimator of the recombination fraction between pairs of markers. A likelihood ratio test for linkage of multidose markers was derived. The information provided by each configuration and power and sample size considerations are also discussed. A set of 294 RFLP markers scored on 90 plants of the species Saccharum spontaneum L. was used to illustrate the construction of an autopolyploid map. Previous studies conducted on the same data revealed that this species of sugar cane is an autooctaploid with 64 chromosomes arranged into eight homologous groups. The methodology described permitted consolidation of 54 linkage groups into ten homologous groups.

[Evaluation of the severity of clinical illness: a psychophysical approach]

The severity of clinical illness was evaluated through the psychophysics method of magnitude estimation. The purpose of this experiment was: 1) to compare the scales derived from right judgement (magnitude estimation) used in three different Brazilian samples; 2) to verify the stability and agreement of severity estimations of clinical situations judged in Brazil, USA and England. In order to develop this study, professionals who work in the areas of psychology, nursing and medicine were invited. The lower coefficient of Pearson's correlation among the groups were of 0.88 the and the greater of 0.94. The exponents found between the Brazilian and American samples were of 1.22 and between the Brazilian and English samples of 1.15.

[Ratio scaling evaluation of nurses' professional prestige through a cross-modality method]

Professional prestige was determined using the psychophysical methods of magnitude estimation and cross-modality matching with line lengths and dynamometric forces as responses. The main results revealed that: (a) the rankings order resulting from all methods employed provide degrees of prestige which are in close agreement with the different professions (w = 0.94), (b) the non-metric continuum of professional prestige exhibits prothetic characteristics, (c) the variability of estimations is a linear function of the estimation of magnitudes, thus confirming that Ekman's law is also valid for non-metric continua, (d) the exponents obtained using matchings of number, line lengths and force of hangrip were not significantly different from the exponents predicted by the transitivity property of scales and, finally (e) the data furnish a scale of professional prestige which, at the level of ratio measurement, is valid, stable and consistent.

[Profile of the resistance to macrolides and imidazoles of Helicobacter pylori in a sample of the Portuguese population]

We studied the sensitivity of H. pylori to clarithromycin and metronidazole, as well as the sensitivity and specificity of H. pylori culture, urease test and histology on a sample of 166 Portuguese patients. We observed a prevalence of 5.8% resistance to clarithromycin and 60% resistance to metronidazole. The sensitivity and specificity for the diagnostic tests were: culture 98% and 100%, urease test 98% and 91%, histology 50% and 95%, respectively.

Cholestasis secondary to Hodgkin's disease: report of 2 cases of vanishing bile duct syndrome

Only a small percentage of patients with Hodgkin's disease become clinically Jaundiced during their disease. This Jaundice may be secondary to biliary obstruction, hemolysis, direct hepatic infiltration by the disease, drug toxicity or viral hepatitis. Vanishing bile duct syndrome secondary to Hodgkin's disease is a rare cause of cholestasis in these patients, only 13 cases having been reported so far. The authors describe 2 patients who developed severe Jaundice secondary to Hodgkin's disease due to vanishing bile duct syndrome affecting small intrahepatic bile ducts.

[Intracranial arachnoid cyst. Report of 9 operated cases]

Analysis of nine patients with intracranial arachnoid cysts surgically treated from 1974 to 1995. The treatment consisted of cystoperitoneal shunt in seven patients and craniotomy with excision of cyst membrane in the other two cases. After surgery, bacterial meningitis and failure shunt device were observed in three cases. Both the infectious process and the shunt device were respectively treated and corrected at once. It has been observed total clinical improvement in all nine cases. A review of the literature has been made and some pathophysiological, diagnostic and therapeutic aspects are discussed.

[Sex hormones and osteoporosis: a physiological perspective for prevention and therapy]

Estrogen deficiency is the main cause of post-menopausal osteoporosis and hormone replacement therapy is consensually regarded as the first line choice for its prevention. Hormone-replacement has also been shown to prevent bone loss associated with rheumatoid arthritis (RA) and corticotherapy. The rationale for its use in RA is reinforced by evidence of beneficial effects on disease activity. Estrogens also have bone-protective effects in males. C-19 progestagens seem to potentiate the skeletal effects of estrogens whereas C-21 derivatives appear to have no significant influence. Progestagens may be particularly useful in the prevention of steroid-induced osteopenia. Testosterone is an effective treatment for male osteoporosis associated with hypogonadism and is also promising in the treatment of osteoporosis in aged eugonadal males. The association of this hormone potentiates the effects of estrogens on bone mineral density in post-menopausal women. However, anabolic androgens have been preferred in this condition, due to a lower androgenizing effect. They represent a valid therapeutic alternative, particularly in cases of cortical osteoporosis with low bone turnover and in the aged and frail. In general, the different modalities of hormonal therapy clearly deserve a higher degree of preference in the treatment and prevention of osteoporosis than common present practice in our country. It is time to reassess this matter, clear unfounded fears and reinforce the physiological and scientific foundations of our therapeutic options for osteoporosis.

[Progressive facial hemiatrophy (Parry-Romberg disease). Report of two cases associated with trigeminal neuralgia and cramps]

The authors report two cases of progressive facial hemiatrophy (PFH) associated with cranial nerves hyperexcitability. One of them (Case 1), a 41-year-old-woman noticed a slight atrophy on the left side of her face at age of ten. For the last three months, she has been suffering from fits of neuralgic pains on the left side of her face which have not ceased by drug treatment In view of this, a surgery procedure was planned for the patient. The other patient (Case 2), a 33-year-old-woman has a 8 year history which started with cutaneous abnormalities (white and dark spots). Two years later she observed that her right cheek and right thigh had got a mild atrophy. Frequently, she has been complaining of cramps in the mandibular region which are precipitated, sometimes, by opening the mouth. A probable relation between neural excitability and PHF is discussed.

[Cruciate hemiplegia associated with basilar impression, Arnold-Chiari malformation and syringomyelia. Case report]

The authors report a case of cruciate hemiplegia associated with basilar impression, Chiari malformation and syringomyelia. The neuroanatomical controversy, the surgical treatment and the good outcome of the patient are discussed.

[Use and application of psychophysical methods in nursing research]

Concepts and subjective phenomena such as social attitudes, opinions, and judgment processes have always been difficult to measure accurately. Many concepts or variables in nursing are of a subjective nature. As with the social sciences, the nursing profession has faced many problems in attempting to obtain precise measurements of such variables. The psychophysical methodology, specially the magnitude estimation and cross-modality matching procedures, developed in sensory psychophysics and currently being used in the social sciences, shows promise for providing nursing with an instrument of precisely scaling subjective phenomena. The purpose of this paper is to describe these measurement techniques, the theoretical paradigm on which it is based, and several social, clinical and nursing studies that have utilized these sensitive measurement strategies.

Reinnervation of post-arthritic joints in the rat

OBJECTIVE

To clarify the role of articular innervation during the acute and post-arthritic phases, we investigated the changes taking place over time in the nerve fibers from joint tissues of adjuvant arthritic rats.

METHODS

Nerve densities (i.e., the number of nerve fibers observed per unit area of tissue section) were estimated in periarticular tissues, synovium and epiphysis from ankle joints. Nerves were identified by immunofluorescence microscopy using antibodies against general neuronal markers (Protein Gene Product 9.5, synaptophysin, neurofilaments and Schwann cells), and markers specific for either sensory or sympathetic nerves (Substance P, calcitonin gene related peptide, neuropeptide tyrosine and its C-terminal flanking peptide, and the catecholamine synthesising enzyme tyrosine hydroxilase).

RESULTS

In arthritic rats, the density of nerve fibers in the periarticular tissues, epiphysis and synovium was significantly reduced when compared to control animals. This decrease was observed using antibodies for both non releasable neuronal products (Protein Gene Product 9.5, synaptophysin, neurofilaments and Schwann cells) and neuropeptides (Substance P, calcitonin gene related peptide, neuropeptide tyrosine and its C-terminal flanking peptide), thus suggesting the existence of a structural nervous lesion with the parallel depletion of peptides. As the clinical arthritis subsided, there was a progressive reinnervation of all the articular structures analysed, which often exceeded the density of nerves in the control animals.

CONCLUSION

This work supports a close relationship between the nervous system and arthritis. We propose that cycles of nerve destruction and regeneration may be related to the characteristic periods of remission and activity of some forms of chronic arthritis.

[Acute neurogenic pulmonary edema: a case report]

The authors report a case of acute neurogenic pulmonary edema in a 28-year-old woman who presented rupture of an internal carotid artery aneurysm and subarachnoid hemorrhage. The respiratory disorders started at the same time the patient's symptomatology aggravated. Some etiological and pathophysiological aspects on neurogenic pulmonary edema are revised.

[Facial expressions and human emotions. Bibliographic survey]

The present work intends to divulge some Nursing and Psychology' publications about human facies and emotions. Intends do help the health professional thinking about the facial expressions of emotion in the interpersonal relationships, showing the researches more cited at specific bibliography, first regarding to children and to adults.

Kinetics and thermal behaviour of the structure formation process in HMP/sucrose gelation

The concentration and temperature dependence of the gelation kinetics of high-methoxyl pectin (HMP; 60% sucrose, pH 3) was investigated using measurements of small-amplitude oscillatory shear. The rate of gelation close to the gel point can be described as a second-order rate process using the kinetic model of Ross-Murphy (Carbohydr. Polym. 1991, 14, 281) and a critical exponent close to that predicted by the percolation approach. The modulus after a long ageing time showed a power concentration dependence with an exponent around 3.1, higher than the classical square of concentration dependence, which was probably either due to the nonequilibrium state of the HMP gels even after long ageing times, or due to the proximity of the concentration range studied to the critical gelling concentration. The gelation rate of HMP/sucrose systems is strongly dependent on the temperature. An Arrhenius relationship was applied to describe this dependence. Two different processes are proposed to explain the discontinuity observed, each one having rates with different temperature dependence. The applicable kinetics at longer times are quite different, with a lower dependence on polymer concentration and ageing temperature. A non-isothermal kinetic model was used to describe the gelation process of the HMP/sucrose system during cooling.

[Surgical findings in 260 cases of basilar impression and/or Arnold-Chiari malformation]

The surgical findings observed in a series of 260 patients with craniovertebral anomaly are presented. There were 29 (11.1%) patients only with basilar impression, 18 (6.9%) cases of pure Arnold-Chiari malformation and 213 (81.9%) cases of basilar impression associated with Chiari malformation. The surgical findings on bone, dura-mater, nervous tissue and blood vessels of this region are reported.

[Ischemic lesion of the CNS in patients with systemic lupus erythematosus]

In a review of 240 patients with Systemic Lupus Erythematosus we found 12 (5%) with cerebral infarctions. The average patient age was 38 years and no relation with the duration of lupus was found. The most common neurologic manifestations were hemiparesis (67%), language disturbances (25%) and ataxia (25%). Clinical signs of diffuse involvement of Central Nervous System (CNS) were also present in 1/3 of the patients. In 5 cases (42%) no signs of lupus activity were found. In the remaining 7 (58%), where other manifestations occurred, all presented cutaneous vasculitis. Known risk factors for atherosclerotic vascular disease were common and 58% of the patients had at least one risk factor.

IN CONCLUSION

1. Recent onset cutaneous vasculitis should alert the physician to the possibility of CNS ischemic lesion and 2. The presence of risk factors for cerebrovascular disease (steroid therapy, hypertension and hypercholesterolemia) is frequent and may be controlled.

[Attitudes of professional nurses towards burn patients: elaboration and reliability tests of a measurement instrument]

In this study it was developed an Instrument for Measuring the Attitudes of Nursing Professionals toward Patients with Burns. 194 items, divided into subscales, expressing favorable and unfavorable attitudes toward patients with burns, were analyzed, concerning their apparent and context validity. Following this psychometric analysis 170 items were selected to compose the definitive scale. The confiability coefficient estimated by the split-half method for the different subscales ranged from 0.61 to 0.82. The confiability coefficient of the total scale was equal to 0.92.

Inflammation-induced cartilage degradation in female rodents. Protective role of sex hormones

OBJECTIVE

To investigate the effects of physiologic levels of sex steroids on inflammation and cytokine production and their consequential cartilage degradation.

METHODS

We used an in vivo model of inflammation-induced cartilage degradation in female mice to study the effects of ovariectomy and hormone treatment, and in vitro culture systems to examine the influence of sex steroids on cartilage metabolism, interleukin-1 (IL-1) production by granulomatous tissue, and its effects on female mouse articular cartilage.

RESULTS

Ovariectomy resulted in accelerated cartilage breakdown associated with increased production of IL-1 by granulomatous tissue. The effects of ovariectomy on cartilage were reversed by treatment with estradiol and androgen, but not by progesterone treatment. Estradiol and progesterone reduced both spontaneous and IL-1-induced cartilage degradation in vitro. Testosterone antagonized the effects of IL-1 on both proteoglycan loss and proteoglycan synthesis.

CONCLUSION

These data suggest that sex steroids have an important influence on inflammation-induced cartilage breakdown in female animals, with protective effects of both estradiol and androgens. Multiple mechanisms may be involved, and they are likely to include direct immunomodulatory effects as well as interactions with the effects of cytokine and of the glucocorticoid response to inflammation.

[Functional assessment of the autonomic nervous system in rheumatoid arthritis]

Sympathetic and parasympathetic nervous system evaluation was performed in 21 patients with rheumatoid arthritis. Every patient had autonomic nervous system (ANS) dysfunction, the parasympathetic involvement being the most frequent. ANS dysfunction may explain some manifestations and may well be the expression of a larger neuropathic involvement with pathogenic implications.

[Brown-Séquard syndrome in schistosomiasis. Report of a case]

The authors report a case of schistosomiasis mansoni with intraspinal localization on a 39 year old man who presented neurologic manifestation likely a Brown-Séquard syndrome. Cerebrospinal fluid examination showed positive immunofluorescent test for schistosomiasis, and treatment was started at once.

Basilar impression and Arnold-Chiari malformation. Surgical findings in 209 cases

The surgical findings observed in a series of 209 consecutive patients with craniovertebral anomaly are presented. The high prevalence of basilar impression in the Northeast of Brazil is noteworthy. There were 28 (13.3%) patients with basilar impression alone, 10 (4.7%) cases of pure Arnold-Chiari malformation and in 171 (81.8%) cases the basilar impression was associated with Arnold-Chiari malformation. This study reflects our surgical experience of the pathology in a 17-year period (1971-1987). It reflects also the peculiarities of neurosurgical practice in an undeveloped region of this Country. The literature is extensively reviewed.

[Autonomic nervous system disorders in 230 cases of basilar impression and Arnold-Chiari deformity]

Within the period of 1971 to 1989 we operated on 230 cases of craniocervical malformations characterised by 189 cases of basilar impression associated with Arnold-chiari malformation, 28 cases of isolated basilar impression and 13 cases of Arnold-Chiari malformation. Autonomic disturbance was observed in 136 (59.1%) cases: sexual disorders like reduced potency and impotency were observed in 86 (60.9%) out of 141 male patients, urinary symptoms in 39 (17%) patients; and other autonomic features like dyspnea, anhidrosis, hyperhidrosis, Claude Bernard-Horner syndrome and constipation in 41 (17.8%) patients.

[Acute cerebellar infarction simulating posterior fossa tumor]

We report a case of space-occupying infarction of the left cerebellar hemisphere with occlusive hydrocephalus and left to right shift of the fourth ventricle. The patient, a 58 years old man, underwent shunting and decompressive craniectomy of the posterior fossa and survived without neurological deficits.

Measurement of visual acuity with logarithmic charts: comparison between methods of threshold estimation

The variability of the repetition of visual acuity measurements with a log MAR acuity chart with five optotypes in each row of acuity was studied in four groups of subjects. In three groups the threshold was calculated by probability of seeing curves, but the optotypes were read in different orders. For the fourth group the acuity was taken as the smallest row discriminated. Estimating the threshold by a probability of seeing curve did not improve the threshold's stability. Poorer acuity was detected when the optotypes were read vertically. It is suggested that clinical visual acuity charts are not suitable tools for generating data points to be fitted by probability of seeing curves.

Agranulocytosis and liver damage associated with pyrazinobutazone with evidence for an immunological mechanism

Agranulocytosis and liver injury is described in a patient with Reiter's syndrome of 3 years duration who received pyrazinobutazone for 6 weeks before the development of the clinical picture reported. Other causes of agranulocytosis and hepatic damage were excluded and a lymphocyte transformation test to the drug revealed significant lymphocyte proliferation in response to the drug. This suggests a hypersensitivity reaction as the mechanism for this previously unrecognized association of adverse effects to pyrazinobutazone.