Lyme disease in Mato Grosso do Sul State, Brazil: report of three clinical cases, including the first of Lyme meningitis in Brazil

The authors report the occurrence of the first three clinical cases of Lyme disease in Mato Grosso do Sul State, including the first case of Lyme meningitis in Brazil. These were identified by clinical and laboratorial criteria. Anti-Borrelia burgdorferi antibody search was carried out through ELISA and Western Blotting techniques, the former providing identification of IgG class antibodies alone, in one only of those cases. Through Immunoblotting, the following features were found in serum: 5 IgG and 2 IgM bands for the first case; 7 IgG and 2 IgM bands for the second; and 5 IgG and 6 IgM bands for the third. In the latter, presence fo specific antibodies was searched in liquor, due to lymphomonocitary meningitis occurrence, and one IgM band was detected. After antibiotic therapy, all patients exhibited significant clinical and laboratorial improvement in their conditions along with symptom regression to the present moment.     

Interfacial properties of self-reinforced composite poly(methyl methacrylate)

The authors describe ten years of experience in breast reconstruction in the Department of Plastic and Reconstructive Surgery in the District Hospital of Santarém--Portugal. Ninety-nine patients were treated with 106 reconstructions, most of these were immediate and some were delayed. The authors were interested in providing an adequate volume, but also into obtaining an acceptable aesthetic result. This contributes considerably to the psychological recovery of the patients.     

A technique revisited: hemodynamic comparison of closed- and open-chest cardiac massage during human cardiopulmonary resuscitation

OBJECTIVE: To compare the hemodynamics of closed-chest cardiac massage vs. open-chest cardiac massage in patients resuscitated from cardiac arrest that occurred outside of the hospital. DESIGN: Prospective, non-outcome, case series. SETTING: Large urban emergency department. PATIENTS: Ten adult, normothermic, nontraumatic, out-of-hospital, cardiac arrest patients who failed advanced cardiac life support (ACLS) therapy. INTERVENTIONS: Patients presenting to the hospital in cardiac arrest were managed according to the ACLS protocol at the clinician's discretion. Proximal aortic and central venous pressure catheters were placed to measure arteriovenous compression- and relaxation-phase pressure gradients. After 5 mins of baseline measurements during closed-chest cardiac massage, patients underwent a left lateral thoracotomy, and open-chest cardiac massage was performed for 5 mins. MEASUREMENTS AND MAIN RESULTS: The mean coronary perfusion pressure and compression-phase pressure gradients were 7.3 +/- 5.7 and 6.2 +/- 5.4 mm Hg, respectively, during closed-chest cardiac massage, while increasing to 32.6 +/- 17.8 and 32.6 +/- 29.9 mm Hg, respectively, during open-chest cardiac massage. The differences between both measurements were statistically significant (p < .05). CONCLUSIONS: Open-chest cardiac massage is superior to closed-chest cardiac massage in providing relaxation-phase and compression-phase pressure gradients during cardiac arrest in patients failing current ACLS protocols. During open-chest cardiac massage, all patients exceeded the minimum coronary perfusion pressure of 15 mm Hg, which is recommended to obtain a return of spontaneous circulation. Further outcome studies are needed to determine the timeliness and appropriate indications for open-chest cardiac massage.     

What is the best biochemical test to diagnose acute pancreatitis? A prospective clinical study

OBJECTIVE: To determine which biochemical test is best to distinguish acute pancreatitis from other pancreatic and nonpancreatic diseases associated with hyperamylasemia. DESIGN: We conducted a prospective clinical study of 836 consecutive patients who had a total serum amylase test requested by a physician during a 7-month period. MATERIAL AND METHODS: Radioimmunoassay and enzymatic activity methods were used to measure pancreas-specific proteins of varied size, charge, and stability. In addition, scoring systems were used for the diagnosis of pancreatitis, and statistical analyses were done to determine sensitivity and specificity. RESULTS: We found minor differences in sensitivity and specificity for diagnosis of acute pancreatitis among pancreatic isoamylase, phospholipase A2, colipase, lipase, and carboxylester lipase. Of these tests, the combination of isoamylase and phospholipase A2 had a small but statistically significant increased sensitivity (90%; 95% confidence interval [CI] = 74 to 98%) and specificity (93%; 95% CI = 91 to 95%) over isoamylase (90% and 92%, respectively; 95% CI = 90 to 94%) and phospholipase A2 (90% and 75%, respectively; 95% CI = 72 to 78%) alone for the diagnosis of acute pancreatitis. CONCLUSION: Pancreas-specific proteins are satisfactory for diagnosing acute pancreatitis if the test is validated by the laboratory. Clinically, the slight advantage of using both isoamylase and phospholipase A2 does not outweigh the expense of performing two assays; we recommend using isoamylase to diagnose acute pancreatitis.     

Discrimination of simulated texture patterns on the human hand

1. Textures formed by periodic dot arrays are defined by the dot density, spacing, and angular orientation with respect to the direction of motion. In this report we evaluate the effects of the dot density (intensive cues) and arrangement (spatial cues) on the ability of human subjects to discriminate texture patterns scanned across an OPTACON tactile stimulator that selective stimulates rapidly adapting cutaneous mechanoreceptors. We compared dot arrays arranged on the index finger in specific patterns (horizontal, vertical, diamond, up diagonal, or down diagonal orientation) and spaced 4.8, 7.2, or 9.6 mm apart (high, medium, and low density) with the use of a two-alternative forced-choice protocol. 2. Textures are well discriminated when their elements are tightly spaced along one axis and widely spaced on all other axes. Humans distinguish textures that differ only in orientation with mean accuracy of 75% at low density and 65% at medium density, but discriminate high-density textures poorly (mean accuracy = 48%). Accuracy is related to the angular disparity between patterns, and to similarity of spacing and orientation along major and minor axes of the arrays. Vertical and horizontal patterns are more accurately distinguished than the oblique ones, and diamond arrays are the least well discriminated. Diagonal and diamond textures are often confounded, and the up and down diagonal patterns are confused with each other particularly as the texture density rises. The preference for the vertical and horizontal patterns may relate to an interaction between the orientation axis of the texture and its direction of motion across the skin. 3. Intensive cues provided by the total number of applied stimuli supplement the spatial cues inherent to the pattern orientation, because textures that differ in both spacing and orientation are discriminated better than those that differ only in orientation or spacing. Mean accuracy ranges from 96% for comparisons of high- and low-density textures, which differ in the total number of dots by a factor of 2, to 80% when medium-density patterns are compared with high- or low-density textures. 4. Textures that differ in density but not in orientation are less well discriminated than those of different orientation. For example, 82% of patterns that differ in both density and orientation are distinguished correctly in pairings of low- and medium-density textures, whereas those that differ only in density are discriminated correctly on 45% of trials. Subjects seem to use spatial rather than intensive cues when discriminating patterns of similar density, suggesting that the similarity of form (the spatial arrangement of the closely spaced dots) is more readily apparent than small differences in spacing along the axis of motion. 5. Subjects are most most successful in differentiating texture patterns when they are able to mentally picture the orientation and spacing of the pattern. We found a strong correlation between the subjects' ability to discriminate textures of a given spacing and their ability to identify the specific texture by matching it to the appropriate visual representation. Subjects are able to identify correctly all five orientations at low and medium densities, with mean accuracy of 76%, but recognize only the vertical arrays when high-density patterns are presented. The ability to image the textures is noteworthy, because subjects received no feedback about performance. 6. Spatial imaging of textures appears limited by the diameter of cutaneous receptive fields on the hand. We propose that the structural axis of a regular texture array results from perceptual linkage of adjacent elements along one principal axis by continuous bands of neural activity when their spacing is smaller than the receptive field diameter.(ABSTRACT TRUNCATED)