Treatment of adolescents with Hansaplate/headgear. Influence on face in profile and on dentition

The treatment effects of Hansaplate/headgear in the course of 1 year were analyzed. Twenty-one girls and 19 boys, 10 and 11 years old, respectively, with postnormal occlusion and an average overjet of 8 mm, made up the treatment group. Forty untreated patients with the same type of malocclusion and dentofacial morphology as the treated children, and paired and matched for sex and age, made up the controls. Measurements were obtained from cephalometric headfilms. Matched-intrapairs analysis of control versus treatment changes after 1 year of treatment was done. This showed that the treatment resulted in inhibited sagittal growth of the maxilla, increased anterior face height and a flattened soft tissue profile with a less protrusive upper lip and a less pronounced sulcus mentolabialis. The overjet decreased by 5 mm on average. Only slight retroclination of the upper incisors without extrusion and retroclination of lower incisors to the mandibular plane occurred. No significant anterior positioning of the mandible as compared with the controls was recorded in this study.

Pulmonary 99mTc-human serum albumin clearance and effects of surfactant replacement after lung lavage in rabbits

OBJECTIVE

Pulmonary clearance of technetium-labeled human serum albumin was measured in order to investigate whether the surfactant layer is a rate-limiting factor for the permeability of the alveolar-capillary membrane for 99mTc-labeled albumin.

DESIGN

Prospective, randomized, controlled trial.

SETTING

Research laboratory.

SUBJECTS

Nineteen white New Zealand adult rabbits.

INTERVENTIONS

Three groups of rabbits were studied: group 1 animals received natural surfactant after lung lavage; group 2 animals underwent lung lavage only; and group 3 animals were not lavaged and served as an untreated, healthy control group. All animals were ventilated with high pressures.

MEASUREMENTS AND MAIN RESULTS

99mTc-labeled albumin was nebulized into the inspiratory line of the breathing circuit with an air jet nebulizer. The clearance measurements were then immediately started. Gamma camera images were obtained in 1-min frames for 120 mins and stored in a 64 x 64 image matrix in a computer. In group 1 animals, surfactant restored blood gases to near normal, and all animals except one had bi-exponential clearance curves. The half-life of the fast compartment was 35.9 +/- 6.4 mins, and the half-life of the slow compartment was 847.5 +/- 143.5 mins. All group 2 animals also had bi-exponential clearance curves of the tracer (the half-lives of the fast and slow compartments were 14.6 +/- 6.7 and 459.8 +/- 167 mins, respectively). The half-lives of both the fast (p < .01) and slow (p < .01) components were significantly different between groups 1 and 2. Group 3 had a mono-exponential half-life of 580 +/- 225 mins.

CONCLUSIONS

The use of 99mTc-human serum albumin as a tracer molecule is possible and feasible. The clearance of this tracer is, in part, determined by the integrity of the pulmonary surfactant system, as it is with 99mTc-diethylenetriamine pentaacetate.

Antibodies to pneumococcal polysaccharides in human milk: lack of relationship to colonization and acute otitis media

BACKGROUND

This study analyzed antibodies to pneumococcal polysaccharides in human milk and their effect on nasopharyngeal colonization and acute otitis media in breast-fed infants.

METHODS

A total of 503 milk samples were collected from 310 mothers. Nasopharyngeal cultures were obtained from their children at 2, 6 and 10 months postpartum, and the capsular groups/types of the Streptococcus pneumoniae isolates were determined.

RESULTS

Types 6A, 6B, 19A, 19F and 23F accounted for 54% of the pneumococcal isolates, but type 3 isolates were uncommon. Milk samples were analyzed for antibody activity to the common capsular polysaccharide types 6A, 19F and 23F; to the type 3 polysaccharide; to C-polysaccharide; and to phosphorylcholine (PC), a major component of the pneumococcal cell wall polysaccharide (CWPS). Anti-capsular antibody activity was low or absent in > 90% of the milk samples. In contrast anti-PC antibody activity was detected in 88% and anti-CWPS in 84% of the samples. The frequency of acute otitis media did not vary with the milk anti-capsular, anti-PC or anti-CWPS antibody activity.

CONCLUSIONS

There was no reduction in nasopharyngeal carriage of S. pneumoniae among children fed milk with anti-capsular or anti-PC antibody activity, but carriage was increased in those children who received milk with anti-CWPS antibody activity. A protective role of antipolysaccharide or anti-CWPS antibodies in milk was not detected under the study conditions.

Urinary excretion of melanocyte metabolites during treatment with chloroquine phosphate

The antimalarial drug chloroquine is also used in the prevention of photodermatoses and in patients with inflammatory connective diseases. The drug binds strongly to melanin. Melanocytic activity can be studied by analysis of the urinary markers of eumelanin (6-hydroxy-5-methoxyindole-2-carboxylic acid, 6H5MI-2-C) and phaeomelanin (5-S-cysteinyl-dopa, 5-S-CD). To determine whether chloroquine interacts with this activity, we measured the urinary excretion of the two metabolites in 16 patients with either systemic or discoid lupus erythematosus, polymorphic light eruption or rheumatoid arthritis, during a period with and without treatment with chloroquine phosphate. Two control groups consisting of 7 untreated patients and 10 healthy subjects were also included in the study. During medication, there was a significant increase in 5-S-CD excretion, while the excretion of 6H5MI-2-C was not significantly affected. No significant changes in the excretion of any of the two urinary markers were found in the untreated patients, while a non-significant increase in 5-S-CD excretion was seen in the healthy controls at the follow-up.

The effect of antiseptic solutions on microorganisms in venous leg ulcers

The effect on the microbial ulcer flora of wet gauze dressings soaked in antiseptic solutions used for desloughing leg ulcers is not known. Quantitative cultures were therefore performed in 45 venous leg ulcers, before application and after 15 minutes' treatment with gauze dressings with four different antiseptic solutions: aluminium acetotartrate (Alsol) 1%, potassium permanganate 0.015%, acetic acid 0.25% and chloramine 0.25%. The percentage of ulcers with each type of microorganism did not differ before and after application of the antiseptic solutions. Staphylococcus aureus was found in 79% of the ulcers, gram-negative rods in 39%, S. epidermidis in 21%, Proteus spp in 21%, Pseudomonas spp in 14% and fungi in none. Potassium permanganate reduced the mean number of bacteria per ulcer from 4.4 x 10(6) to 0.9 x 10(6) (ns), chloramine from 2.7 x 10(6) to 2.2 x 10(6) (ns), Alsol from 1.2 x 10(7) to 3.5 x 10(6) (ns) and acetic acid from 6.3 x 10(6) to 2.6 x 10(5) (p = 0.007). S. aureus was reduced by acetic acid (p = 0.002), gram-negative rods by both chloramine (p = 0.03) and acetic acid (p = 0.03). The number of Pseudomonas, Proteus, S. epidermidis and Streptococcus haemolyticus group G was not reduced significantly (p > 0.05) by any of the solutions.

Fusarium infection with unusual skin lesions in a patient with acute lymphocytic leukemia

A 27-year-old woman with acute lymphocytic leukemia developed red painful skin lesions, asymmetrically distributed over the face and extremities. They gradually increased in size and number, and in the center of each lesion blisters appeared followed by central necrosis with surrounding erythema. In several lesions the central necrosis was covered with a white powder shown to be fungal mycelium. Cultures from skin lesions and blood showed a Fusarium species. The skin lesions are helpful in recognizing this deep fungal infection in an immunocompromised host.

Oxidative activation of the propolis hapten isoprenyl caffeate

The reactions of isoprenyl caffeate, the strongest allergen known to be present in propolis, with plausible functional groups of proteins were studied. The thiols glutathione and cysteine, which add to isoprenyl caffeate after having been oxidised to the corresponding quinone, served as model substances. The structure of the thiol adducts was determined by spectroscopic methods, addition being found to occur at C-2. The results support the hypothesis that the catecholic propolis hapten is a pro-hapten that forms a complete antigen after oxidation to caffeate quinone and addition to nucleophilic groups of proteins.

The microbial flora in venous leg ulcers without clinical signs of infection. Repeated culture using a validated standardised microbiological technique

The change of ulcer size in relation to the presence of species and quantities of microorganisms was analysed in 58 patients with venous leg ulcers, all without clinical signs of infection. Microbiological samples were taken on the day of inclusion and then repeated 4 times at monthly intervals or until the ulcer had healed or was too small to be cultured from. There was growth of microorganisms in all ulcers, and the numbers were below 10(4) per mm2 of ulcer surface in all cases. No correlation was found between ulcer size change and the species and amounts of microorganisms. Sixty-nine species were isolated. Staphylococcus aureus was found in 88%, Enterococcus faecalis in 74%, Enterobacter cloacae and Peptococcus magnus in 29%, and fungi in 11% of the samples. One or more obligate anaerobe species was found in 41% of the samples and in half of the ulcers and constituted 62% of all bacterial species. The colonising ulcer flora was markedly constant over time in the individual ulcers regardless of change in size. Resident bacterial species were found in 57 of the 58 ulcers. If all samples were considered, the microorganisms were associated with not more than one fifth of the variability in healing rate, as shown by linear multiple regression analysis. The same species of microorganisms were found in ulcers that decreased (or healed) and in those that increased in size. Although an association between the microorganisms and ulcer healing could not be ruled out in this study, there seems to be no indication for routinely performed culture in the absence of clinical signs of infection in venous leg ulcers.

Optimal treatment of venous (stasis) ulcers in elderly patients

In elderly patients, even those with a typical venous (stasis) ulcer, coexisting conditions like peripheral arterial insufficiency and diabetes are very common. Therefore, all elderly patients with leg ulcers should have a complete medical assessment. The mainstay of treatment for venous ulcers is compression therapy, exercise and leg elevation at rest. Long term treatment with double bandages (zinc paste bandages and elastic compression), changed once weekly, is the recommended standard treatment in the elderly. Hydrocolloid dressings are also suitable for long term treatment in clean ulcers, and should be changed once or twice weekly and combined with compression. Sloughy, exudating ulcers might need redressing daily with a desloughing agent for a short period of time. The risk of sensitising patients with chronic leg ulcers is high and few topical preparations, with low antigenicity, should be used. Infection and ulcerated skin cancers should be ruled out in nonhealing ulcers if the patient complies with compression therapy. After healing, the patient should be advised to continue compression therapy with stockings to prevent recurrences. New noninvasive techniques for investigation of venous insufficiency can select patients suitable for venous surgery, but many elderly patients are not interested in surgery or have other ailments that prevent surgery.

Identification of a substance, previously shown to enhance mitogenesis of human lymphocytes, as the acetamide of p-aminobenzoic acid

We characterize here an arachidonic acid (AA)-derived metabolite previously found to have an adjuvant effect in phytohemagglutinin-induced mitogenesis of lymphocytes from mothers of newborn babies and from immunodeficient infants. We named the metabolite 'compound 4' due to its position in a thin-layer chromatography system developed for isolation of eicosanoids. The compound was originally found to be produced by peripheral blood mononuclear leukocytes and the T cell leukemia line Jurcat after long-term (18-24 h) incubation with [1-14C]AA. Compound 4 is also produced by lymphocytes, monocytes, platelets, thrombocytes, cultured fibroblasts and various types of malignant cell lines. We purified this metabolite by means of high pressure liquid chromatography with synchronous detection of radioactivity and measurement of ultraviolet-light absorption at 278 nm. Proton nuclear magnetic resonance spectroscopy and mass spectrometry with electron impact techniques demonstrated that compound 4 is not an eicosanoid, but is identical to p-acetamidobenzoic acid (PACBA). The cells synthesize PACBA from p-aminobenzoic acid and a two-carbon residue from AA.

Repeated treatment with lidocaine/prilocaine cream (EMLA) as a topical anaesthetic for the cleansing of venous leg ulcers. A controlled study

Repeated topical analgesia with EMLA 5% cream prior to the cleansing of venous leg ulcers was studied. Patients were randomly allocated to a series of 8 treatments with EMLA (n = 22) or to a control group (n = 21). A thick layer of the cream was applied to the ulcers for 30 min. At each of the 8 treatments, local reactions were assessed on a 4-point scale and pain from ulcer cleansing on a visual analogue scale. At the first and the last treatment the area of the ulcer was determined by mapping, a sample for a bacterial culture was taken and the amount of dead tissue, slough and granulation tissue present was assessed. Treatment with EMLA for 30 min significantly decreased the pain from cleansing of the leg ulcers and the frequency of post-cleansing pain. The analgesic effect remained unchanged with successive treatments. Repeated treatment with EMLA in leg ulcers would appear to be safe, as indicated by the absence of any serious untoward events. No statistically significant differences in local reactions or adverse effects on granulation tissue, ulcer area or bacterial flora were observed in the EMLA-treated patients compared with the control patients.

Leg and foot ulcer prevalence and investigation of the peripheral arterial and venous circulation in a randomised elderly population. An epidemiological survey and clinical investigation

Five thousand one hundred and forty questionnaires concerning leg ulcers were sent to a randomly selected population aged 65 years and older in Gothenburg in April 1989. The response rate was 89%. Ninety-seven individuals answered affirmatively, that they had leg ulcers, which corresponds to a prevalence of 2.15 +/- 0.42 per cent. These 97 individuals and the same number of controls were asked to come for a medical examination with tests of the peripheral circulation and an interview. Seventy-five (of the 97) were examined. Thirty-five had leg or foot ulcers caused by vascular insufficiency and/or diabetes and the true prevalence was estimated to be 1.02 +/- 0.29 per cent.

Occupational exposure to hexahydrophthalic anhydride: air analysis, percutaneous absorption, and biological monitoring

Urinary hexahydrophthalic acid (HHP acid) levels were determined in 20 workers occupationally exposed to hexahydrophthalic anhydride (HHPA) air levels of 11-220 micrograms/m3. The levels of HHP acid in urine increased rapidly during exposure and the decreases were also rapid after the end of exposure. The elimination half-time of HHP acid was 5 h, which was significantly longer than in experimentally exposed volunteers, possibly indicating distribution to more than one compartment. There was a close correlation between time-weighted average levels of HHPA in air and creatinine-adjusted levels of HHP acid in urine collected during the last 4 h of exposure (r = 0.90), indicating that determination of urinary HHP acid levels is suitable as a method for biological monitoring of HHPA exposure. An air level of 100 micrograms/m3 corresponded to a postshift urinary HHP acid level of ca. 900 nmol/mmol creatinine in subjects performing light work for 8 h. Percutaneous absorption of HHPA was studied by application of HHPA in petrolatum to the back skin of three volunteers. The excreted amounts of HHP acid in urine, as a fraction of the totally applied amount of HHPA, were within intervals of 1.4%-4.5%, 0.2%-1.3%, and 0%-0.4% respectively, indicating that the contribution from percutaneous absorption is of minor importance in a method for biological monitoring.

Stability of the mercaptobenzothiazole compounds

An analytical quantitative high-pressure liquid chromatography (HPLC) method was developed for simultaneous determination of all mercaptobenzothiazole derivatives in the mercapto mix patch testing standard. The stability of the mercaptobenzothiazoles constituting the mercapto mix was studied both in petrolatum and in buffer solution at pH 6.5, with and without glutathione. In petrolatum vehicle, dibenzothiazyl disulfide was the dominant compound found in stored mercapto mix. In buffer solution at pH 6.5, 2-mercaptobenzothiazole and the sulfenamide derivatives morpholinyl mercaptobenzothiazole and N-cyclohexyl-2-benzothiazyl sulfenamide were converted into dibenzothiazyl disulfide. In the presence of glutathione, both the sulfenamide derivatives and the dibenzothiazyl disulfide were rapidly converted into 2-mercaptobenzothiazole. The findings explain the "cross-sensitivities" reported for the mercaptobenzothiazole group as a result of chemical reactions resulting in one main hapten. The use of a single substance for patch testing for mercaptobenzothiazole hypersensitivity is proposed.