Hall technique versus conventional preformed metal crowns: can paediatric dentists tell the difference on radiographs?

PURPOSE

Hall technique (HT) preformed metal crowns (PMCs) are allegedly oversized compared to conventional (C) PMCs. To investigate paediatric dentists' (PDs) perception of HT-PMCs and perception/ability to identify HT or C-PMCs on bitewings radiographs.

METHODS

An online cross-sectional questionnaire including ten bitewings (five of each of HT/CPMCs) was sent to PDs across the globe. A PMC type score (from '10') was calculated. T test, Pearson's and Fischer's Chi-square, and Odd Ratios (OR) (p < 0.05).

RESULTS

A total of 476 PDs from around the world responded. Most (97%) used PMCs in their practice. Most (98.7%) knew of, and 79% used HT-PMCs. A clear opinion shift, towards supporting HT, over time was noted (OR 11.154 [95% confidence interval (CI) 6.006-20.715]. A majority (67%) thought that HT/C-PMCs were similar radiographically. Only five PMCs were identified correctly [mean score 4.9 (± 1.73)]. A minority who thought that HT/C-PMCs were dissimilar scored higher than those who thought they were similar (5.31 ± 1.22; 4.68 ± 1.9, respectively, p < 0.00001). Nobody identified all ten PMCs. HT-PMCs were 4.63 times more identifiable than C-PMCs [(OR 24.857 CI 15.059-41.028) and (OR 5.361 CI 3.089-9.304)] for HT-PMCs and CP-MCs, respectively (p < 0.0001).

CONCLUSIONS

PDs identified the PMC type in half of the bitewings. They perceived no clear radiographic difference between HT-PMCs and C-PMCs, but their chance of recognizing HT-PMCs was five times higher than C-PMCs. HT-PMC support was high.

Exclusive surgical approach for facial arteriovenous malformations in precarious conditions

Arteriovenous malformations (AVMs) are high-flow vascular lesions that does not regress spontaneously. They are located in the cranio-facial region in 50% of cases. Most of the time, the management of these lesions is a combination of surgery and vascular embolization. However, when the conditions are precarious, even without access to embolization, it's possible to treat some of those lesions with safety. We report four cases of patients suffering from cranio-facial AVM, treated exclusively by surgery during humanitarian missions.

Can treating rheumatoid arthritis with disease-modifying anti-rheumatic drugs at the window of opportunity with tight control strategy lead to long-term remission and medications free remission in real-world clinical practice? A cohort study

OBJECTIVE

The aim of this retrospective study is to compare the results of starting rheumatoid arthritis (RA) treatment with tight control strategy in the window of opportunity and later phases of the disease in real-world clinical practice.

METHODS

In this cohort, 609 RA patients were divided into three groups: (i) very early treatment (VET): ≤ 3 months; (ii) early treatment (ET): 3-12 months; and (iii) late treatment (LT) > 12 months after the onset of the disease. Four levels of remission were defined: (i) sustained remission on treatment, (ii) sustained glucocorticoids free remission, (iii) sustained disease-modifying anti-rheumatic drugs (DMARDs) free remission, and (iv) long-term remission. Outcome was assessed based on the number of patients in sustained or long-term remission and patients with poor joint outcome and systemic involvement.

RESULTS

There were no significant differences in the remission rate between the groups. Time to sustained remission in VET group was shorter than ET and LT groups. There were no significant differences in the rate and duration of prednisolone discontinuation in the studied groups. DMARDs were discontinued in VET, ET, and LT groups in 8.7%, 10.2%, and 7% of the patients, respectively. Poor joint outcome occurred in 33.2%, 50.5%, and 59.4% of the patients in the VET, ET, and LT groups, respectively. Remission induction in the first year of the treatment was associated with long-term remission in the VET, ET, and LT groups.

CONCLUSIONS

Medications free remission in RA is rare, and although treatment with DMARDs within 3 months of the onset of the disease can prevent joint damage, it cannot lead to long-term remission and discontinuation of medications.

KEY POINTS

• Medications free remission in rheumatoid arthritis is rare. • Treatment with DMARDs within 3 months of the onset of the disease can prevent joint damage, but it cannot lead to long-term remission and discontinuation of medications.

An unusual cause of Lemierre Syndrome

Lemierre syndrome is a rare, grave and life-threatening disease characterized by a septic thrombophlebitis of the internal jugular vein. Fusobacterium necrophorum is the most causative germ but sometimes others germs can be responsible. The authors report the first published case of Lemierre syndrome caused by a coinfection Levinea sp - Mycobacterium tuberculosis.

Brain weights in adult africans

Introduction: The average brain weight of adult humans, using Caucasian figures, is said to be between 1300g to 1400g. Few studies have however been done to make actual evaluations of brain weights in adult Africans. This study seeks to examine the weight of brains from people of African descent with respect to variations in sex and age in decades using autopsy specimens. Materials and Methods: Analysis of the weight of brains removed from both male and female adult patients during fresh autopsy of their bodies in our center over a ten year period was done. The study criteria required non-involvement of the central nervous system in the cause of death. The brains were grouped based on age in decades and further grouped into early, middle and late age groups. Descriptive statistical analysis was done using SPSS 20 statistics software. Results: A total of one hundred and sixteen brains were included in the study and the mean brain weight was 1280g with a range between 1015g to 1590g. There was no statistically significant difference in the mean brain weight of the different age groups. The average male brain was heavier than those of females and the difference was statistically signiicant. Conclusion: The brain weight of adult Africans in our study is similar to that seen in Caucasians. There is no statistically significant difference in the brain weight of adults from early adulthood to the elderly adults. Male adults have statistically heavier brains than the females.

[Researches' Institutional Framework in Three Sub-Saharan African Countries]

This paper presents the overview of the legal and institutional frameworks of research with human beings in sub-Saharan Africa, in particular in Benin, Cameroon and Nigeria. Concerning the methodology, a literature review focused on the regulations of institutional frameworks was done. Then, 28 semi-structured interviews were conducted with members of ethics committees to assess their composition and their mode of operation. Finally, we describe the existing courses in research ethics included in programs of first, second and third cycles in major universities from concerned countries.Concerning structures, all countries have normative and functional ethics committees concerned with the basics of ethics in health research. However, these ethics committees face several challenges including the lack of funding, deficiencies in the training of their members and the application of the ethical evaluation to qualitative and mixed researches.

[Pseudo-tumoral invasive fungus infection of the maxillary sinus in Abidjan]

INTRODUCTION

The invasive fungal infection of the maxillary sinus is a rare and serious disease generally favored by immunosuppression. We report an exceptional case of pseudotumoral invasive fungal infection of the maxillary sinus in an immunocompetent patient.

OBSERVATION

A 32-year-old patient consulted for labial and left temporal swelling associated with proptosis and chemosis that has been developing for 18 months. The scanner objectified a filling of the left maxillary sinus, and the ipsilateral orbital cavity, and the surrounding muscles. Histological examination of the surgical specimen revealed invasive fungal infection of the left maxillary sinus. The relevant antifungal therapy, namely voriconazole, could not be administered due to the unavailability of the medicine. However, the patient has received 200mg of itraconazole every 12hours for three weeks. The change proved disappointing with recurrence and significant sequelae, sort of sagging of the right hemifacial, severe limitation of mouth opening and functional loss of the right eye.

CONCLUSION

The invasive fungus infections of the maxillary sinus and the orbit are exceptional in immunocompetent patient. Healing is based on early diagnosis and administration of the reference antifungal to face the risk of recurrence.

Evaluation of immune response in challenged chickens vaccinated with Newcastle disease vaccine using gums from Cedrela odorata and Khaya senegalensis as delivery agents

Immune response of challenged chickens following previous vaccinations with Newcastle disease vaccine using gums from Cedrela odorata and Khaya senegalensis as delivery agent were evaluated. Two hundred and fifty-two one-day old chickens were divided into vaccine-gum oral (GVOR), vaccine-gum ocular (GVOC), vaccine oral (VOR), vaccine ocular (VOC), gum oral (GOR), gum ocular (GOC), No-gum-no-vaccine/challenged (NGNV/C), and No-gum-no-vaccine/unchallenged (NGNV/U) groups. They were vaccinated at days 21 & 42 and challenged at day 84. Trachea and intestinal washings were collected at intervals as well as weekly serum samples. These were analyzed using enzyme-linked immunosorbent assay (ELISA) and haemagglutination inhibition (HI) test for mucosal and systemic IgG response (MA and SA). Statistical analysis was done using Omnibus one-way ANOVA. MA and SA were not different (P > 0.05) post first and second vaccination although gum-vaccine groups were marginally higher post second vaccination. Post Infection (PI), there was an early and sustained spike in both MA and SA for the GV groups especially GVOR (P < 0.05). MA and SA for the Gum alone (especially GOR) groups also spiked PI (P < 0.05). Therefore, phytogenic polymers used could be said to possess immunopotentiating property with a possible induction of immunologic memory mechanism.

[Harlequin syndrome in a melanoderm patient]

INTRODUCTION

Harlequin's syndrome is a neurological disorder due to a dysfunction of the sympathetic innervation of the face. It has been rarely reported in the literature. The authors report one case occurring in a melanoderm patient.

OBSERVATION

A 38-year-old melanoderm man, without any history of surgery or neck trauma, consulted for a strictly right unilateral facial hyperhidrosis. Clinical and radiological investigations concluded to an idiopathic Harlequin's syndrome. Therapeutic abstention was proposed because of non-invalidating symptoms.

DISCUSSION

Harlequin's syndrome is a rare sudoral and vaso-motor disorder. On dark skin, flush and erythrosis may be subtle and the diagnosis less obvious. Etiologies are varied but essentially idiopathic. Its association with others dysautonomic facial syndromes is possible. Main differential diagnosis is the Frey's syndrome. Treatment is not clearly codified.

[A cervical necrotizing cellulitis revealing a Lemierre syndrome]

INTRODUCTION

Lemierre syndrome is characterized by a septic thrombophlebitis of the internal jugular vein (IJV) following an oropharyngeal infection.

CASE REPORT

We report a case of Lemierre syndrome that occurred in a context of angina and necrotizing cellulitis of the neck in a 45-year-old patient. The Doppler ultrasound exam of the neck vessels and a neck CT showed an IJV thrombophlebitis. No germ could be isolated in the samples (blood culture, pus). The treatment associated antibiotics, heparin and surgical debridement of the necrotic tissues with extraction of the thrombus after ligation and section of the IJV. The postoperative course was uneventful.

DISCUSSION

Lemierre syndrome is a rare but serious disease. Its low incidence makes him a forgotten disease. It should be systematically suspected in any oropharyngeal infection with the presence of a large painful swelling of the neck.

Neuroplasticity in response to cognitive behavior therapy for social anxiety disorder

Patients with anxiety disorders exhibit excessive neural reactivity in the amygdala, which can be normalized by effective treatment like cognitive behavior therapy (CBT). Mechanisms underlying the brain's adaptation to anxiolytic treatments are likely related both to structural plasticity and functional response alterations, but multimodal neuroimaging studies addressing structure-function interactions are currently missing. Here, we examined treatment-related changes in brain structure (gray matter (GM) volume) and function (blood-oxygen level dependent, BOLD response to self-referential criticism) in 26 participants with social anxiety disorder randomly assigned either to CBT or an attention bias modification control treatment. Also, 26 matched healthy controls were included. Significant time × treatment interactions were found in the amygdala with decreases both in GM volume (family-wise error (FWE) corrected P(FWE) = 0.02) and BOLD responsivity (P(FWE) = 0.01) after successful CBT. Before treatment, amygdala GM volume correlated positively with anticipatory speech anxiety (P(FWE)=0.04), and CBT-induced reduction of amygdala GM volume (pre-post) correlated positively with reduced anticipatory anxiety after treatment (P(FWE) ⩽ 0.05). In addition, we observed greater amygdala neural responsivity to self-referential criticism in socially anxious participants, as compared with controls (P(FWE) = 0.029), before but not after CBT. Further analysis indicated that diminished amygdala GM volume mediated the relationship between decreased neural responsivity and reduced social anxiety after treatment (P=0.007). Thus, our results suggest that improvement-related structural plasticity impacts neural responsiveness within the amygdala, which could be essential for achieving anxiety reduction with CBT.

[Sinonasal mucormycosis revealed by a necrotic velar ulceration]

INTRODUCTION

Mucormycosis is a deep mycosis which has been spreading out in recent years. It is still poorly understood and poorly described in sub-Saharan Africa. The authors report a case of sinonasal localization, of fatal evolution and late diagnosis in a young child.

OBSERVATION

It is about a 13-year-old child suffering from chronic rhinosinus syndrome for two years. He was observed in stomatology for a necrotic velar ulceration that have occurred for three months. The clinical, radiological and histological explorations were in favor of a sinonasal mucormycosis. The administration of amphotericin B and the surgical treatment did not slow down the fatal evolution.

CONCLUSION

Mucormycosis should not be dealt with any diagnostic error and no therapeutic improvisation. It has to be thought about when dealing with a rhinosinusal syndrome with cleft ulceration.

Diagnostic accuracy of tru-cut biopsy of breast lumps at University College Hospital, Ibadan

BACKGROUND

Tru-cut needle biopsies form an integral part of Triple assessment of breast cancer and include clinical assessment, mammography and core needle biopsy. No study has been done to evaluate the validity of the procedure in our environment. This study was done to evaluate the validity of core needle biopsies in our centre.

METHOD

A retrospective study of patients with tru-cut needle biopsies of breast lumps and follow-up excisional biopsy or mastectomy done in the Department of Surgery, University College Hospital, Ibadan over a ten year period was done. Fifty one patients who fulfilled the inclusion criteria had their records obtained from the Department of Pathology. The diagnosis was classified into benign and malignant with the excisional biopsy or mastectomy diagnosis used as the gold standard. The sensitivity, specificity and accuracy were calculated and kappa was also done to evaluate the degree of agreement.

RESULTS

A total of 51 cases were included in this study. The average age of the patients was 47 ± 13 years with a range from 19 to 81 years. Thirty of the biopsies (59%) had a definitive diagnosis of malignancy while twenty one (41%) were benign. The overall sensitivity, specificity and accuracy were 86%, 71% and 80.4% respectively. The specificity of malignant biopsies was 68% while benign was 35%. The level of agreement for malignant biopsies was higher than benign biopsies with a kappa of 0.39 for malignant diagnosis as against 0.29 for benign.

CONCLUSION

Tru-cut needle biopsies have a comparable sensitivity and specificity to excisional biopsies. Diagnostic accuracy can be further enhanced with the adoption of image guided biopsies.

[Post-dental extraction tetanus. About an observation]

The authors report a case of tetanus diagnosed in the aftermath of tooth extraction, in the absence of any other front door.

OBSERVATION

A patient showed a persistent trismus several days after the extraction of tooth 38 performed at the dental office. The diffusion of tension and the appearance of paroxysms allowed the diagnosis of tetanus.

DISCUSSION

The possibility of occurrence of tetanus after a tooth extraction should be kept in mind before a persistent trismus with rapid expansion in the neck and limbs. The dentist should be aware of the symptoms of tetanus to refer the patient to a specialized department.

Correlation of intraoperative cytological and final histological diagnoses: a retrospective 10-year study of neurosurgical cases from Ibadan, Nigeria

OBJECTIVE

Intraoperative cytology is a cost-effective, rapid, and easy technique, and studies have shown good correlation between intraoperative cytology and histology. We undertook this study to compare the intraoperative cytology diagnoses of brain lesions made in our unit over a 10-year period with the definitive histological diagnoses. The aim was to determine the degree of accuracy of this procedure.

STUDY DESIGN

This is a retrospective study of intraoperative neuropathology consultation cytology smears or imprints and histology of 69 cases obtained over a 10-year period. Cytology smears were stained using both Papanicolaou and Giemsa. Histology sections were prepared from routine formalin-fixed paraffin-embedded tissue and stained using H and E method. Each of the smears and histology samples were assessed by at least two pathologists. Cytological diagnosis was correlated with final histological diagnosis. The sensitivity and specificity of cytological diagnosis was evaluated using final histological diagnosis as gold standard.

RESULTS

Correlation was strongest with inflammatory lesions followed by low-grade neoplasms. High-grade neoplasms also showed good concordance, but the degree of correlation was lower than in the other categories. Misdiagnosis was commonest with benign tumors.

CONCLUSION

Intraoperative cytology is a relatively simple, reliable, and accurate diagnostic technique and should be more commonly used, particularly in low-resource settings.

Role(s) of formyl-peptide receptors expressed in nasal epithelial cells

Chronic rhinosinusitis is one of the most frequent chronic diseases in humans. Little is known about stimuli initiating tissue remodeling process that determines the morphological expression of the disease. N-formyl peptide receptors (FPRs) are innate immunity receptors important in tissue remodeling of gastric and intestinal epithelium. The expression and functions of FPRs in nasal epithelial cells were examined to evaluate whether they could be important in the remodeling of nasal mucosa. The aim of this study is to examine FPR expression in a nasal epithelial cell line (RPMI-2650) at mRNA and protein levels. To determine whether FPRs were functional, chemotaxis experiments were carried out. In addition the effects of FPRs agonists on the expression (PCR and ELISA) of VEGF-A and TGF-beta, two key mediators of tissue remodelling, were examined. Here we demonstrate that RPMI-2650 express FPR and FPRL2, but not FPRL1. fMLP, a bacterial product active on FPR, and uPAR(84-95), an inflammatory mediator agonist for FPRL2, stimulated migration of nasal epithelial cells. fMLP and uPAR(84-95) induce expression and secretion of VEGF-A and TGF-beta. Our results suggest a possible mechanisms initiating tissue remodeling observed during chronic rhinosinusitis. This study provides further evidence that FPRs play a more complex role in human pathophysiology than bacterial recognition.

Induction chemotherapy in head and neck cancer patients followed by concomitant docetaxel-based radiochemotherapy

Concurrent chemoradiotherapy has become the standard of care for patients with inoperable squamous cell head and neck carcinoma. More recently, induction chemotherapy has been adopted as an approach in the management of these patients. We report the results of a phase II trial associating induction chemotherapy and concomitant chemoradiotherapy in a series of patients with inoperable squamous cell head and neck cancer. Twenty-nine patients with advanced squamous cell carcinoma ineligible for surgery were enrolled. Induction chemotherapy with docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2) every 21 days was administered for two cycles. Radiotherapy followed the induction phase. During radiotherapy, docetaxel was administered weekly at the dose of 33 mg/m(2) . Primary end point of the study was feasibility of treatment. Six (18%) patients failed to conclude the treatment schedule. Although response rates in evaluable patients were very high (disease control rate >90%), toxicities were a matter of concern. The reported treatment schedule proved infeasible. However, some modifications in ancillary therapies aimed at exploiting its efficacy could make it practicable.

Screening platelet concentrates for bacterial contamination: low numbers of bacteria and slow growth in contaminated units mandate an alternative approach to product safety

BACKGROUND AND OBJECTIVES

We introduced 100% screening of platelets for bacterial contamination in 2005 to reduce the risk of clinical sepsis from platelet transfusion. We test all outdating units again at expiry to assess the sensitivity of the initial test.

MATERIALS AND METHODS

We test all platelet concentrates prior to release for clinical use using a large volume automated culture technique on the day after manufacture. All units that expire unused are retested. Platelets still in stock on day 4 of storage may have a repeat culture performed, and are returned to stock with two extra days of shelf life.

RESULTS

Of 43,230 platelet units screened, 35 (0.08%) were positive; of 8282 expired unused, 18 (0.22%) were positive; and of 3310 day-4 retests, four (0.12%) were positive. Overall sensitivity of the initial screening test was 29.2% (95% confidence interval 19.4 to 39.1%). Thirteen of the 35 positive screening tests would have been expected to grow in both aerobic and anaerobic bottles; eight grew in aerobic culture only and five grew in anaerobic culture only, indicating that the likely number of bacteria in the contaminated platelet units at the time of sampling was less than 60 colony-forming unit per platelet unit.

CONCLUSIONS

Screening platelet concentrates for bacterial contamination using the most sensitive method available has a sensitivity of less than 40% because of the low numbers of bacteria in the initial contamination. Effective resolution of this problem will require a pathogen-inactivation technique.

Static and dynamic posturography in patients with asymptomatic HIV-1 infection and AIDS

Alterations of the vestibulo-ocular reflex, optokinetic nystagmus, and visuo-vestibular-ocular reflex, have already been described in patients with AIDS and HIV-1 positive asymptomatic subjects. The introduction to the clinical practice of posturographic techniques allows us to study, with precision, postural perturbation that may be present when performing Romberg's test and to study the vestibulo-spinal reflex as a component of the vestibular system. The relative lack of studies on posturography and AIDS, encouraged us to continue our research on the vestibular system both in asymptomatic HIV-1 seropositive patients and in patients with AIDS (IV stage according to the classification proposed by the Centre for Disease Control). Recordings were made in group 1 (control group, 55 normal subjects), in group 2 (15 asymptomatic HIV-positive subjects), and in group 3 (15 patients with AIDS stage IV). Static and dynamic posturography were carried out using Tonnies platform system (Tonnies GmbH & Co., Wurzburg, Germany) and the data were analysed with Tonnies Posturographic Tübingen (TPOST) software vers. 5.19. In asymptomatic HIV+ subjects, we observed an increase in RW, RA and M3 reflex latency. AIDS patients (stage IV) exhibited significant alterations in almost all the posturographic parameters and the electromyographic potentials. Our results validate static and dynamic posturography as a method for otoneurological investigation and appear to confirm that the entire vestibular system is involved since the earliest stages of the HIV infection. In the HIV+ subjects, a variable dysfunction in the reflex control to long latency was observed, which is correlated with the alteration of the central dopaminergic system; in AIDS patients, the central nervous system damage appears more important, globally distributed and correlated also with immunosuppression.

Concurrent radio-chemotherapy with docetaxel and cisplatinum in inoperable or relapsed head and neck cancer

Usually head and neck cancer is treated with combined therapy, applying surgery, if possible, and then radiotherapy and chemotherapy in a sequential or concomitant way. Sequential approach seems to be preferred, because of the high toxicity rate of concomitant therapy. Platinum compounds and 5-fluorouracil are the standard drugs, but new drugs are entering therapeutic arena: gemcitabine and taxanes are the most promising ones. The efficacy of these drugs, especially in association with radiotherapy, must be assessed; moreover it is essential to ascertain how to associate these drugs to radiotherapy and to evaluate drug toxicity when combined with the latter. End point of the study here presented is a preliminar assessment of toxicity and feasibility of concurrent radio-chemoterapy with docetaxel and cisplatinum in patients with head and neck cancer. The number of enrolled patients and the relatively short time of follow up do not allow to evaluate treatment efficacy.

OSAS in children

BACKGROUND

Major risk factors for obstructive sleep apnea syndrome (OSAS) in children include adenotonsillar hypertrophy, neuromuscular disease and syndromes such as Down's or Pierre-Robin's syndrome; there is currently no consensus concerning diagnosis and therapy.

METHODS

The study analyses 40 children, aged 2 through 14 years, with macroscopic tonsillar hypertrophy (without recurrent tonsillitis but with OSAS) underwent adenotonsillectomy. Parents were invited to indicate the intensity of their children's symptomatology using a subjective evaluation scale, each patient underwent cephalometric analysis and polysomnography (PSG) before and after surgery.

RESULTS

The subjective scale of symptoms passed from 3.01 before treatment to 0.42 after treatment, rhinomanometry, passed from 3.456 to 0.896 p after 1 month the surgical operation (P<0.05). The polysomnography showed a resolution of the number of obstructive events in 37 patients and a reduction in 3 patients and RDI index fell from a mean of 26.9-2.6 after therapy. The average of oxygen saturation changed from 79% before treatment to 95% after therapy.

CONCLUSIONS

Adenotonsillectomy plays a major role in the treatment of OSAS.

High frequency surgery in the treatment of turbinate hypertrophy: 11 years' experience

For over a century, surgical management of lower turbinate hypertrophy has given rise to much discussion. Aim of the present investigation was to establish, by means of the analysis of a large patient population, the efficacy and reproducibility of high frequency surgery in the treatment of this condition. A total of 1689 non-allergic patients with nasal obstruction, presenting hypertrophy of the lower turbinates, were submitted, under local anaesthesia, to turbinates decongestion using a high frequency instrumental unit with a bipolar terminal electrode. Efficacy of the procedure was evaluated on the basis of objective examination, results of questionnaires, active anterior rhinomanometry and mucociliar transport time. Results revealed a reduction of hypertrophy, an improvement in symptoms, a reduction in nasal resistances and an improvement of mucociliar transport time. The large patient population, low post-operative complication rate and the good patient compliance, due also to the fact that no haemostatic procedure is necessary, would suggest that this method is particularly valid, effective and safe for the treatment of hypertrophy of the lower turbinates.

[Behavior of serum IgE and IgA in patients with allergic rhinitis treated with iodine bromide thermal water]

The aim of this study was to test the effects of the iodine bromide water of the thermal baths of Salsomaggiore on patients suffering from specific nonseasonal rhinitis (Dermatophagoides Farinae and Dermatophagoides Pteronyssinus). The patients, 80 in all, were divided in two groups (group A and group B). All of the patients underwent rhinoscopic examination, anterior rhinomanometry, prick test, rast screening, total IgE assay together with that of the other immunoglobulins (IgA, IgM, IgG), mucociliary clearance evaluation and were asked to evaluate their degree of nasal obstruction, before and after 30 days of treatment. Group A carried out the experiment by applying endonasal Acqua Sal spray seven times a day for 30 days; group B used oily drops for the same time and with the same frequency. At the end of the trial period, the patients in group A showed a 100% improvement in their subjective perception of their symptomatology, in comparison with a 33% improvement in the control group. A characteristic decrease in the IgE and increase in the IgA was observed in the serum of the patients who had been treated with Acqua Sal spray. Iodine bromide water has a general and local anti-inflammatory effect, which is also due to the activation of the corticosurrenal system (with a relative increase in cortisol). The cleansing action of hypertonic water in the nasal cavities must also be cited, as it minimizes contact between the mucosa and allergens.

[Allergic rhinitis: evaluation of prick test positivity for German and American cockroaches (Blatella Germanica, Periplaneta Americana)]

Allergies are a widespread phenomenon and one that is in continuous expansion, especially in large cities. A heretofore underestimated allergen, at least in Italy, is the cockroach. Between April and June 2000, we administered a prick test (including the cockroach antigen in the allergen kit) to 163 patients. The prick test was executed utilizing histamine as the positive control and a normal diluent as the negative control; both indoor allergens (including dermatophagoids and dog and cat epithelium) and outdoor allergens (including trees, grasses, pollens and spores) were employed. The results obtained were evaluated by comparing the reaction provoked by these allergens to that of the histamine. About 20% of the patients who reacted to the other indoor allergens also tested positive to the cockroach antigen. Also on the basis of experiences previously carried out in other countries (United States, Korea, Japan, Turkey), the cockroach must be borne in mind as a possible significant cause of allergic reactions in Italy, too.

[Study of click-induced vestibule-sternocleidomastoid reflex recorded with surface electromyography]

The otolithic organs serve to control posture and maintain the visual objective during linear accelerations. Recent experimental research in man and animals has suggested that it may be possible to explore the function of these organs by studying the vestibule-sternocleidomastoid reflex induced by high intensity clicks. The aim of the present work was to identify the parameters which are most reproducible in normal subjects and, therefore, best suited to this purpose. The instrument normally used to study evoked auditory potentials (ERA) was used to perform an electromyographic recording at the surface of the sternocleidomastoid muscle (SCM) and then average the electromyographic response to short clicks (0.1 ms) introduced through the headphones. In normal subjects clicks at an intensity of 85-100 dB HL evoked a reproducible electromyographic response in the venter of the SCM muscle with an average latency of 8.75 ms. The latency parameter proved to present the most suitable characteristics for possible clinical use. The possibility of using this method to study human vestibular lesions is certainly enticing although further research is needed to better characterize the precise site of origin for the vestibule-sternocleidomastoid reflex.

Inhibition of eosinophil transepithelial migration and downregulation of adhesion molecule expression on eosinophils and airway epithelial cells induced by budesonide

In asthma, eosinophil migration through the bronchial mucosa is mediated by the expression of surface molecules on eosinophils and airway epithelial cells. To characterize the activity of budesonide on eosinophil transepithelial migration, blood eosinophils were isolated from atopic asthmatic subjects and human bronchial epithelial cells (HBECs) from surgically resected bronchi. In the presence of different concentrations of budesonide (0.1-100 nM), we tested: a) eosinophil migration induced by C5a through HBEC monolayers; b) ICAM-1 expression on HBECs, stimulated with C5a and c) LFA-1 and Mac-1 expression on eosinophils, stimulated with C5a or with ah-CD23 mabs plus GM-CSF. Eosinophils showed a remarkable chemotactic response to C5a (P<0.001), that was effectively down-regulated by the presence in the chemotactic chambers of budesonide at all the concentrations tested (P<0.05). A weaker, but still present, inhibitory activity on cell locomotion was observed when HBECs or eosinophils were preincubated with budesonide before the chemotaxis assay, which was performed in absence of the drug. Preincubation of the cells with different concentrations of budesonide was also effective in down-regulating the C5a-induced ICAM-1 expression on HBECs and the ah-CD23 and GM-CSF-induced LFA-1 and Mac-1 expression on eosinophils. Thus, budesonide-induced down-regulation of eosinophil migration through airway epithelial cells is associated with, and possibly partially dependent on inhibition of adhesion molecule expression on both cell types.

[Mid-latency auditory evoked responses in Alzheimer's disease: evaluation of P1 and P3 waves]

A great deal of research has revealed a frequent association between hearing impairment and Alzheimer's disease. Many of these studies have, however, been criticized for the lack of statistical significance, for the methodology used and for doubts regarding the diagnostic criteria used. The lack of uniform results prompted the present research. On the basis of some works in the literature, the authors felt that the study of middle and long-latency auditory evoked potentials, and their expression characterized by the P1 and P3 waves, the appropriate instrument for exploring the cortical and subcortical tracts of the auditory system which are most compromised in Alzheimer's disease. In fact, numerous studies have suggested that wave P1 is generated by peduncle-pontine nucleus cells of the tegmentum and that wave P3 is generated by sites located in the temporal lobes and hippocampus. The present study was conducted on 15 subjects suffering from Alzheimer's disease and 15 controls. Four subjects were excluded from the study because they were affected by Alzheimer's disease with severe dementia and were, thus, unable to cooperate. The 15 controls underwent accurate clinical and instrumental evaluation to rule out any neurological and intellectual disorders. The results for wave P1 show a statistically significant difference between the subjects affected by Alzheimer's disease and the controls. In fact, there was a difference in the presence of this potential. Moreover there was a statistically significant difference in P1 between those patients with average dementia and the controls but not between those with slight dementia and the controls. Finally, comparison of the abnormalities in P1 potential and P3 latency showed that in Alzheimer's disease alterations in P3 arise earlier and are more constant than alterations in P1. The physiopathological meaning of these results is discussed.

Characterization of variables defining hindpaw withdrawal latency evoked by radiant thermal stimuli

We have examined the stability and sources of variation within the nociceptive model of rat hind paw withdrawal from an under-glass radiant stimulus (Hargreaves et al., 1988) using a system where stimulus intensity and floor temperature can be controlled and reproducibly changed. The current study demonstrates that: (i) increased stimulus intensity with a fixed surface temperature is associated with a monotonic decrease in mean response latency and its variance; (ii) for a fixed stimulus intensity, the mean paw withdrawal latency and variance increased as the glass floor temperature is lowered from 30 degrees C to room temperature (25 degrees C). Using subcutaneously-implanted thermocouples and a 30 degrees C glass surface, the subcutaneous paw temperature observed at an interval corresponding to the time at which the animal displayed a paw withdrawal did not differ across multiple heating rates (41-42.5 degrees C). This finding is in agreement with human studies of pain thresholds and C-fiber activity. These studies emphasize the importance of maintaining a fixed surface temperature to reduce experimental variability and the utility of this apparatus across multiple stimulus intensities to define agonist efficacy.

[Optokinetic nystagmus and visual-vestibular interaction in subjects with "whiplash injuries"]

We studied the behaviour of Vestibular Nystagmus (VOR), of Optokinetic Nystagmus (OKN) and of Visuo-Vestibular-Ocular-Reflex (VVOR) in seven normal subjects and in thirty-two patients who had undergone cervical trauma in an automobile accident with the so called "whiplash mechanism". Thirteen subjects underwent examination within the first three months after the accident (first group), six subjects between the third and the sixth months (third group). Ocular movements was recorded according to the usual method by means of a Tonnies electronystagmograph with eight channels. The subjects, head blocked, sat on a Tonnies rotatory chair Pro model which was placed in the middle of a rotatory cylindrical chamber 2 metres in diameter and 1.9 metres in height. The width internal area was covered with thirty-two black vertical contrast. The rotatory cylinder was lighted from above by a 100 W bulb and was driven by a direct current engine which turned it clockwise and counterclockwise up to 200 degrees/sec., maximum speed, with preset acceleration ranging from 1 degree to 2 degrees/sec. All the subjects underwent to Rotatory Vestibular Stimulation by Stop test from a constant angular velocity of 90 degrees/sec. with clockwise and counterclockwise rotation, "stare type" Optokinetic stimulation with a cylinder rotation velocity of 30 degrees/sec. for 60 seconds and to contemporary Rotatory Vestibular and Optokinetic Stimulation (VVOR) so that OKN was VOR counterdirectional. The results of our experience show a statistically significative mean gain decrease of VOR and VVOR nystagmus (beating OKN direction) calculated on the first three beats in the patients of the first group and a significative increase of OKN mean gain in all the patients of the three groups. Furthermore, in sixteen out of thirty-two patients (seven in the first group, two in the second and seven in the third) we observed (during VVOR examination, immediately after stop) a nystagmus beating VOR direction lasting from 3 to 15 seconds.

Kinetics of analgesic response in man; an example with two non-steroidal anti-inflammatory analgesic drugs

A double-blind, controlled trial is described in which a total of forty hospital in-patients suffering from severe post-operative pain were randomly allocated to treatment with one of two non-steroidal anti-inflammatory drugs, namely, either indoprofen which has a short half-life (two-hours) or naproxen which has a long half-life (thirteen hours). The drugs were administered orally on a single-dose basis. The doses used in this way were 300 mg of indoprofen or 250 mg of naproxen. Patients scored the severity of their pain on a five-point scale and these scores were recorded prior to and at fixed time intervals up to eight hours following administration of medication. No significant differences emerged between the two test drugs and the duration of the response was also found to be similar for the two compounds despite their very different plasma half-life values.