How I do it: Surgical management of maxillary sinus hemangiomas via prelacrimal approach

Hemangiomas are tumours originating from the vascular endothelium and can be found throughout the body. These are relatively common in the head and neck regions but very rarely seen in sinonasal region. In the nose and sinuses tumours typically are seen on the septum or lateral nasal wall (1-4). These tumours can be quite vascular and bleed during attempted resection. Incomplete resection does result in residual disease or recurrence so the best approach to achieve complete resection is important.

Interband cascade lasers with long lifetimes

Narrow-ridge interband cascade lasers were subjected to accelerated aging. The aging curves were statistically evaluated by a log-normal distribution of the failure time, and by the mixed effects of the degradation parameters. Based on 10,000 h of output power trend data for lasers operating at 90°C and the maximum cw power, an unexpectedly long lifetime is predicted. The projected lifetimes range from about 500,000 h (57 years) for the linear degradation model to 183,000 h (21 years) for the exponential one.

Integrated care pathways for airway diseases (AIRWAYS-ICPs)

The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. In the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers).

Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs

Allergic rhinitis (AR) and asthma represent global health problems for all age groups. Asthma and rhinitis frequently coexist in the same subjects. Allergic Rhinitis and its Impact on Asthma (ARIA) was initiated during a World Health Organization workshop in 1999 (published in 2001). ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. Patients, clinicians, and other health care professionals are confronted with various treatment choices for the management of AR. This contributes to considerable variation in clinical practice, and worldwide, patients, clinicians, and other health care professionals are faced with uncertainty about the relative merits and downsides of the various treatment options. In its 2010 Revision, ARIA developed clinical practice guidelines for the management of AR and asthma comorbidities based on the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. ARIA is disseminated and implemented in more than 50 countries of the world. Ten years after the publication of the ARIA World Health Organization workshop report, it is important to make a summary of its achievements and identify the still unmet clinical, research, and implementation needs to strengthen the 2011 European Union Priority on allergy and asthma in children.

Severe chronic allergic (and related) diseases: a uniform approach--a MeDALL--GA2LEN--ARIA position paper

Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.

Development and implementation of guidelines in allergic rhinitis – an ARIA-GA2LEN paper

The links between asthma and rhinitis are well characterized. The Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines stress the importance of these links and provide guidance for their prevention and treatment. Despite effective treatments being available, too few patients receive appropriate medical care for both diseases. Most patients with rhinitis and asthma consult primary care physicians and therefore these physicians are encouraged to understand and use ARIA guidelines. Patients should also be informed about these guidelines to raise their awareness of optimal care and increase control of the two related diseases. To apply these guidelines, clinicians and patients need to understand how and why the recommendations were made. The goal of the ARIA guidelines is to provide recommendations about the best management options for most patients in most situations. These recommendations should be based on the best available evidence. Making recommendations requires the assessment of the quality of available evidence, deciding on the balance between benefits and downsides, consideration of patients’ values and preferences, and, if applicable, resource implications. Guidelines must be updated as new management options become available or important new evidence emerges. Transparent reporting of guidelines facilitates understanding and acceptance, but implementation strategies need to be improved.

Cancer-Related Parental Beliefs: The Family Illness Beliefs Inventory (FIBI)

OBJECTIVE

The goal of this study was to develop a reliable and valid method for assessing the cancer-related beliefs of parents with a child in treatment for cancer.

METHOD

One hundred twenty-five families (119 mothers, 56 fathers) completed a measure of cancer-related beliefs written to reflect common themes associated with the diagnosis and treatment of childhood cancer. Participants also completed self-report questionnaires used for validation of the Family Illness Beliefs Inventory (FIBI).

RESULTS

Principal-components analysis was used to derive a 41-item five-factor solution from the maternal data--Factor 1: Treatment-Related Suffering; Factor 2: Death and Devastation; Factor 3: Caregiver Competence; Factor 4: Connection; and Factor 5: Finding Meaning. Correlations with validation measures supported the factor structure. Paternal data showed similar patterns.

CONCLUSIONS

The FIBI is a psychometrically sound method for identifying parental cancer-related beliefs. This measure may be helpful in developing and evaluating interventions to reduce parental distress related to childhood cancer and promote adaptive family functioning.

Suicide in mood disorders

A selective literature review was conducted to determine the link between mood disorders and suicide in children and adolescents. On-line searches of Medline and PubMed were performed and research articles from 1978 to 2001 were reviewed. Mood disorders are reported to be the most common psychiatric illnesses in children and adolescents who attempt or commit suicide. Reports suggest that depression co-morbid with any other psychiatric illness, externalizing disorders, or substance abuse further increases the risk for suicide completion. Mood disorders in children and adolescents are frequently underdiagnosed, misdiagnosed, and undertreated. Data suggest that very early identification combined with aggressive and sustained treatment of mood disorders in youth may actually lessen the risk for suicide.

Birthweight outcomes among Asian American and Pacific Islander subgroups in the United States

BACKGROUND

Information on birth outcome among the Asian and Pacific Islander populations in the US is limited. This report examines the risks of moderately low (MLBW) and very low birthweight (VLBW) among six Asian subgroups (Chinese, Japanese, Fillipinos, Asian Indians, Koreans, Vietnamese) and three Pacific Islander subgroups (Hawaiians, Guamanians, Samoans) as compared with non-Hispanic whites.

METHODS

Data from the 1992 US Natality File were used to calculate the percentage of MLBW and VLBW births among each Asian American and Pacific Islander subgroup. Logistic regression was used to calculate odds ratios (OR) after adjustment for maternal characteristics.

RESULTS

VLBW OR ranged from 0.75 among Chinese to 1.59 among Asian Indians. MLBW OR ranged from 0.89 among Samoans to 2.12 among Asian Indians. Adjusted OR increased for most Asian American groups (e.g. VLBW OR = 1.89 for Asian Indians) and decreased among Pacific Islander subgroups, indicating relatively favourable risk characteristics for Asian Americans and unfavourable characteristics for Pacific Islanders. Risk of VLBW was not necessarily related to risk of MLBW. For instance, the VLBW OR among Japanese was 1.07, compared to an MLBW OR of 1.47.

CONCLUSIONS

Marked heterogeneity in birthweight outcome was observed between Asian American and Pacific Islander subgroups. This heterogeneity was not related to traditional demographic risk factors. Additionally, risks of VLBW and MLBW were not always related. These findings suggests that the Asian American and Pacific Islander populations should not be aggregated into a single category, and that traditional measures of risk and birth outcome may not be valid for those groups.

Isolation of progesterone-dependent complementary deoxyribonucleic acid fragments from rhesus monkey endometrium by sequential subtractive hybridization and polymerase chain reaction amplification

The steroid sex hormone progesterone (P) induces the expression of a variety of genes through a signal transduction pathway mediated by the P receptor, a DNA-binding regulator of transcription. To identify genes and gene networks that are P dependent in the rhesus endometrium, we used a powerful technique employing subtractive hybridization coupled with polymerase chain reaction (PCR). Poly(A)+ RNA was isolated from both P-dominant (days 21-23 of artificial menstrual cycles) and estrogen (E)-dominant (days 9-13) endometrium. The two classes of RNA were converted to cDNA, ligated to EcoRI adaptors, and amplified by PCR using an adaptor-complimentary primer. E-dominant cDNA was labeled with biotin, hybridized in excess to P-dominant cDNA (PcDNA), and complexed with streptavidin. Labeled cross-hybrid sequences common to both populations were subtracted by phenol-chloroform extraction. The remaining cDNA fragments were amplified by PCR. After four rounds of hybridization/amplification, the subtracted PcDNA was analyzed for P-dependent sequences by semiquantitive PCR. Initial analysis revealed that housekeeping genes were undetectable in subtracted cDNA, but a previously characterized P-dependent gene was retained. Three of five clones sequenced at random from the subtracted library exhibited P-inducibility/dependency by PCR analysis of E and PcDNA. One of these, an 835-basepair fragment designated H5, may represent a novel P-dependent gene, as no comparable homology could be found with existing sequences in GenBank and Swissprot databases. We estimate that the procedure described here resulted in highly significant enrichment of up-regulated cDNA fragments from P-dominant tissue.