537 Oro-Nasal Fistula: A Very Rare Complication Following Routine Palatal Biopsy

Biopsies of the palate are generally well-tolerated with known complications of pain, bleeding, or infection, that can usually be well-controlled. We report a case of a 63-year-old male who developed a rare complication following a biopsy of an ulcer on the junction between hard and soft palate. Despite an uneventful routine biopsy, the patient presented with an oro-nasal fistula and complaints of nasal discharge. The cause of the fistula was unclear, and the histopathology results excluded malignancy. The possible hypotheses considered for this very rare and unusual complication were infection, vascularity, and underlying systemic co-morbidities. We believe in this case that the cause of wound breakdown was secondary to loss of vascularity of the mucosa from his CPAP device. The patient has since been referred to a tertiary unit for consideration of surgical repair. To the author's knowledge, there are no similar published reports of such complications following routine palatal biopsy.

The diabetes community exercise programme plus usual care versus usual care in patients with type 2 diabetes: A randomised, two-arm, parallel, open-label trial

BACKGROUND

Exercise is important in type 2 diabetes (T2D) management. Focussing on Māori and Pacific people and those from deprived circumstances, the Diabetes Community Exercise Programme (DCEP) was developed to engage people with T2D in exercise. We report the evaluation of whether being offered DCEP (plus usual care) was more effective than usual care in improving glycaemic control at 1-year.

METHODS

A randomised, two-arm, parallel, open-label trial with blinding of outcome assessor and data analyst. Adults (age ≥35 years) with T2D recruited from two New Zealand (NZ) communities were randomised, using opaque sealed envelopes and stratified by centre with random block lengths, to DCEP or usual care. DCEP comprises twice-weekly, two-hour sessions of exercise and education over 12-weeks, followed by a twice-weekly maintenance exercise class. The primary outcome was between-group differences in mean changes of glycated haemoglobin (HbA1c) from baseline to 1-year follow-up with intention-to treat analysis. This trial is registered with the Australian NZ Clinical Trials Registry (ANZCTR): ACTRN12617001624370p and is closed to new participants.

FINDINGS

From 2018 - 2019, of 294 people screened, 165 (mean age 63·8, SD16·2 years, 56% female, 78·5% European, 14% Māori, 6% Pacific, 27% most deprived) were baseline evaluated, randomised, and analysed at study end (DCEP = 83, control = 82). Multimorbidity (≥2) and polypharmacy (>5 medications) were high (82%, 69%). We found no statistically significant between-groups differences in HbA1c (mmol/mol) change at 15 months (mean 3% higher in DCEP, 95% CI 2% lower to 8% higher, p = 0·23). Twelve-week intervention adherence was good (41% attended >80% available sessions). No adverse events were reported.

INTERPRETATION

DCEP was not effective in improving glycaemic control, possibly due to insufficient exercise intensity. Our attendance demonstrated DCEP's cultural accessibility. DCEP might be good to engage in exercise marginalised people with high Hb1Ac levels, multimorbidity, and high polypharmacy.

FUNDING

Health Research Council of New Zealand.

Tissue quantification of radioiodine thyroid uptake in humans by an isotopic imaging technique on slides

BACKGROUND

Thyroid metabolism involves iodine, which allows us to use radioactive iodine for diagnostic and therapy purposes. The efficiency of radioiodine therapy depends on several parameters; the ability of thyroid tissue to uptake radioactive iodine is one of them.

OBJECTIVE

The objective of this work is to quantify the radioactive iodine uptake on thyroid tissue.

METHODS

In this work, we developed a method to quantify the in vivo uptake of iodine-131 on sections of thyroid glands removed by thyroidectomies. We performed an analysis of histological sections of the thyroid tissue by beta imaging. We had the opportunity to quantify the fixed radioactivity and to analyze its distribution in the thyroid gland, thanks to the good spatial resolution available with the type of detector used.

RESULTS

The results gave a high image resolution showing the heterogeneity of iodine-131 fixation by the thyroid tissue. We were able to quantify the tissue radioactivity in mega Becquerel (MBq) per volume unit.

CONCLUSION

This work has shown that the direct quantification of the thyroid tissue uptake is possible using the beta imaging system.

Use of Laser Doppler Flowmetry and Transcutaneous Oxygen Tension Electrodes to Assess Local Autonomic Dysfunction in Patients with Frozen Shoulder

The laser Doppler flowmeter (LDF), which measures changes in cutaneous blood flow, and the transcutaneous oxygen electrode which measures cutaneous perfusion, were used to study reflex changes in the microcirculation of the shoulder in 38 patients with frozen shoulder and 10 normal controls. In all controls and 22 patients with frozen shoulder, a normal LDF response to inspiration/expiration was observed. In 16 patients with frozen shoulder, LDF responses were either unilaterally or bilaterally absent. Comparison between the two patient groups showed a significant association (chi 2 = 6.43, P less than 0.02) between abnormality of response and the persistence of pain. TcPO2 was in the normal range in all patients and controls. These findings suggest that the LDF together with the TcPO2 may be a useful method of studying the skin microcirculation over the shoulder.

Tissue Oxygenation, Venous Ulcers and Fibrin Cuffs

Skin oxygen tension (TcPo2) was measured at 43°C on patients (n=27) with venous ulcers. Measurements were made at ulcer edge and, proximally on the same limb for control. Similar measurements were also made on healthy volunteers (n=14) in the medial aspects of the distal third of the legs. TcPo2 at ulcer edge was significantly lower (P=0.001) than control values which in turn were lower than that measured on healthy volunteers. TcPo2 reflects skin nutrition. While low TcPo2 at ulcer edges might be the result of pericapillary barriers to oxygen transport, the control values measured on apparently normal skin suggest the need for further studies.

A rare case of bullhorn-injury associated traumatic hernia of anterior abdominal wall managed by laparoscopic sutured tissue-only repair

Traumatic abdominal wall hernias (TAWHs) are relatively uncommon entities. Common mechanisms that predispose to such hernias include motor vehicle accidents, seat belt injuries, fall from height, handlebar injuries, and bullfighting. Bullhorn injury leading to TAWHs is an uncommon mechanism. We report here one such patient who was managed by laparoscopic transperitoneal anatomical repair of the defect using polypropylene suture. The patient recovered well without any complication and is being followed up. Such small defects can be managed laparoscopically and tissue-only repair using a nonabsorbable suture is a feasible option. Our case is the first reported case of bullhorn-injury associated traumatic hernia managed laparoscopically and first reported case of TAWH in an adult which was managed by laparoscopic sutured tissue-only repair.

Low-level laser therapy does not aid the management of tennis elbow

The value of low-level laser therapy (LLLT) as a therapy for painful tennis elbow is dubious since evidence for its efficacy is conflicting. This report presents the results of a randomized, double-blind, controlled study on patients with tennis elbow (n = 29) using a gallium aluminium arsenide laser. Two different methods of assessing pain, visual analogue scores and a Marcy Wedge Pro® exerciser, were used. No significant differences were found between the treatment and placebo groups. This suggests that LLLT at the dosage and duratiion used in this study is without benefit in the short-term management of painful tennis elbow.

Randomized controlled study of ultrasound therapy in the management of acute lateral ligament sprains of the ankle joint

Objective: To determine the efficacy of a fixed dose of ultrasound energy to treat acute lateral ligament sprains of the ankle joint.

Study design: Double-blind randomised controlled trial.

Setting: Accident and Emergency department of University Teaching Hospital.

Subjects: Patients presenting at Accident and Emergency with ankle injuries.

Intervention: Ultrasound or placebo, and Tubigrip.

Outcome measures: Pain measured with visual analogue scales, swelling using a tape measure, range of movement using a fluid-filled goniometer, and weight bearing using two scales simultaneously.

Results: Patients in both groups improved symptomatically. There were no statistically significant differences between groups in any outcome measure. Within groups, statistically significant differences were detected in pain perceived, and range of movement (dorsiflexion).

Conclusion: At the dose and duration used, ultrasound therapy is no better than placebo in the management of lateral ligament injuries.

Changes in Skin Microcirculation at Periulcerous Sites in Patients with Chronic Venous Ulcers during Leg Elevation

Objective:

To investigate the effect of limb elevation on the microcirculation of the skin in patients with venous ulceration of the leg.

Design:

Prospective study in patients receiving in patient treatment for venous ulceration.

Setting:

Health Service teaching hospital.

Patients:

Thirteen patients with venous ulceration of the lower limb for more than two years were investigated.

Interventions:

Patients were admitted to hospital and treated by bedrest with elevation of the lower limbs by 10° above the horizontal.

Main outcome measures:

Laser Doppler fluximetry and transcutaneous oximetry of the skin surrounding the venous ulcers was undertaken.

Results:

The laser Doppler fluximetry in the periculcerous region increased by 10.8 A.U. (95% CI 17 to 4.54). However, the transcutaneous oxygen measurements did not change during the period of treatment.

Conclusions:

Admission to hospital with elevation of the limb for patients with venous ulceration results in ***microcirculatory changes which are probably attributable to reduction in lower limb oedema.

How to Measure Changes in Oedema in Patients with Chronic Venous Ulcers?

objective:

To assess changes in limb volume and oedema in Patients admitted to hospital for treatment of venous ulceration.

Design:

Prospective study in thirteen patients.

Setting:

Health Service teaching hospital.

Patients:

Thirteen patients with venous ulceration for 2 years.

Interventions:

Patients were admitted to hospital for bed-rest and lower limb elevation for a period of 24 hours

Main outcome measures:

Limb volume was measured by water displacement and impedance plethysmography.

Results:

During limb elevation there was a mean reduction limb volume of 524 mls (95% CI 377–671 mls) after 24 hours of bedrest. This corresponded with a reduction in impedance measured by the impedance plethysmograph of 19–0 ohms (95% CI 24.3 to 15.6 ohms).

Conclusion:

Measurement of the lower limb volume by water displacement and by impedance plethysmography are likely to be useful methods in the investigation of Patients with chronic venous insufficiency.

Non-immunosuppressive FTY720-derivative OSU-2S mediates reactive oxygen species-mediated cytotoxicity in canine B-cell lymphoma

OSU-2S is a FTY720 (Fingolimod) derivative that lacks immunosuppressive properties but exhibits strong anti-tumour activity in several haematological and solid tumour models. We have recently shown OSU-2S to mediate potent cytotoxicity in human mantle cell lymphoma cell lines and primary cells. We report here the pre-clinical activity of OSU-2S in spontaneous B-cell lymphoma of dogs which shares many characteristics of human lymphoma. OSU-2S mediated apoptosis in canine B-cell lines and primary B-cell lymphoma cells obtained from spontaneous lymphoma bearing dogs. OSU-2S induced reactive oxygen species (ROS) in canine lymphoma cells and inhibition of ROS partially rescued OSU-2S-mediated cell death. These studies provide a rational basis for the use of spontaneous lymphoma in pet dogs as a preclinical large animal model for the development of OSU-2S as small molecule for treating people and dogs with lymphoma.

Immunoglobulin G4 related tubulointerstitial nephritis

Tubulointerstitial nephritis is an uncommon manifestation of IgG4 related disease. A case of tubulointerstitial nephritis with special features including isolated renal involvement in this multisystem disorder and the absence of response to steroid therapy in a young male is reported here. There was no nephromegaly, eosinophilia or other organ involvement. The importance of early detection and treatment for preservation of kidney function is highlighted.

Immunoexpression of vascular endothelial growth factor and Ki-67 in human gingival samples: An observational study

Aim:

To evaluate immunohistochemically vascular endothelial growth factor (VEGF) and Ki-67 in human gingival samples and to compare these factors between healthy and diabetic patients.

Materials and Methods:

A total of 50 subjects were included in the study. They were categorized into three groups: Periodontally healthy group, periodontally diseased gingiva without any systemic disease group and periodontally diseased gingiva with controlled type II diabetes mellitus (DM) group. Gingival biopsies were performed and immunohistochemical analysis were done for VEGF and Ki-67 staining in gingival samples.

Results:

The present study found moderate intensity staining for VEGF in periodontitis group and periodontitis with controlled type II DM group and mild intensity staining for VEGF in periodontally healthy group. With regard to Ki-67, negative staining was observed in periodontally healthy group and mild staining in periodontitis group and periodontitis with controlled type II DM group.

Conclusion:

Further investigation needs to be conducted to identify how VEGF and Ki-67 are involved in the tissue inflammation associated processes and the relationship between VEGF and Ki-67 in progression of periodontitis.

Tumor antigen ROR1 targeted drug delivery mediated selective leukemic but not normal B-cell cytotoxicity in chronic lymphocytic leukemia

Selective cytotoxicity to cancer cells without compromising their normal counterparts pose a huge challenge for traditional drug design. Here we developed a tumor antigen-targeted delivery of immunonanoparticle carrying a novel non-immunosuppressive FTY720 derivative OSU-2S with potent cytotoxicity against leukemic B cells. OSU-2S induces activation of protein phosphatase 2A (PP2A), phosphorylation and nuclear translocation of SHP1(S591) and deregulation of multiple cellular processes in chronic lymphocytic leukemia (CLL) resulting in potent cytotoxicity. To preclude OSU-2S-mediated effects on these ubiquitous phosphatases in unintended cells and avoid potential adverse effects, we developed an OSU-2S-targeted delivery of immunonanoparticles (2A2-OSU-2S-ILP), that mediated selective cytotoxicity of CLL but not normal B cells through targeting receptor tyrosine kinase ROR1 expressed in leukemic but not normal B cells. Developing a novel spontaneous CLL mouse model expressing human ROR1 (hROR1) in all leukemic B cells, we demonstrate the therapeutic benefit of enhanced survival with 2A2-OSU-2S-ILP in vivo. The newly developed non-immunosuppressive OSU-2S, its delivery using human CLL directed immunonanoparticles and the novel transgenic (Tg) mouse model of CLL that expresses hROR1 exclusively in leukemic B cell surface are highly innovative and can be applied to CLL and other ROR1+ malignancies including mantle cell lymphoma and acute lymphoblastic leukemia.

Clinical and radiographic evaluation of demineralized bone matrix (grafton) as a bone graft material in the treatment of human periodontal intraosseous defects

PURPOSE

The purpose of this clinical trial was to evaluate the efficacy of demineralized bone matrix (DBM) as a bone graft material in the treatment of human intrabony periodontal defects as compared with control defects treated by open flap debridement (OFD) alone.

MATERIALS AND METHODS

A controlled clinical trial was carried out for a period of 9 months in 11 patients (4 males and 7 females) with an age group of 25-50 years, contributing to a total of 30 defects. The selected defects were then randomly divided in to experimental sites (OFD + DBM) and control sites (OFD alone). Probing depth, clinical attachment levels and position of the gingival margin were recorded at baseline 3, 6 and 9 months post-operatively. Standardized radiographs (parallel technique) were also documented at these recall intervals.

RESULTS

On completion of 9 months, the mean percentage of probing depth reduction achieved in the experimental sites and control sites was 61.70%, 23.86% respectively. The mean percentage of clinical attachment level gain was 61.34% and 19.37% in the experimental and control sites respectively. In the experimental sites recession was observed to a lesser extent.

CONCLUSION

The use of DBM was more effective than OFD in improving clinical parameters and radiographic bone fill as shown in the present study. However, there is a need for further long term studies.

Tuberculous syringomyelia in an HIV-infected patient: a case report

A 37-year-old HIV-positive Gambian woman presented with spastic weakness of the right leg six years after receiving treatment for tuberculous meningitis (TBM). Magnetic resonance imaging (MRI) of the spine showed a multiloculated syrinx in the thoracic spinal cord extending from the T2 to the T11 level. Syringomyelia and syringobulbia have been reported as complications of TBM. We describe the first case of syringomyelia as an uncommon late complication of treated TBM in the setting of HIV infection. Early recognition of this rare entity may avoid irreversible neurological sequelae.

Clinical evaluation of the biological width following surgical crown-lengthening procedure: A prospective study

BACKGROUND AND OBJECTIVES

The purpose of this study was to evaluate the positional changes of the periodontal tissues, particularly the biological width, following surgical crown-lengthening in human subjects.

MATERIALS AND METHODS

A clinical trial study involving 15 patients was carried out for a period of 6 months. Sites were divided into 3 groups: treated (TT) sites, adjacent (AD) sites and nonadjacent (NAD) sites. Free gingival margin [FGM], attachment level, pocket depth, bone level, biological width [BW] were recorded at baseline, 1, 3 and 6 months. Direct bone level after flap reflection was recorded before and after osseous resection at baseline only. Level of osseous crest was lowered based on BW, and supracrestal tooth structure needed using a combination of rotary and hand instruments.

STATISTICAL ANALYSIS

Student t test and ANOVA were used.

RESULTS

Overall, apical displacement of FGM at TT, AD and NAD sites was statistically significant compared to baseline. The apical displacement of FGM at TT site was more when compared to that at AD and NAD sites at 3 and 6 months. The BW at the TT site was smaller at 1, 3 and 6 months compared to that at baseline. However, at all sites, BW was reestablished to the baseline value at the end of 6 months.

INTERPRETATION AND CONCLUSION

The BW at TT sites was reestablished to its original vertical dimension by 6 months. In addition, a consistent 2-mm gain of coronal tooth structure was observed at the 1, 3 and 6-month examinations.

Modeling electroencephalography waveforms with semi-supervised deep belief nets: fast classification and anomaly measurement

Clinical electroencephalography (EEG) records vast amounts of human complex data yet is still reviewed primarily by human readers. Deep belief nets (DBNs) are a relatively new type of multi-layer neural network commonly tested on two-dimensional image data but are rarely applied to times-series data such as EEG. We apply DBNs in a semi-supervised paradigm to model EEG waveforms for classification and anomaly detection. DBN performance was comparable to standard classifiers on our EEG dataset, and classification time was found to be 1.7-103.7 times faster than the other high-performing classifiers. We demonstrate how the unsupervised step of DBN learning produces an autoencoder that can naturally be used in anomaly measurement. We compare the use of raw, unprocessed data--a rarity in automated physiological waveform analysis--with hand-chosen features and find that raw data produce comparable classification and better anomaly measurement performance. These results indicate that DBNs and raw data inputs may be more effective for online automated EEG waveform recognition than other common techniques.

[Cervico-facial hydatidosis. Report of 17 cases]

BACKGROUND

Cervico-facial hydatid cyst is rare. It accounts for 1 % of echinococcosis locations.

AIM

To describe the epidemiological, clinical and therapeutic aspects of cervico-facial hydatid cysts based on our clinical experience and data in the literature.

METHODS

A retrospective study was made concerning 17 patients with cervico-facial hydatid cyst treated surgically over a 25-year period from 1982 to 2006.

RESULTS

Mean patient age was 27 years (range 2-79). Hydatid cyst localization was: cervical muscle (7 cases), thyroid gland (5 cases), parotid gland (2 cases), cervico-thoracic (1 case), larynx (1 case) and cheek (1 case). Hydatic origin of the cyst was suspected for 6 patients (35.3 %) preoperatively. Surgical treatment was used in all cases and adapted to each case. Diagnosis was always confirmed by macroscopic aspects and pathology.

CONCLUSION

Hydatid cysts are rarely found in the cervico-facial region, even in highly endemic zone. The manifestation of symptoms depends on the location and the size of the cyst. Positive diagnosis can be difficult during preoperative period. Exclusively surgical treatment is indicated, ideally for total pericystic resection without rupture.

Therapeutic approaches to complicated cholesteatoma of the external auditory canal: a case of associated facial paresis

Spontaneous cholesteatoma of the external auditory canal (EAC) is an uncommon condition that is difficult to diagnose. In a patient with such a possibility, serious clinical investigation along with radiologic and histologic exploration should be performed early on because a delay in treatment can lead to severe complications. Given the rarity of EAC cholesteatoma, no therapeutic consensus has emerged. The type of management depends on the extensiveness of invasion and bone erosion and the status of the neighboring structures. The primary therapeutic objectives are to eradicate the cholesteatoma and then to fill in the residual cavity, which in our opinion can be best accomplished with a muscle flap and EAC reconstruction. Postoperative follow-up should be carried out to look for infections, stenosis, and recurrence. We report a new case of spontaneous EAC cholesteatoma, and we review its diagnostic and therapeutic challenges.

The awareness of postexposure prophylaxis for HIV infection following sexual exposure in emergency departments in a regional HIV network

The introduction of UK clinical guidelines in 2006 set clear standards for the provision of postexposure prophylaxis for HIV following sexual exposure (PEPSE) to patients who present to health-care settings. However, some patients have reported wide inequities in provision of PEPSE. We used a questionnaire to evaluate staff awareness and provision of PEPSE in various clinical situations in three major emergency departments (EDs) in the Wessex region of the UK. Thirty-three doctors and 50 nurses completed the questionnaire. There was a general lack of awareness regarding local protocols, availability of postexposure prophylaxis (PEP) packs and whom to contact for advice. Knowledge about PEP provision varied according to clinical scenario but was better among senior medical staff. The deficits in awareness and knowledge of PEPSE among ED staff highlighted in this study raises concerns about patients' access to this intervention. We plan to implement local training to address these issues and raise awareness of the local genitourinary medicine/HIV services as a source of advice.

Management of pregnancy in an HIV elite controller

Elite control of HIV infection has been defined as spontaneous and sustained maintenance of HIV RNA to <50 copies/mL in the absence of therapy. It is estimated to occur in approximately one in 300 HIV-infected individuals. We present the case of a Zimbabwean woman who tested positive for HIV-1 infection on routine antenatal bloods at 15 weeks gestation. Her CD4 count was 500 cells/mm3; however, HIV-1 RNA viral load measured below the level of detection on several assays. A Cavidi ExaVir reverse transcriptase assay was below the level of detection. Pro-viral DNA was positive using long terminal repeat primers and sequencing demonstrated subtype C virus. Zidovudine monotherapy (250 mg twice daily) was commenced at 24 weeks for the prevention of mother to child transmission. She was keen for a standard vaginal delivery, having had one previously, and she delivered a healthy baby without complications at 39 weeks gestation. The neonate received four weeks of Zidovudine and tested negative for HIV infection. We discuss some challenges involved in the management of a pregnant ‘elite controller’.

A self-administered screening instrument for psychogenic nonepileptic seizures

BACKGROUND

Delay in distinguishing psychogenic nonepileptic seizures (PNES) from epilepsy may result in significant health and economic burdens. Screening tools are needed to facilitate earlier identification of patients with PNES, thereby maximizing cost-effective use of video electroencephalography (VEEG), the expensive gold standard for differentiating PNES from epilepsy. We developed and prospectively validated a self-administered PNES screening questionnaire using variables known to distinguish PNES from epilepsy patients.

METHODS

Adults referred for inpatient VEEG monitoring at two epilepsy centers were prospectively invited to complete a preliminary 209-item questionnaire assessing demographic, clinical, seizure-related, and psychosocial information that appeared in the literature as potentially useful indicators of PNES. A hybrid neural-bayesian classifier was trained to predict PNES using a sample at one center, and was prospectively validated on a separate set of naive patients from both centers.

RESULTS

Of 211 enrolled subjects from the training center, 181 met the study criteria for either PNES (n = 48, 27%), epilepsy (n = 116, 64%), or coexisting PNES and epilepsy (n = 17, 9%). Variable reduction procedures identified 53 questionnaire items that were necessary to accurately predict PNES diagnosis. The hybrid classifier predicted PNES diagnosis with 94% sensitivity and 83% specificity at the training center, and 85% sensitivity and 85% specificity at the second center (n = 46; 17 PNES, 26 epilepsy, 3 with coexisting PNES and epilepsy).

CONCLUSIONS

We developed and prospectively validated a self-administered psychogenic nonepileptic seizure screening questionnaire that could hasten referral for video electroencephalography and reduce the health and economic burdens from delayed diagnosis or misdiagnosis.

Anti-CD20 monoclonal antibody in acute life threatening haemolytic anaemia complicating childhood onset SLE

Haematological involvement occurs frequently in childhood onset systemic lupus erythematosus (SLE) with autoimmune haemolytic anaemia occurring in 10%. Conventional treatment includes high-dose steroids. Second line agents used in refractory cases include azathioprine, mycophenolate mofetil, cyclosporine and cyclophosphamide. Rituximab, anti-CD20 monoclonal antibody, is emerging in the treatment of SLE refractory to conventional therapy. We report the successful use of anti-CD20 therapy in the treatment of acute life threatening haemolytic anaemia, complicating childhood onset SLE. We propose that earlier introduction of rituximab may reduce the side effects related to other cytotoxic therapy mainly steroids and cyclophosphamide. However, in view of controversies in the reported side effects of rituximab in childhood onset SLE, multicentred randomised controlled trials are required to determine the long-term efficacy, safety and optimal dosing of rituximab in childhood onset SLE.

[Bronchoscopic findings in children with prolonged respiratory symptoms]

OBJECTIVE

This retrospective study aims to establish an algorithm indicating a bronchoscopy, based on clinical and radiological criteria predictive of the presence of a foreign body (FB), in children with prolonged respiratory symptoms and no history of foreign body aspiration (FBA); to establish a study of these criteria and to compare the clinical, radiological and broncoscopic findings in such cases.

METHODS

We chose to review the records of 73 children (age < or = 15 years) with prolonged respiratory symptoms (for at least 15 days) and no history of FBA who underwent bronchoscopy at our institution between 1996 and 2005.

RESULTS

The mean age was 3 years and 2 months, the majority of the patients were between 1 and 3 years of age (56%), 59% of the patients were boys and the mean of evolution of symptoms before the broncoscopy was 3 months and 3 weeks. We found a foreign body (FB) in 17 cases (23.2%). The FBs were in 88.2% of the cases of vegetable origin. A granulation tissue was associated in 47% of positive bronchoscopies. There were no complications related to bronchoscopy. The clinical and the radiological findings were no specific of FBs.

CONCLUSION

Bronchoscopy must be indicated in suspected cases of FBA to prevent delayed diagnosis and pulmonary sequelae. The clinical and radiological findings may help the clinician to indicate it.

[Laryngeal cryptococcosis revealing AIDS: a case report]

The cryptococcal infection of the larynx is uncommon. We present a case of a 65-year-old woman who was seen because of chronic hoarseness. Direct laryngoscopy revealed an infected lesion of the laryngeal vestibule. Histologic examination showed yeasts surrounding by capsules allowing a diagnosis of laryngeal infection by cryptococcus neoformans. The patient had also meningitis and pulmonary localisation. We have undergone a risk factors research and this results in finding out that HIV serology was positive. She received a treatment with amphotericin B followed by fluconazole during 6 months with complete recovery of her laryngeal infection. The patient died 11 months after the AIDS diagnostic.

Polynucleotide kinase as a potential target for enhancing cytotoxicity by ionizing radiation and topoisomerase I inhibitors

The cytotoxicity of many antineoplastic agents is due to their capacity to damage DNA and there is evidence indicating that DNA repair contributes to the cellular resistance to such agents. DNA strand breaks constitute a significant proportion of the lesions generated by a broad range of genotoxic agents, either directly, or during the course of DNA repair. Strand breaks that are caused by many agents including ionizing radiation, topoisomerase I inhibitors, and DNA repair glycosylases such as NEIL1 and NEIL2, often contain 5'-hydroxyl and/or 3'-phosphate termini. These ends must be converted to 5'-phosphate and 3'-hydroxyl termini in order to allow DNA polymerases and ligases to catalyze repair synthesis and strand rejoining. A key enzyme involved in this end-processing is polynucleotide kinase (PNK), which possesses two enzyme activities, a DNA 5'-kinase activity and a 3'-phosphatase activity. PNK participates in the single-strand break repair pathway and the non-homologous end joining pathway for double-strand break repair. RNAi-mediated down-regulation of PNK renders cells more sensitive to ionizing radiation and camptothecin, a topoisomerase I inhibitor. Structural analysis of PNK revealed the protein is composed of three domains, the kinase domain at the C-terminus, the phosphatase domain in the centre and a forkhead associated (FHA) domain at the N-terminus. The FHA domain plays a critical role in the binding of PNK to other DNA repair proteins. Thus each PNK domain may be a suitable target for small molecule inhibition to effectively reduce resistance to ionizing radiation and topoisomerase I inhibitors.