Aspirin 300 mg/day is effective for treating aspirin-exacerbated respiratory disease

BACKGROUND

Aspirin desensitization (AD) treatment at doses of up to 1300 mg/day improves outcomes in aspirin-exacerbated respiratory disease (AERD). The aim of this study was to investigate the efficacy of aspirin 300 mg/day in the treatment of patients with AERD.

METHODS

The study included 40 patients diagnosed in our clinic as AERD that were desensitized and treated with aspirin 300 mg/day between December 2005 and December 2012. Changes from the baseline status were analyzed at 1 year and at 3 years of follow-up.

RESULTS

Of the 40 patients included, 24 (60%) were female and median (interquartile range [IQR]) age was 45 (40-51) years. Median (IQR) duration of AD was 31.5 (10.5-48.5) months. In total, 29 patients continued treatment for at least 1 year and 18 patients for at least 3 years. The annual rate of use of systemic corticosteroid regimens, episodes of sinusitis, and surgery was significantly lower both at 1 year (P = 0.002, P = 0.01, and P < 0.001, respectively) and at 3 years (P = 0.001, P = 0.03, and P = 0.002, respectively). Significant improvement was observed in the nasal congestion score (P = 0.01) and sense of smell score (P = 0.05) at 1 year and in the postnasal drainage score (P = 0.01) at 3 years.

CONCLUSION

Daily treatment with aspirin 300 mg had beneficial effects in patients with AERD, especially for the control of upper airway disease.

Maxillofacial osteosarcoma successfully treated with surgery and adjuvant chemotherapy in a child

Maxillofacial osteosarcoma constitutes a minor percentage of all the head and neck tumors. We describe a 10 year-old girl presenting with swelling and pain in left maxillary region and diagnosed as low grade osteosarcoma. The patient was operated and given a chemotherapy protocol consisted of Cisplatin and Doxorubicin. After six courses of chemotherapy the patient was in complete remission and she is well with no evidence of disease for five years. Since high local recurrence rates have been reported in craniofacial osteoarcoma and we know the deleterious side effects of radiation therapy in children, we believe that best management strategy for osteosarcomas in maxillofacial region in children is radical surgical excision and postoperative chemotherapy (Fig. 3, Ref. 11).

Treatment of penetrating hepatic injuries: a retrospective analysis of 50 patients

AIM

The aim of this study was to determine the possibility of non-operative treatment via retrospective analysis of our patients.

METHODS

Fifty patients with penetrating hepatic injuries were examined retrospectively with respect to trauma scores, associated injuries, complications, and mortality parameters.

RESULTS

Thirteen injuries were caused by firearms, whereas 37 injuries were caused by stab wounds. Forty-three patients (86%) underwent laparotomy and 7 patients (14%) were monitored by CT and clinical findings (nonoperative group, NO group). The laparotomies were evaluated as non-therapeutic in 11 patients (22%) (NTL group) and therapeutic in 32 patients (64%) (TL group). The morbidity and mortality rates were 40 and 10%, respectively. RTS and ISS scores of the nonsurviving and the surviving patients were significantly different. The rates of major venous, grade IV-V hepatic injuries, and gunshot wounds were significantly higher in the nonsurviving patients when compared to the surviving patients.

CONCLUSION

Major venous and grade IV-V hepatic injuries were the primary factors determining mortality and these injuries generally occurred as a result of firearm injuries. NTL occurring at a rate of 22% would decrease to 2% if 'RTS <7' criteria was added to the hemodynamic instability and/or peritoneal irritation findings determining surgical candidacy.

The global network on dental education: a new vision for IFDEA

The advent of globalization has changed our perspectives radically. It presents increased understanding of world affairs, new challenges and exciting opportunities. The inequitable distribution and use of finite energy resources and global warming are just two examples of challenges that can only be addressed by concerted international collaboration. Globalization has become an increasingly important influence on dentistry and dental education. The International Federation for Dental Educators and Associations (IFDEA) welcomes the challenges it now faces as a player in a complex multifaceted global community. This report addresses the new circumstances in which IFDEA must operate, taking account of the recommendations made by other working groups. The report reviews the background and evolution of IFDEA and describes the extensive developments that have taken place in IFDEA over the past year with the introductions of a new Constitution and Bylaws overseen by a newly established Board of Directors. These were the consequence of a new mission, goals and objectives for IFDEA. An expanded organization is planned using http://www.IFDEA.org as the primary instrument to facilitate the exchange of knowledge, programmes and expertise between colleagues and federated associations throughout the world, thereby promoting higher standards in oral health through education in low-, middle- and high-income countries of the world. Such aspirations are modified by the reality and enormity of poverty-related global ill health.

MR imaging in squamous cell carcinoma of the head and neck with no palpable lymph nodes

PURPOSE

To assess the efficacy of MR imaging in the detection of lymph node metastasis in patients with no palpable lymph nodes ("N0 neck") who have squamous cell carcinoma of the head and neck region.

MATERIAL AND METHODS

MR neck imagings in 18 patients who underwent neck dissection (bilaterally in 2) for squamous cell carcinoma of the head and neck region were examined preoperatively for the purpose of detecting lymph node metastases. The imaging features taken into consideration were: size (cutoff point 10 mm), grouping, presence of central necrosis, and appearance of extracapsular spread. The MR examinations comprised spin-echo T1- and T2-weighted sequences. The MR findings were compared with those of surgery and histopathological examination.

RESULTS

MR suggested metastatic lymph node involvement in 5 necks. In 2 of these, central necrosis was seen in the enlarged lymph nodes. In a third, a grouping of the lymph nodes was noted. Extracapsular spread was not present. Histopathological examination revealed metastatic lymph nodes in 7 of the 20 necks, the rate of clinically occult disease being 35%, and 4 of them had been accurately graded by MR. There was one false-positive MR examination. The MR sensitivity was 57.1% and specificity 92.3%.

CONCLUSION

MR may reveal metastatic lymph nodes in patients with no clinical evidence of metastasis. However, conventional MR techniques are not always sufficient for decision-making on surgery in cases of "N0 neck".

Primary antiphospholipid syndrome emerging following thymectomy for myasthenia gravis: additional evidence for the kaleidoscope of autoimmunity

The etiology of autoimmune diseases is multifactorial. In many of them the stimulation by a specific autoantigen is claimed to be responsible for the initiation of the disease. Alternatively, an autoimmune state may be induced by a pure dysregulation of the immune system. Such is the case in which severe systemic lupus erythematosus (SLE) is induced in young patients with myasthenia gravis following thymectomy. We have referred to this set of events as the 'kaleidoscope of autoimmunity'. Herewith, we would like to present another example of the kaleidoscope phenomenon, namely: the emergence of a full blown clinical presentation of the primary antiphospholipid syndrome (APS-recurrent thromboembolic phenomena, repeated fetal loss with high titers of anti-cardiolipid antibodies) in a 32 y old female with myasthenia gravis, two years following thymectomy. Thymectomy in myasthenic patients may be associated with the emergence of new autoimmune conditions such as SLE and APS, pointing to the importance of immune dysregulation in the induction of these autoimmune diseases.

Overall proteolysis in perfused and subfractionated chemically induced malignant hepatoma of rat: effects of amino acids

Control livers and chemically induced hepatoma-bearing livers of nonstarved rats were perfused cyclically with and without the addition of amino acids (known to suppress proteolysis) to the perfusate. Morphologic analysis of the fractional cytoplasmic volume of the lysosomal apparatus (dense bodies and autophagic vacuoles) demonstrated that the addition of amino acids to the perfusion medium inhibited autophagic sequestration of cytoplasm in both tumor and control hepatocytes, although the inhibition was stronger in control than in tumor hepatocytes. The fractional cytoplasmic volume of autophagic vacuoles (AVs) was larger in hepatoma cells than in control hepatocytes regardless of whether amino acids were added or not. The transition (degradation of sequestered cytoplasm) of AVs into dense bodies seems to be prolonged in malignant hepatoma cells. Assessment of rates of protein degradation both in the perfusion medium and in isolated lysosomes disclosed that proteolysis was much lower in tumor liver than in control liver. This can be explained by lower lysosomal enzyme activities in tumor cells, as was evident from tissue homogenate and isolated lysosomes. The addition of amino acids to the perfusate reduced total proteolysis from 1.73 to 0.78% per hour in control hepatocytes and from 0.49 to 0.33% per hour in tumor hepatocytes, i.e., inhibitions of 55 and 33%, respectively. Proteolysis as estimated from isolated lysosomes was also inhibited by amino acids added to the perfusion medium but the inhibition was more conspicuous in control (from 14 to 7.4%) than in tumor cells (from 5.2 to 3.6%). In conclusion, the results show that the relative cytoplasmic volume of AVs is higher but overall proteolysis lower in malignant hepatoma tissue than in control liver. Amino acids in perfusion medium inhibit overall proteolysis and AVs sequestration in both tumor and control hepatocytes, although the inhibition is stronger in control hepatocytes. Thus, even highly neoplastic cells maintain their ability to respond to physiologic regulators.

Protein degradation in lysosomes from chemically induced malignant rat hepatoma

Hepatocellular carcinomas were induced in rat liver by exposing the animals to diethylnitrosamine and 2-acetylaminofluorene in combination with partial hepatectomy. Light and electron microscopy demonstrated that the general appearance of the tumour tissue was that of highly differentiated malignant hepatocytic cells. Morphometrically there was a difference between normal and malignant cells in that the entire lysosomal apparatus was twice as large in malignant cells as in normal cells. This was mainly due to an increase in the fractional volume of autophagic vacuoles. A total lysosomal fraction (dense bodies and autophagic vacuoles) was isolated and characterized from both control and tumour livers. Marker enzyme analysis showed that the lysosomal enzyme activities were significantly lower in malignant liver tissue. Injection of leupeptin, an inhibitor of cathepsins B, H, and L, into rats did not increase the fractional volume of autophagic vacuoles in tumour tissue as much as in normal liver tissue. The proteolytic rate was lower in the lysosomal fraction from hepatoma cell tissue compared with the lysosomal fraction from normal cell tissue. This could conceivably be due to the lower activities of lysosomal enzymes. However, if the recovery of lysosomes is taken into account no clear-cut difference in lysosomal proteolysis between control and malignant liver tissue was noted. Accordingly, in malignant liver tissue a proteolytic balance is obtained characterized by an increased fractional volume of AVs and lower rate of protein degradation in individual lysosomes.

Characterization of the proteolytic compartment in rat hepatocyte nodules

Persistent liver nodules (hepatocyte nodules, neoplastic nodules) were produced in rat liver by intermittent feeding with 2-acetylaminofluorene. Dense bodies (secondary lysosomes) were purified and characterized from the nodules. The purity of the dense body fraction was 90%. The levels of various lysosomal enzyme activities were lower in these dense bodies in comparison with dense bodies from control liver. Similarly, protein degradation was 50% lower in dense bodies from liver nodules than in control liver. The number of autophagic vacuoles (AVs) in the nodular tissue increased considerably after 3 h vinblastine treatment. We have taken advantage of this expansion in an effort to isolate these organelles from liver nodules. Autophagic vacuoles have been isolated recently from liver and kidney but not from putatively premalignant liver nodules. Fraction purity of AVs from liver nodules was 95%. As with dense bodies, AVs from nodular tissue displayed lower activities of proteinases and lower rates of protein degradation when compared with their counterparts from normal liver tissue. Accordingly, the lower rate of overall protein degradation in liver nodules can be ascribed to a decrease in lysosomal activity. A diminished autophagic sequestration capacity is the most plausible explanation for the decreased rate of proteolysis in cells. This could conceivably give these nodular cells a growth advantage and assist in their selective outgrowth as well as in their transformation from neoplastic into true cancer cells.