Comparative status of oxidative damage and antioxidant enzymes in chronic tonsillitis patients

Comparative study of two modalities i.e. antioxidant therapy (by vitamin E) and tonsillectomy was done in chronic tonsillitis patients, the study included 80 cases. It was found that both modalities were affective than tonsillectomy. Thus the use of antioxidant may be a promising alternative for the tonsillectomy.     

Post-tonsillectomy bacteraemia in children

It has been postulated that the bacteraemia rate following guillotine tonsillectomy is lower than that following dissection tonsillectomy due to intra-operative compression of tonsillar blood vessels by the guillotine. The aim of this study was to evaluate the incidence of bacteraemia following dissection and guillotine tonsillectomy. Sixty-four patients undergoing elective tonsillectomy for recurrent acute tonsillitis were randomly selected, 32 underwent dissection tonsillectomy and 32 guillotine tonsillectomy. Positive intra-operative blood cultures were obtained in 16 patients (25 per cent), nine (28.1 per cent) of the dissection group and seven (21.8 per cent) of the guillotine group. There was no significant difference between the two methods (Chi-squared test, p = 0.77).     

The effect of tonsillectomy and adenoidectomy on neutrophil chemotaxis

Although tonsillectomy and adenoidectomy are common surgical procedures, the effects of these operations on the immune system have not been thoroughly determined. Our data on neutrophil chemotaxic functions in a group of 17 patients with chronic tonsillitis and adenoid hypertrophy show that chronic tonsillitis and adenoid hypertrophy impair neutrophil chemotaxic functions and that there is a subsequent normalization of these values following tonsillectomy and adenoidectomy.     

The effect of tonsillectomy on the level of circulating immune complexes and urine changes in patients with glomerulonephritis

The influence of tonsillectomy on circulating immune complexes (C.I.C.) level, proteinuria and erythrocyturia was studied in 42 patients with chronic tonsillitis (Ch.T.) and urine abnormalities. The level of C.I.C. was examined by two methods: the 3.5% polyethyleneglycol (PEG) precipitation method and the 125I-C1q binding method. After tonsillectomy, bacteriological analysis of removes facial tonsilla was performed in 7 patients and morphological analysis in 11. Renal biopsy was done in 28 patients. The control group was consisted of 18 patients with Ch.T. without urine abnormalities. The presence of C.I.C. was established in 48% of patients with urine abnormalities using PEG method and in 33% with 125I-C1q binding method. Mean values of C.I.C. in patients with proteinuria or erythrocyturia were statistically higher than in the control group. After tonsillectomy, transitory increase of C.I.C. level was observed in 60% of patients, accompanied by augmentation in urine changes, especially proteinuria. During one year of observation, significant decrease in C.I.C. levels detected by PEG method, as well as in proteinuria and in erythrocyturia was found. In 10 patients urine abnormalities disappeared. No differences between both groups of patients were found in the results of bacteriological and morphological studies of removed tonsilla. However, the normalisation of urine changes was noticed in patients without hypertension and in whom renal disease did not exceed two years. Renal histology revealed mesangocapillary proliferative Gn in 14, mesangial proliferative Gn in 11, and focal/segmental glomerulosclerosis in 3 patients. In one patient with mesangial proliferative Gn complete retreat of urine changes was observed. We suggest that the presence of Ch.T. influences on the C.I.C. detectability in patients with chronic glomerulonephritis. The tonsillectomy can lead do the decrease of C.I.C. levels, as well as to the decrease of proteinuria and/or erythrocyturia. Serum C.I.C. examination seems to be helpful in qualifying patients with Ch.T. for tonsillectomy, in immunological monitoring after the operation and in later prognosis in case of chronic glomerulonephritis.     

Inhalation of an extract from the leaf buds of the deltoid poplar during the early period following tonsillectomy

To prevent inflammatory processes in the mucous membrane of the upper respiratory tract during early periods after tonsillectomy (2-7 days) the authors practiced inhalations of the extract of Eastern poplar leaf buds in 40 patients with chronic tonsillitis after the operation. The use of the extract of Eastern poplar leaf buds at early periods after tonsillectomy promotes abating of pains, speedy cicatrization of postoperative wounds, decrease of reactive inflammation in the pharynx and improvement of the general condition in the patients.     

The novel ascomycin derivative SDZ ASM 981 is effective for psoriasis when used topically under occlusion

Topical SDZ ASM 981 has been found to be highly effective in preclinical models of T-cell-mediated skin disease. T cell activation is crucial in the pathogenesis of psoriasis. It has been hypothesized that SDZ ASM 981 may prove to be an effective treatment for chronic plaque psoriasis. Therefore, the study objective was to determine the efficacy, tolerability and safety of the new topical macrolactam, SDZ ASM 981, for chronic plaque psoriasis. Ten patients with chronic plaque-type psoriasis were treated with SDZ ASM 981 (0.3% and 1.0%), the corresponding ointment base (placebo) and open-labelled clobetasol-17-propionate ointment (0.05%) in a randomized, double-blind, within-subject comparison for 2 weeks using the microplaque assay. Evaluation was performed by daily determination of clinical scores for erythema and induration. The results of the study showed that, after 2 weeks of treatment, total scores described by 92% for clobetasol, by 82% for 1 SDZ ASM 981, by 63% for 0.3% SDZ ASM 981 and by 18% for the ointment base (placebo). No adverse drug effects were seen in any patient throughout the study. We conclude from our results that the new macrolactam SDZ ASM 981 (1%) is similar to clobetasol-17-propionate (0.05%) in plaque-type psoriasis when applied topically under occlusion for 2 weeks using the microplaque assay.     

Factors in the development of chronic infection foci in the nasopharynx

Antigens were studied of HLA system in always ailing patients presenting with the formed chronic focus of infection in the tonsils. A total of 56 patients with chronic decompensated tonsillitis who were assigned for tonsillectomy by clinical indications were examined together with 53 essentially healthy subjects. Tonsillitis patients revealed HLA-antigens B7, A1, associations A10B7, more frequently than controls, the difference being statistically significant. The data obtained are helpful in identification of risk groups in relation to formation in recurrent respiratory diseases of chronic focal pathology in the nasopharynx.     

PUVA and anthraline therapy of psoriasis, a clinical, histological and autoradiographic comparison

Treatment of psoriasis with 8-Methoxypsoralen and long wave ultraviolet rays (UV-A) (PUVA) was carried out on 63 patients with severe psoriasis. 41 patients were given the medication orally, the other 22 had it applied locally. After 8.5 weeks, with an average of 25 radiations, about 54% of the patients were cleared of all symptoms or improved considerably. Histological and autoradiographical examinations were carried out to 10 of the orally treated patients. After three weeks of treatment we found a reduced H 3-thymidine-labelling-index (H 3-I) and a shortened DNA-synthesis-time (ts). The average cell cycle time (tc) was lengthened. The effect of PUVA is comparable to that of Anthralin therapy, but the clinical success and the length of treatment with the PUVA-method are inferior to those of the Anthralin-method. There we consider the Anthralin-method as used on in-patients at the Department of Dermatology at the University of Cologne, to be the more suitable method. The PUVA-method ist less complicated and its application easier for the physician as well for the patient, therefore we consider the PUVA-method more suitable for the treatment of out-patients.     

High concentrations of ammonia, but not volatile amines, in gastric juice of subjects with Helicobacter pylori infection

A variety of external stimuli are accepted as important in modifying the severity of psoriasis. We sought to determine whether there is any difference in the influence of external factors on psoriasis in relation to extent of involvement or clinical type. A total of 870 psoriasis patients seen between 1982 and 1995 were categorized as mild, moderate, or severe on the basis of extent of the disease, and as guttate, nummular/plaque, or exfoliative/generalized pustular according to clinical type. We then performed a questionnaire survey concerning the influence of external factors such as seasonal changes, sunlight, stress, and pregnancy. These data sets were combined and analysed. The majority of patients stated favorable effects of summer, sunlight, and pregnancy and adverse effects of winter and stress. A statistically significant correlation was noted between the extent of psoriasis and the proportion of patients stating that their disease worsened at times of psychological stress (p < 0.01). We confirmed that psoriasis patients with more extensive involvement experience greater fluctuations in their condition, notice these changes, and therefore relate them to psychological stress.     

Technical report: Cystic air spaces in the lung: change in size on expiratory high-resolution CT in 23 patients

BACKGROUND: Urticaria is a common disease that is always a challenge to the dermatologist due to its evasive etiology. PATIENTS AND METHODS: One hundred and seven chronic urticaria patients were studied. Routine laboratory investigations were performed and Helicobacter pylori (H. pylori) immunoglobulin G (IgG) antibody determinations, autoimmune reactivity, infections, allergies, and hyperreactivities were investigated. RESULTS: Pathologic findings were seen in 92 patients. Concomitant diseases suggesting autoimmune reactivity were detected in nine patients and, in 16 patients, infections including maxillary sinusitis, streptococcal tonsillitis, and tooth infection were found. Elevated total IgE level was detected in 37 out of 75 patients and positive skin prick test results in 47 out of 91 patients. Fifty-five patients had a history of recent dyspeptic symptoms. A diagnosis of adult celiac disease was made in two patients and, additionally, IgA antigliadin antibodies were seen in four patients. H. pylori IgG antibodies were found in 40 out of 107 patients. Active gastritis was verified by esophagogastroduodenoscopy in 30 out of 32 patients with positive Helicobacter staining in 24 samples. An elevated IgE level was detected in 64% of H. pylori-positive and in 39% of H. pylori-negative patients. CONCLUSIONS: In this study, several findings suggesting aberrant immunologic activation were detected in chronic urticaria patients. Inflammation in the gastrointestinal tract, e.g. caused by H. pylori infection, may have an important role in the etiology of chronic urticaria.     

Treatment of refractory psoriasis with fluocinonide gel

Twenty patients with refractory psoriasis that had responded poorly to previous therapy were treated with fluocinonide gel (0.05 percent), unoccluded, for six weeks. Patients were evaluated weekly. By the sixth week, all patients had improved, and seventeen (85 percent) showed "excellent" improvement. One patient discontinued the trial after four weeks because the lesions had completely cleared. No other patient discontinued using the medication for any reason. Patient complaints were minimal and consisted of stinging (three patients), itching (two patients), and drying (two patients). The study suggests that fluocinonide gel (0.05 percent) is a cosmetically acceptable alternative for the treatment of refractory psoriasis.     

The Laboratory of Pathological Anatomy of the A. L. Polenov Russian Neurosurgical Research Institute. The results of research over 20 years (1976-1996)

Chronic tonsillitis (CT) was found in 63.1% of 190 obese children aged 3-15 years, 15% of them had no quinsy in the past. Onset of obesity was attributed to frequent quinsy in 18.3% of the examinees. Marked CT exacerbations were more typical for the children aged 6-7 years (10%). In 12-15-year-olds the disease tended to a sluggish course with scarce symptoms (25.8%). Pharyngoscopy discovered edema and hypertrophy of the tonsils in 74.1% of the patients. 35 patients underwent tonsillectomy. Examination of the removed tonsil tissue for phospholipids revealed pathological phospholipids lysophosphatidylcholine and phosphatidylinosite the quantities of which rose with growing obesity. It may be the result of negative action of obesity on tonsil structure.     

Differences in estimates of percent body fat using bioelectrical impedance

The effect of heliotherapy on psoriasis skin lesions and arthritis was studied in a trial comprising 4 weeks of therapy in the Canary Islands and a 6-month follow-up period. A total of 373 patients participated in the heliotherapy and 361 patients completed the follow-up period. The severity of skin lesions was evaluated using a psoriasis severity index (PSI), and that of the arthropathy by using an arthritis index (AI). During heliotherapy, the PSI decreased significantly from the initial median value of 4.5 to the final value of 0.2. A reduction in the PSI of at least 75% was achieved in 84% of the patients. Guttate psoriasis improved significantly better than plaque-type or erythrodermic psoriasis. There was no correlation between skin type and improvement. Initially, 129 patients had symptoms of arthritis. During heliotherapy, the AI decreased significantly from the initial median value of 6 to the final value of 2. The median time until starting another treatment after heliotherapy was 80 days, and the PSI had returned to its original value in 49% of the patients in 6 months. In patients with joint symptoms the AI returned to the pretreatment level within 6 months. A 4-week heliotherapy period effectively cleared psoriasis, alleviated joint symptoms, and reduced both morbidity and treatment requirement to a considerable extent in the ensuing 6-month period.     

Acute upper respiratory tract infections and indications for tonsillectomy in children. I. Immunoglobulin synthesis in the palatine tonsil tissue

Current viewpoints and practice concerning indications for tonsillectomy are presented. The annual specific risk for upper respiratory infection in children aged up to 15 is 1.1. The risk is higher in the youngest age group, in whom it rises to 1.8, decreasing with age and being lowest among children aged 12-15 years (0.5). The proportion of tonsillitis among acute upper respiratory tract infections is highest in the age group up to 3 years (36.9%); at the age of 4-5 years it is 37.1%, and is lowest among children aged 12-15 years (21.9%). The risk of tonsillitis caused by streptococci is highest among children aged up to 5 years. Statistical significance of differences in the synthesis of immunoglobulins (G, M, A and sA) and lysozymes in the palatine tonsil tissue of tonsillectomized children and healthy volunteers was tested by non-parametric tests for independent samples. Significant differences of the above mentioned syntheses were found in all entities studied. Any contribution to the documentation on the nature and cause of each tonsillitis in childhood is of great clinical value, because it is the only basis for rational consideration of indications for tonsillectomy.     

The effects of topical calcipotriol on systemic calcium homeostasis in patients with chronic plaque psoriasis

BACKGROUND: Calcipotriol is an effective treatment of chronic plaque psoriasis. We have previously demonstrated that it has a small effect on systemic calcium homeostasis even at recommended doses. OBJECTIVE: We attempted to determine the mechanism of the effect of calcipotriol on systemic calcium homeostasis so we could assess the possible consequences of long-term use. METHODS: Sixteen patients with extensive chronic plaque psoriasis were hospitalized and treated with high-dose topical calcipotriol. Up to 360 gm of calcipotriol (50 micrograms/gm) ointment was applied per week for 2 weeks under controlled conditions. RESULTS: There was a dose-dependent rise in intestinal absorption of calcium. No effect on bone turnover was demonstrated over this short period. Five patients became hypercalcemic, and there was a dose-dependent rise in serum total adjusted calcium, serum ionized calcium, serum phosphate, urine calcium, and urine phosphate. There was a dose-dependent fall in serum parathyroid hormone and serum 1,25 dihydroxyvitamin D3. CONCLUSION: Calcipotriol exerts its effects on systemic calcium homeostasis by increasing intestinal absorption of calcium and probably phosphate. This results in suppression of parathyroid hormone and 1,25 dihydroxyvitamin D3.     

Myocardial infarction in france: Prognosis improvement?

BACKGROUND: Cyclosporine for the treatment of psoriasis constitutes a new approach. Alternative systemic cyclosporine derivatives have been studied to find an immunosuppressive drug with fewer adverse effects. Tacrolimus is one of these new immunosuppressive drugs. Systematically, it has been proven effective in treating psoriasis. A topical formulation of tacrolimus is attractive because it has fewer adverse effects and is useful for a large group of patients. We report for the first time on the efficacy of nonocclusive topical tacrolimus in the treatment of psoriasis. OBSERVATIONS: After a washout phase of 2 weeks, patients were randomized to receive 0.005% calcipotriol ointment twice daily, placebo ointment once daily, or 0.3% tacrolimus ointment once daily. One psoriatic plaque was treated with a surface area of 40 to 200 cm2. Efficacy was estimated using the local psoriasis severity index. The reduction in the local psoriasis severity index score after 6 weeks was 62.5% in the calcipotriol group, 33.3% in the tacrolimus group, and 42.9% in the placebo group. CONCLUSIONS: There was no statistically significant difference between the efficacy of tacrolimus and placebo ointment (P = .77). Calcipotriol ointment, applied twice daily, had a better effect than tacrolimus ointment and placebo ointment once daily.     

Reoperation for recurrent chronic visceral ischemia

PURPOSE: Recurrent visceral ischemia after a failed visceral revascularization occurs in up to one third of patients, yet no comprehensive report has described the management of this problem. The purpose of this study was to examine the presentation, surgical management, and outcome of patients with recurrent visceral ischemia. METHODS: Between 1959 and 1997, 109 patients underwent primary visceral revascularization at the University of California, San Francisco. Nineteen patients (17.4%) had recurrent visceral ischemia (12 chronic visceral ischemia, seven acute visceral ischemia). Fourteen additional patients with recurrent chronic visceral ischemia were referred after failed primary revascularization (two patients underwent multiple operations before referral). Thirty visceral reoperations were performed for recurrent visceral ischemia in 24 patients (10 patients with recurrence at University of California, San Francisco, 14 referred patients). Symptom-free and overall survival rates were determined by life table analysis. RESULTS: Of seven patients (6.4%) who had recurrent acute visceral ischemia, six (85.7%) died of bowel infarction. Twelve patients (11%) had recurrent chronic visceral ischemia. Patients with recurrent chronic visceral ischemia received their diagnoses earlier and lost less weight than at their initial presentation (p = 0.004 and 0.001, respectively). Recurrent ischemia was associated with younger age, greater weight loss, and modification of surgical technique at the time of initial operation (p = 0.5, 0.009, and 0.02, respectively). For 20 (90.9%) of the 22 first reoperations, antegrade aortovisceral bypass (n = 10) or transaortic visceral endarterectomy (n = 10) was used. Multiple techniques (four antegrade bypass, two retrograde bypass, one endarterectomy, one anastomotic revision) were used in the eight second or third reoperations. Postoperative mortality and complication rates were 6.7% and 33.3%, respectively. Symptoms recurred in six of 22 patients (27.3%) after the first reoperation, three of whom were cured or improved after additional reoperations. The life table symptom-free survival rate after reoperation was 77.3% and 62.8% at 1 and 5 years, respectively. The life table overall survival rate after reoperation was 74.6% at 5 years. CONCLUSIONS: Recurrent visceral ischemia is not uncommon after primary visceral revascularization. These results show that reoperation for recurrent chronic visceral ischemia can be accomplished safely and effectively with established revascularization techniques. Furthermore, after repeat visceral revascularization patients achieve durable relief of symptoms and have life expectancy rates comparable with those of patients who undergo primary visceral revascularization.     

Changes in multidrug transporter protein expression in endothelial cells cultured from isolated human brain microvessels

Retinol and proguanil are metabolised by the same family of hepatic cytochrome P450, i.e. CYP2C. We used proguanil as a probe to study CYP2C activity, and by implication retinol metabolism, in psoriasis. In vitro studies showed that retinol competitively inhibited the hepatic metabolism of proguanil to cycloguanil. Proguanil metabolism was assessed in 82 patients with chronic plaque psoriasis. Following proguanil orally (200 mg), urine was analysed for proguanil and cycloguanil. A proguanil to cycloguanil ratio < 1 signified extensive metabolism and a ratio > 10 poor metabolism. A wider range of ratios was observed in psoriasis than previously reported for normal subjects. The proguanil to cycloguanil ratio was assessed in 10 cases each of know severe and mild psoriasis. Low CYP2C activity was associated with severe psoriasis, poor metaboliser status occurring in 50% of the severe group, but in none of the mild cases, p < 0.01. These findings may indicate differences in retinoid metabolism in psoriasis.     

Simulated postaggression metabolism in healthy subjects: metabolic changes and insulin resistance

BACKGROUND: Psoriasis vulgaris can be effectively treated with trimethylpsoralen (TMP) bath PUVA therapy (psoralen plus UVA), but no data exist on the extent to which psoriatic pathology is affected by this treatment, or on its cellular mechanism of action. OBSERVATIONS: Eleven patients with recalcitrant psoriasis vulgaris were treated with TMP bath PUVA therapy and observed through clinical and histological measures. Clinical resolution of psoriasis was achieved in 10 of 11 patients. Histopathological resolution of epidermal hyperplasia (marked by keratin 16 expression) was achieved in 90% of individuals treated with TMP bath PUVA. Epidermal acanthosis was reduced by 40% at 2 weeks and 66% by the end of treatment. Epidermal improvement correlated best with reduction in intraepidermal T lymphocytes, which were reduced by 76% at 2 weeks of treatment and 93% at the end of treatment. Furthermore following TMP bath PUVA therapy, the numbers of epidermal CD1a+ Langerhans cells were markedly reduced, and CD86+ cells were eliminated. Through in vitro assays, TMP was found to be about 10,000-fold more active as a lymphotoxic agent compared with 8-methoxypsoralen (8-MOP). Additionally, at physiologic concentrations, lymphocytes were killed more readily by TMP PUVA (TMP plus UVA) than were keratinocytes. CONCLUSIONS: Treatment with TMP bath PUVA was effective in treating moderate to severe psoriasis, even in darker pigmented individuals. It is likely that this treatment ameliorates psoriasis through direct effects on activated leukocytes in lesional skin.