Clinical and laboratory basis for the diagnosis and understanding of neonatal metabolic diseases

The evaluation, classification, and treatment of carpal instability continues to be one of the most controversial topics in hand surgery. One explanation is the lack of standardized findings and radiographic criteria. No good modality to date has been proposed to accurately aid in evaluating carpal instability. Wrist arthroscopy has become increasingly useful in the assessment of mechanical wrist pain. With this technology, specific patterns of injury can more accurately be identified by direct visualization. This will also aid in implementing a reproducible, less subjective means of describing wrist instability. The treatment can then be focused on management of the specific ligamentous injury responsible for the pattern of instability visualized. The following is an attempt to categorize these instability patterns as seen through arthroscopy and provide our proposed treatment options.     

Immunologic aspects of allergic and non-allergic asthma

METHODS: The peripheral blood lymphocytes and lung function have been studied in 25 patients: 12 affected by atopic asthma and 13 affected by non atopic asthma. RESULTS: The results obtained indicate that peripheral blood CD3 and CD4 cell as well as HLA-DR marker are higher in the extrinsic asthma group. CONCLUSIONS: These findings confirm that an active inflammatory process exists in the group of non-atopic and functionally more compromised patients.     

Immunologic detection of fecal occult blood from upper digestive tract diseases

BACKGROUND/AIMS: This study was conducted to evaluate the accuracy of the immunochemical occult blood test for upper digestive tract diseases. METHODOLOGY: The test was performed on 226 subjects, including 124 upper digestive tract diseases (12 ulcerative esophagitis cases, 10 esophageal cancer cases, 33 gastric ulcer cases, 33 gastric cancer cases, and 36 duodenal ulcer cases), 34 colorectal cancer cases, and 68 healthy subjects, after which, the accuracy of this test was evaluated. RESULTS: The test was positive 23 in upper digestive tract diseases (2 in ulcerative esophagitis, 2 in esophageal cancer, 5 in gastric ulcer, 8 in gastric cancer, 6 in duodenal ulcer), 31 in colorectal cancer, and 3 in healthy subjects, respectively. Thus, the sensitivity was 19% for upper digestive tract diseases (16.7% for ulcerative esophagitis, 20% for esophageal cancer, 15% for gastric ulcer, 24% for gastric cancer, 20% for duodenal ulcer) and 91% for colorectal cancer, and the specificity was 96%. Significant difference was noted in the sensitivity between upper digestive tract diseases and colorectal cancers (p0.001), whereas there was no difference among 5 upper digestive tract diseases. CONCLUSIONS: These results indicate that the immunochemical occult blood is inadequate as means for detection of upper digestive tract diseases, and that an examination of upper digestive tract is unnecessary in cases where the immunochemical occult blood test is positive, but there is no evidence of diseases in colon and rectum.     

Immunologic bullous diseases: blisters without a precipitating event

Although the overall incidence of immunologic bullous diseases is comparatively low, they are nonetheless potentially lethal dermatologic disorders that occur most commonly in individuals age 55 and older. Thus familiarity with the signs, symptoms, and treatments will be valuable to the primary care physician. For bullous diseases in general, the challenge is to differentiate between those arising from immunologic rather than exogenous causes, such as drug-induced or drug-triggered pemphigus. Treatment goals include screening for associated malignancies, managing the lesions, and minimizing the morbidity and mortality associated with the disease. Collaboration with a dermatologist can aid in achieving these objectives.     

Sexually transmitted diseases: laboratory diagnosis

Betel chewer's mucosa (BCM) was first described and defined in 1971. Its clinical appearance is characterised by a brownish-red discolouration of the oral mucosa with an irregular epithelial surface that has a tendency to desquamate or peel off. The buccal mucosa is most frequently affected. The prevalence of BCM varies between 0.2% and 60% in different studies from South and Southeast Asia. Women are more frequently affected than men. Betel chewer's mucosa may be found together with other oral mucosal lesions such as leukoedema, leukoplakia and ulceration. The histological features are characteristic. The epithelium is often hyperplastic, and brownish amorphous material derived from the betel quid may be demonstrated not only on the epithelial surface but also intra- and inter-cellularly. Ballooning of epithelial cells may occur. The etiology is traumatic and possibly chemical. Betel chewer's mucosa is most likely not precancerous. Differential diagnoses include cheek biting, with which it has a number of similarities, and other predominantly white lesions that may have taken up stains from tobacco and other substances. The natural history of BCM should be studied in more detail and its association with other oral mucosal diseases, particularly of a precancerous nature, should be the aim of further investigations.     

Clinical advice from the bench

The objectives of the equine dental physical examination are to detect and quantify oral and dental disorders, to propose and carry out their treatment, and to implement management programs. The veterinarian should be able to offer a prognosis and to detail any future treatment or management plans that may be required. These objectives should take into account the cost of these procedures, and the veterinarian should be prepared to offer a cost-benefit analysis of the problem and the proposed cures.     

Immunologic aspects of lung diseases and cystic fibrosis

Immunologic lung disorders are accompanied by an array of laboratory abnormalities, some of which contribute to disease pathogenesis. Allergic bronchopulmonary aspergillosis, which complicates asthma and cystic fibrosis, causes mucous plugging of airways, eosinophilic pneumonia, and bronchiolitis obliterans. Aspergillus fumigatus, growing saprophytically in bronchial mucus, is responsible for most cases, and prednisone, not antifungal agents, is the drug of choice because it controls the immunologic responses of the lung. In cystic fibrosis, epithelial surface fluid from the lung does not kill Pseudomonas aeruginosa, in part because antibodies to P aeruginosa are plentiful but ineffective in opsonizing bacteria. Neutrophil-derived elastase cleaves immunoglobulins and digests the C3b receptor on neutrophils, which limits phagocytosis of pathogens. In helminth infections and infestations, pulmonary and peripheral blood eosinophilia can be accompanied by increases in total and antiparasite IgE concentrations and generate T(H)2 CD4+ T-lymphocyte responses. Understanding the immunologic abnormalities of lung disorders may lead to more effective therapies.     

Molecular genetics: from bench to bedside

Pancreatic ductal adenocarcinoma is characterized by a high rate of activating mutations involving codon 12 of the K-ras protooncogene. As a means of ras-targeted intervention, the effects of enhanced Krev-1 gene expression on the growth and tumorigenicity of the hamster pancreatic adenocarcinoma cell line PC-1 were evaluated. Overexpression of the Krev-1 gene product resulted in morphologic reversion to a less transformed phenotype, as well as retarded growth kinetics and diminished potential for anchorage-independent growth. Among six transfected cell lines, the magnitude of these changes correlated with the degree of Krev-1 overexpression as assessed by Western blot. When PC-1 cells overexpressing high levels of the Krev-1 gene product were assessed for tumorigenicity in syngeneic animals, an increased latency to tumor growth and a decreased tumor size were noted. The results confirm that overexpression of the Krev-1 gene may provide a useful strategy for ras-targeted intervention in this disease.     

Helicobacter pylori: from bench to bedside

Within occupational therapy education, there has been increased attention to curricula and courses that emphasize problem solving, clinical reasoning, and synthesis of information across traditional discipline-specific boundaries. This article describes the development, implementation, and outcomes of a problem-based learning course entitled Selected Cases in Occupational Therapy. The course was designed to help students to integrate the various elements of a specific occupational therapy curriculum and to enhance their abilities to respond to an ever-changing health care environment. An evaluation of the course by the first 11 students who completed it revealed both strengths and weaknesses. Students responded that the course enhanced their professional behavior, including interpersonal communication skills, team work, and follow-through with professional responsibilities; helped them to integrate the various elements of the total occupational therapy academic program; enhanced their clinical reasoning skills by providing a structure for thinking through clinical issues; and provided personal gain or benefit (i.e., students perceived the course to be a valuable, realistic, and motivating experience). The students also identified several specific course elements that contributed to its integrating function, including content, class session format, and students' role. Identified course weaknesses included the methods of evaluating student performance and the format and content of specific cases.     

Molecular basis of neuromuscular diseases

For many neuromuscular disorders, the chromosomal location is known, the causal gene has been identified, and direct application of this knowledge may be made in a clinical setting. The benefits resulting from molecular-based methods include improved diagnostic accuracy and genetic counseling for patients and other at risk family members. This chapter discusses in detail four of the most frequently encountered neuromuscular disorders. These diseases include spinal muscular atrophy, Charcot-Marie-Tooth neuropathy, Duchenne/Becker type muscular dystrophy, and myotonic dystrophy.     

Experts in court: A view from the bench.

There has been a significant increase in the frequency of expert testimony over the past 25 years in Canada. As such, there has also been an increase in psychological expert testimony. In drawing from his experience as a litigator and judge, and reflecting on the articles by A. D. Yarmey and M. Peters (see records 2001-06561-002 and 2001-06561-003, respectively), the author explains what it is that judges expect of an expert and how experts should be prepared. He also summarizes some of the legal rules concerning expert testimony. Finally, the author considers the future of expert psychological testimony. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical pharmacokinetics: the basis of laboratory monitoring of drugs (lecture)

The purpose of this article is to educate the dental hygienist about the seriousness of latex allergy and provide background information necessary for treating the latex allergic patient, including basic information on immunology, hypersensitivity reactions, latex, and natural rubber latex. Symptoms of latex allergy, types of reactions, and methods of exposure are discussed. Methods for achieving a minimal latex environment are presented, along with information to treat the patient with latex allergy, which can affect health, career, future, and lifestyle. Because the number of latex-allergic individuals increases daily, a thorough understanding of its diagnosis and implications is necessary for all oral health care workers.     

The pathogenetic basis for detoxifying and antioxidant therapy in the combined treatment of chronic diffuse liver diseases

As many as 98 patients with chronic diffusive liver diseases were studied for markers of endogenous intoxication syndrome as they were for intensity of lipid peroxidation (LPO) processes, condition of the antiradical defence systems, and detoxicating effectiveness of the drug "Thiotriasoline". Revealed in the patients were intensification of LPO processes, enhancement of the glutathionic system enzymes activity, decrease in superoxide dismutase. Accumulation in blood of malonic dialdehyde and molecular LPO products is believed to be a factor of the endogenous intoxication syndrome progression. A correlation was found between activity of LPO processes, intensification of endotoxicosis and degree of activity of the inflammatory process in the liver. The results obtained attest to the need for the antioxidant and adequate detoxicative therapy. High detoxicating efficacy of the drug "Thiotriasoline" has been shown.