Oral Candida infections--a review

Candida species are the commonest agents of oral mycoses. They cause a variety of diseases including the new variant, erythematous candidosis, which is frequently described in HIV infection. Due to these and other reasons the classification of oral candidosis has been recently revised, and further more new therapeutic regimes have been described. Hence in this article an overview of oral Candida infections is presented with special emphasis on current concepts related to classification and treatment.     

Retained pieces of wood in the retromaxillary space: a case report

Detection and operative removal of wood as a foreign body in the cranio-maxillary area has received frequent attention in the literature. However, as a rule, most of the cases described are related to the orbit or the orbito-neurocranial space. Almost no literature exists on the detection and treatment of wooden foreign bodies in the retromaxillary space. The authors present an unusual case of long-term retained wood in this area in a child. The case inspires discussion of the general problem of detecting retained retromaxillary wood, even using modern diagnostic tools in this area and the question of the operative therapy, especially the most favourable surgical access.     

Use of Total Suspended Solids in Characterizing the Impact of Spent Filter Backwash Recycling

Recycling of spent filter backwash water is a widely practiced residual management approach throughout the United States for drinking water utilities. The United States Environmental Protection Agency (USEPA), under the 1996 Safe Drinking Water Act Amendments, has recently proposed regulations governing the recycle of this waste stream. Considering this new regulation, a comprehensive study was conducted by researchers at Colorado State University, and a suspended solids mass balance model was developed to characterize the impact of backwash water recycling on the overall treatment process. Online particle count data indicated that certain recycle practices could impact the overall treatment process. Data from pilot-scale experiments showed that total suspended solids (TSS) is a useful tool for characterizing the impacts of the backwash recycle processes. TSS can be used to assess whether solids loading or suboptimal coagulation conditions are the cause of recycle related issues. For the study described here, filter breakthrough occurred at about the same total influent solids load, regardless of the manner in which backwash recycling was performed, indicating that recycle of backwash solids did not impact the overall treatment process.     

Chlamydia pneumoniae as an etiologic factor in disease of the respiratory tract

The described recently species of Chlamydia pneumoniae is the subject of a large number of scientific reports. The majority of infections caused by this microorganism are asymptomatic. However, a lot of cases of symptomatic infections have been described with both mild and severe clinical course. Symptoms related to infection may affect both upper and lower parts of the respiratory tract and may be accompanied by disorders in other systems and organs. Reports on the influence of chronic inflammation by Chlamydia pneumoniae on the development of arteriosclerosis are still controversial. The effective drugs in the treatment of Chlamydia pneumoniae infections are macrolides and tetracyclines.     

Multilateral transference relationship and therapeutic regression-a case report

In this work, we have presented the treatment of a young woman with a psychotic character disorder, and we have described the multilateral transference configuration that derived from the treatment of this disorder. We have described some of the manifestations of this multivalent transference, and have described some aspects of its role in the patient's treatment. The theoretical background has been outlined. Although this transference configuration is relatively unique, we think that the nature of the treatment team that arose in this situation might have treatment implications for others with this disorder.     

Survival and vasculitis activity in patients with end-stage renal disease due to Wegener's granulomatosis

BACKGROUND: In patients with end-stage renal disease (ESRD) due to Wegener's granulomatosis, a decrease in vasculitis activity after the development of ESRD, as described in other autoimmune diseases, has been postulated. However, up to now no data in a larger group of patients with Wegener's granulomatosis on chronic dialysis have been available. METHODS: We retrospectively analysed the clinical course of 35 patients with Wegener's granulomatosis and ESRD during chronic dialysis treatment. Diagnosis was based on clinical manifestation, antineutrophil cytoplasmic antibodies and/or histology. RESULTS: During a mean follow-up of 43 months (5-113 months), six patients died, three related to treatment toxicity. The patient survival rates (according to Kaplan-Meier calculation) were 93% after 2 years and 79% after 5 years. Twenty-nine relapses of Wegener's granulomatosis occurred in 17 patients (relapse rate 0.24/patient/year); 2/3 of the relapses were seen during treatment with steroids, 1/6 during cyclophosphamide therapy. The relapses were not related to the dialysis membrane used. Remission or partial remission could be achieved in 93% of the relapses. CONCLUSIONS: The survival of patients on chronic dialysis treatment due to Wegener's granulomatosis was comparable to that of other patient groups with ESRD. The relapse rate was not different from that of non-dialysed patients with Wegener's granulomatosis, and this finding underlines the need for a therapeutic strategy to maintain long-term remission in dialysis-dependent patients, too.     

Malaria in six patients hospitalized in the Department of Parasitic and Tropical Diseases of the Medical Academy in Poznan in 1994 and 1995

Clinical course of malaria was described in the observed patients. Principal aspects of the respective pathomechanism, diagnostics, therapy and prophylaxis were discussed. Practical recommendations were presented, as related to procedures which should be followed in suspicion of malaria and his treatment.     

Effect of gonadotropin-releasing hormone on estrogen receptor messenger ribonucleic acid level in perifused pituitary cells

Porphyria cutanea tarda is a disorder of heme biosynthesis resulting from a defect or deficiency in the enzyme uroporphyrinogen decarboxylase. Heme precursors accumulate in the blood, urine, stool, and skin, where exposure to sunlight results in the clinical manifestations. Porphyria cutanea tarda has been described in adult hemodialysis patients. The pathogenesis of porphyria cutanea tarda in this population is thought to be related to the inability of hemodialysis to adequately clear porphyrin precursors, resulting in increased precursor serum levels, precursor skin deposition, and subsequent clinical manifestations. A proper diagnosis of porphyria cutanea tarda in hemodialysis patients requires fractionation of serum porphyrins. Normalization of the porphyrin profile and reversal of the dermal manifestations require the withdrawal of hepatotoxic agents and the reversal of hepatic iron overload. A case of porphyria cutanea tarda in an adult ESRD patient treated with continuous ambulatory peritoneal dialysis is described. In this patient, the disease was related to elevated serum levels of phenytoin, which had been administered for seizure disorder.     

Testing basic visual functions in the evaluation of extrapyramidal side effects of antipsychotic agents

A female patient presenting with B-CLL and coincident eosinophilia-myalgia syndrome (EMS) after ingestion of L-tryptophan is described. The manifestations of EMS disappeared completely during treatment with cyclophosphamide/prednisone. and there was an intermittent clinical remission of CLL with absence of the monoclonal B-cell population. A few years later, the B-CLL relapsed, but without sign and symptoms of EMS. Whereas other eosinophilic syndromes such as eosinophilic fasciitis, panniculitis, or cellulitis Wells have been found to occur in relation to malignant underlying diseases, only a single patient with malignant fibrous histiocytoma following EMS has been described. There are no reports about an increased occurrence of B-CLL or other non-Hodgkin's lymphomas combined with or following EMS or related to L-tryptophan itself. The variant types of eosinophilic syndromes occurring due to malignant disorders, the differentiation from EMS, and the possible association between B-CLL and L-tryptophan-related EMS are discussed.     

Occipital neuralgia in a football player: a case report

Occipital neuralgia, a painful condition thought to be caused by nerve entrapment, has been described in the general population. Athletes, particularly those who participate in collision sports, such as football, may be predisposed to this condition. An illustrative case is presented along with discussion of the differential diagnosis and treatment of this type of headache.     

Synthesis of cholesterol esterase by monocyte-derived macrophages: a potential role in the biodegradation of poly(urethane)s

Many studies have described the role of monocyte-derived macrophages (MDM) in inflammation leading to atherosclerosis, a process in which alterations in the metabolism of cholesterol esters is well established. On the other hand, the mechanism of MDM activation in response to biomaterial surfaces is still not well understood. Several studies have described the different degrees of activation of monocytes on poly(urethane) surfaces by measuring the release of early markers of differentiation, such as cytokines. It has been possible to decrease MDM activation in contact with materials by modifying the material surface with antioxidants. Therefore, it has been proposed that it is the reactive oxygen species provided by MDM which are responsible for deleterious effects observed in material-derived inflammation. A recent study has shown that one of the markers of the degree of differentiation of MDM is the synthesis of cholesterol esterase (CE), an enzyme demonstrated as causing biodegradation of polyester(urethane)s and more recently polyether- and polycarbonate-poly(urethane)s as well. In this review article, markers used to assess MDM differentiation on material surfaces will be described and related to the activation of MDM. In particular, the CE accumulation in MDM which is associated with atherosclerosis will be related to its degradative potential during chronic inflammation. How this may impact on the biostability of implanted poly(urethane) medical devices is discussed.     

端淬试验可疑数据的分析

通过现场过程控制的调查和分析，对试样加工、试样热处理、洛氏硬度测试等相关环节提出了技术整改方案并作了对比试验验证。试验表明可疑数据与试样加工形状尺寸、试样热处理对中性、试样洛氏硬度试验送样装置对试样距离控制和各环节的规范操作有关。     

Fulminant angiopathy caused by allogenic transplantation of bone marrow with cerebral involvement: clinico-pathologic correlation

We present a 41 woman who underwent an allogeneic bone marrow transplantation as a treatment for a multiple myeloma. After presenting graft-versus-host disease, hyperbilirubinemia, cyclosporine toxic levels, renal failure and peripheral schistocytosis, she developed complex partial seizures and bilateral hypodensity lesions in occipital lobes. Fulminant microangiopathy was diagnosed; though promptly treated with immunoglobulins and fenitoin, she died in few days. Necropsy showed diffuse thrombotic disease and a haematoma in left occipital lobe. We review the types of thrombotic microangiopathy described up to now, and the different pathogenic theories related to them. According to our reviewing of the literature, this is the first case of fulminant thrombotic microangiopathy ever described in Spanish language.     

Incidence of SLE in a patient thymectomized for myasthenia gravis

The appearance of systemic lupus erythematosus (SLE) as well as thymopoietin (TP3) treatment in a patient who has undergone thymectomy because of myasthenia gravis (MG) is described. To the authors' knowledge this is the first case of this treatment upon the diagnoses above. The therapy was performed for 12 weeks by the Hungarian Thymotrinan (TP3) preparate according to a previous protocol worked out for Hodgkin's disease. At the beginning and during therapy, cellular and humoral immune parameters were monitored. Twenty months after the therapy the patient has remained in clinical remission for both diseases, MG and SLE, respectively. There is a brief survey of the biochemistry of thymic hormones as well as their clinical use, especially in the treatment of autoimmune disorders. The relative rarity of SLE after operative treatment of MG is under discussion together with the effectiveness of substitutional thymic hormone therapy.     

A monoclonal antibody directed against the non-toxic subunit of a dimeric phospholipase A2 neurotoxin, crotoxin, neutralizes its toxicity

Cancer patients undergoing radiotherapy frequently report fatigue. However, knowledge of the importance of fatigue for these patients and of the factors associated with their fatigue is limited. The aim of the current investigation was to gain more insight into fatigue as related to radiotherapy by answering the following questions. First, how is the experience of fatigue best described? Secondly, to what extent is fatigue related to sociodemographic, medical (including treatment), physical and psychological factors? Finally, is it possible to predict which patients will suffer from fatigue after completion of radiotherapy? Patients with different types of cancer receiving radiotherapy with curative intent (n = 250) were interviewed before and within 2 weeks of completion of radiotherapy. During treatment, patients rated their fatigue at 2-weekly intervals. Results indicate a gradual increase in fatigue over the period of radiotherapy and a decrease after completion of treatment. Fatigue scores obtained after radiotherapy were only slightly, although significantly, higher than pretreatment scores. After treatment, 46% of the patients reported fatigue among the three symptoms that caused them most distress. Significant associations were found between post-treatment fatigue and diagnosis, physical distress, functional disability, quality of sleep, psychological distress and depression. No association was found between fatigue and treatment or personality characteristics. Multivariate regression analysis demonstrated that the intensity of pretreatment fatigue was the best predictor of fatigue after treatment. In view of this finding, a regression analysis was performed to gain more insight into the variables predicting pretreatment fatigue. The degree of functional disability and impaired quality of sleep were found to explain 38% of the variance in fatigue before starting radiotherapy. Fatigue in disease-free patients 9 months after treatment is described in paper (B) in this issue.     

Spontaneous regression of tumoral calcinosis in an infant: a case report

A case of tumoral calcinosis presenting as a supraclavicular mass in an infant is reported. After confirmation by incisional biopsy, the lesion spontaneously resolved without further surgical or medical treatment. This phenomenon has not been described previously in a child with this condition.     

Ventilating tubes in tympanoplasty

The successful surgical treatment of chronic otitis media or its sequela is frequently related to a ventilated tympanic cavity. Tubes at tympanoplasty have been recommended to assure ventilation until eustachian tube and middle ear mucosal functions have been restored and to prevent the complications of graft loss, atelectasis, cholesteatoma and ossicular destruction. This presentation reviews the literature on the subject and documents our results in 40 patients treated by tympanomastoid surgery with ventilating tubes. The types of tubes used, the surgical technique involved, and the selection of cases suitable for this method are described. Cholesteatoma was the primary disease in 32 patients, 6 had chronic otitis media, 1 cholesterol granuloma, and 1 eosinophilic granuloma. Complete healing of grafts following extrusion or removal of the tubes occurred in 34 patients, 2 tubes remain in place, 3 patients had persistent tube site perforations, and 1 was lost to follow-up. None of the patients had graft breakdown as a result of tube placement, and there has been no recurrence of cholesteatoma. In all cases, the follow-up period is a minimum of 18 months and extends to 92 months.     

Rates of change in naturalistic psychotherapy: Contrasting dose–effect and good-enough level models of change.

Most research on the dose–effect model of change has combined data across patients who vary in their total dose of treatment and has implicitly assumed that the rate of change during therapy is constant across doses. In contrast, the good-enough level model predicts that rate of change will be related to total dose of therapy. In this study, the authors evaluated these competing predictions by examining the relationship between rate of change and total dose in 4,676 psychotherapy patients who received individual psychotherapy. Patients attended 6.46 sessions on average (SD = 4.14, range = 3–29, Mdn = 5). The results indicated that although patients improved during treatment, patients' rate of change varied as a function of total dose of treatment. Small doses of treatment were related to relatively fast rates of change, whereas large doses of treatment were related to slower rates of change. Total dose had a nonlinear relationship with the likelihood of clinically significant change. Given the variability in rates of change, it appears that time limits for treatment uniform to all patients would not adequately serve patients' needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients' expectancies, the alliance in pharmacotherapy, and treatment outcomes in bipolar disorder.

Bipolar disorder is characterized by a chronic and fluctuating course of illness. Although nonadherence to pharmacotherapy is a frequent problem in the disorder, few studies have systematically explored psychosocial factors related to treatment discontinuation. Previous research with depressed patients receiving psychotherapy has suggested that expectancies for improvement are related to treatment outcomes and that the therapeutic alliance may partially mediate this relationship. The current study found evidence for a similar relationship between patients' initial expectancies for improvement, patient and doctor-rated alliance, and long-term outcomes in bipolar patients treated with pharmacotherapy for up to 28 months following an acute episode. The results highlight the need for the assessment of expectancies and alliance in bipolar treatment and suggest possible targets for psychosocial interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Successful treatment with immunosuppression, anticoagulation and vasodilator therapy of pulmonary hypertension in SLE associated with secondary antiphospholipid syndrome

Severe pulmonary hypertension (PHT) occurring in patients with systemic lupus erythematosus (SLE) is uncommon. Different modalities have been tried in the treatment for this condition but have not been effective because of progressive increase of pulmonary resistance over time. Our patient with SLE and PHT with antiphospholipid syndrome (APS), a condition which has previously never been described, responded rapidly to combination treatment with immunosuppression, anticoagulation and vasodilator therapy.