Impact of imported beverages on fluoridated and nonfluoridated communities

In the last 10 years an increasing number of cases of group A streptococcal toxic shock syndrome have appeared in various clinical settings. The manifestation of this syndrome includes rapidly progressive multiorgan failure and soft-tissue necrosis. This report presents a case of streptococcal toxic shock syndrome caused by Streptococcus pyogenes with severe necrotizing fasciitis of the abdominal wall following hysterectomy. Aggressive surgical intervention with debridement of all necrotic tissue necessitated resection of the complete abdominal wall (skin, subcutaneous tissue, muscle and peritoneum). The abdominal wall defect was covered with free myocutaneous flaps and split-skin grafts. Optimal treatment, including adequate antibiotic therapy and radical surgical intervention, is an indispensable prerequisite of successful outcome.     

Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans

A study was conducted to investigate chronic pain patterns in Vietnam veterans with posttraumatic stress disorder (PTSD). Combat veterans with PTSD completed standardized PTSD severity, pain, somatization, and depression measures. Of 129 consecutive out-patient combat veterans with PTSD, 80% reported chronic pain. In descending order were limb pain (83%), back pain (77%), torso pain (50%), and headache pain (32%). Compared to PTSD combat veterans without chronic pain, PTSD veterans who reported chronic pain reported significantly higher somatization as measured by the Minnesota Multiphasic Inventory 2 hypochondriasis and hysteria subscales. In the sample of 103 combat veterans with PTSD and chronic pain, MMPI 2 hypochondriasis scores and B PTSD symptoms (reexperiencing symptoms) were significantly related to pain disability, overall pain index, and current pain level MMPI 2 hypochondriasis and depression scores were also significantly related to percent body pain. These results are discussed in the context of current conceptualizations of PTSD.     

Ovarian germ cell tumors: an update

Study of an amorphous phase in plasma-sprayed hydroxyapatite (HA) coatings is important owing to its unique characteristics and nonnegligible amount of the amorphous phase compared to crystalline HA. However, little is known about the component parts of an amorphous phase. It is known that amorphous phase usually appears as the diffusion maximum (Dmax) in X-ray diffraction (XRD) patterns. Analyzing Dmax, including the position (Pmax) and area of Dmax, we can indicate the component parts of an amorphous phase and their transitions. In this study, the variation of Dmax in XRD patterns of the coatings during plasma spraying, in postheating, and in dissolving in vitro was studied with the aid of XRD. It was found that component parts of the amorphous phase in the coating varied with increasing thickness, consisting of two part represented by Dmax1, located between 29.4 and 29.8 degrees (2 theta), and Dmax2, located between 31.0 and 31.4 degrees (2 theta). It was concluded that Dmax3, located between 32.0 and 32.4 degrees (2 theta), should be referred to as nanocrystals of HA. In addition, the particle size of the starting powder may affect the component parts of the amorphous phase in the coating in addition to thickness. With vacuum heating (650 degrees C) and water vapor treatment at a low temperature (125 degrees C) in a saturated vaporic atmosphere, transition of the amorphous components was not as efficient as that at 490 degrees C with water vapor. The reason might be that the amorphous-to-crystalline HA conversion is dependent on both temperature and water vapor pressure. It was found that amorphous components were transformed completely into crystalline HA after heating at 490 degrees C with a partial water vapor pressure of 0.01 MPa for 2 h. It was concluded that the unstable amorphous components (Dmax1, Dmax2) converted into more stable nanocrystals of HA (Dmax3). Degradation in vitro showed that Dmax3 was more stable than Dmax1 and Dmax2. It was concluded that nucleation of apatite in vitro should be attributed to nanocrystals of HA (Dmax3) except for the amorphous components. It is recommended that the optimal phasic contents of the plasma-sprayed HA coating be mainly composed of crystalline HA and nanocrystals of HA (Dmax3) in terms of the stability and biocompatibility of the coating.     

Gender-related differences in bile acid and sterol metabolism in outbred CD-1 mice fed low- and high-cholesterol diets

These studies were undertaken to determine whether in young adult outbred CD-1 mice there were any gender-related differences in basal bile acid metabolism that might be important in determining how males and females in this species responded to a dietary cholesterol challenge. When fed a plain cereal-based rodent diet without added cholesterol, 3-month-old females, compared with age-matched males, manifested a significantly larger bile acid pool (89.1 vs. 54.1 micromol/100 g body weight), a higher rate of fecal bile acid excretion (13.6 vs. 8.5 micromol/d/100 g body weight), a more efficient level of intestinal cholesterol absorption (41.1% vs. 25. 3%), and a lower rate of hepatic sterol synthesis (338 vs. 847 nmol/h/g). Similar results were found in C57BL/6 and 129Sv inbred mice. In matching groups of CD-1 mice fed a diet containing 1% cholesterol for 21 days, hepatic cholesterol levels increased much more in the females (from 2.4 to 9.1 mg/g) than in the males (from 2. 1 to 5.2 mg/g). This occurred even though the level of stimulation of cholesterol 7-hydroxylase activity in the females (79%) exceeded that in the males (55%), as did the magnitude of the increase in fecal bile acid excretion (females: 262% vs. males: 218%). However, in both sexes, bile acid pool size expanded only modestly and by a comparable degree (females: 19% vs. males: 26%) so that in the cholesterol-fed groups, the pool remained substantially larger in the females than in the males (102.3 vs. 67.6 micromol/100 g body weight). Together, these data demonstrate that while male and female CD-1 mice do not differ qualitatively in the way cholesterol feeding changes their bile acid metabolism, the inherently larger bile acid pool in the female likely facilitates the delivery of significantly more dietary cholesterol to the liver than is the case in males, thereby resulting in higher steady-state hepatic cholesterol levels.     

Treatment of hemangioblastomas in von Hippel-Lindau disease with linear accelerator-based radiosurgery

OBJECTIVE: Stereotactic radiosurgery is increasingly being used to treat hemangioblastomas, particularly those that are in surgically inaccessible locations or that are multiple, as is common in von Hippel-Lindau disease. The purpose of this study was to retrospectively evaluate the effectiveness of radiosurgery in the treatment of hemangioblastomas. METHODS: From 1989 to 1996, 29 hemangioblastomas in 13 patients with von Hippel-Lindau disease were treated with linear accelerator-based radiosurgery. The mean patient age was 40 years (range, 31-57 yr). The radiation dose to the tumor periphery averaged 23.2 Gy (range, 18-40 Gy). The mean tumor volume was 1.6 cm3 (range, 0.07-65.4 cm3). Tumor response was evaluated in serial, contrast-enhanced, computed tomographic and magnetic resonance imaging scans. The mean follow-up period was 43 months (range, 11-84 mo). RESULTS: Only one (3%) of the treated hemangioblastomas progressed. Five tumors (17%) disappeared, 16 (55%) regressed, and 7 (24%) remained unchanged in size. Five of nine patients with symptoms referable to treated hemangioblastomas experienced symptomatic improvement. During the follow-up period, one patient died as a result of progression of untreated hemangioblastomas in the cervical spine. Three patients developed radiation necrosis, two of whom were symptomatic. CONCLUSION: Although follow-up monitoring is limited, stereotactic radiosurgery provides a high likelihood of local control of hemangioblastomas and is an attractive alternative to multiple surgical procedures for patients with von Hippel-Lindau disease.     

Treatment of pigment epithelial detachments due to age-related macular degeneration with intra-ocular C3F8 injection

AIMS: Epstein-Barr virus (EBV) is associated with a subset of gastric and head and neck carcinomas. While p53 mutation and overexpression is common in gastric cancer, in nasopharyngeal carcinoma p53 is overexpressed yet mutation is uncommon, leading to a proposed viral mechanism of p53 upregulation. We examined the expression of p53 protein in 18 EBV-associated gastric carcinomas (EBV-GA) and compared it with 29 age and sex matched EBV-negative gastric carcinomas (EBV0-GA) and 23 non-nasopharyngeal EBV-associated carcinomas (EBV-CAs) arising from various head and neck regions. METHODS AND RESULTS: Using two monoclonal antibodies (DO7 and PAb1801) with microwave pre-treatment, the p53 protein was scored according to the intensity and percentage of positive cells. The EBV0-GA showed a clear cut bimodal distribution of p53 levels, with either homogeneous intense staining of most tumour nuclei, or only very weak expression in a few cells. Nearly all the EBV-GA and EBV-CAs showed a weak to moderate p53 expression, characterized by heterogeneous intensity of staining in a variable proportion of tumour cells. CONCLUSIONS: The difference in p53 levels in the EBV0-GA and EBV-GA is statistically significant. The heterogeneous level of p53 in the EBV-GA and EBV-CAs and its difference from the EBV0-GA is suggestive of a non-mutational mechanism of p53 upregulation and underscores the role of the virus in the oncogenic pathway.     

The effect of inhaling a dry powder of sodium chloride on the airways of asthmatic subjects

Wet aerosols of 4.5% sodium chloride (NaCl) are often used to assess the bronchial responsiveness associated with asthma. We questioned whether dry NaCl could be used as an alternative. Dry powder NaCl was inhaled from capsules containing either 5, 10, 20 or 40 mg to a cumulative dose of 635 mg. The powder was delivered via an Inhalator or Halermatic. The airway sensitivity to the dry and wet NaCl was compared in 24 patients with asthma aged 19-39 yrs. All subjects responded to both preparations and the geometric mean (95% confidence intervals) for the provocative dose of NaCl causing forced expiratory volume in one second (FEV1) to fall 20% from baseline (PD[20,NaCl]) for dry NaCl was 103 mg (68-157) versus 172 mg (102-292), p<0.03 for the wet NaCl. The response to dry NaCl was reproducible and on repeat challenge the PD20 was 108 mg (75-153). The mean maximum fall in FEV1 was approximately 25% on each of the two test days. Spontaneous recovery occurred within 60 min after challenge with dry NaCl and within 5 min after bronchodilator. There were no serious side-effects requiring medical attention, however some patients coughed on inhalation of the 40 mg dose and three gagged. Arterial oxygen saturation remained within normal limits. We conclude that a suitably prepared dry powder of sodium chloride could potentially replace wet sodium chloride to assess bronchial responsiveness in patients with asthma, but further studies are required to establish the long-term stability of the dry powder preparation.     

Regulation of the effector stages of experimental autoimmune encephalomyelitis via neuroantigen-specific tolerance induction. III. A role for anergy/deletion

Whereas the photodynamic therapy (PDT) of cancer has recently shown rapid clinical acceptance, photodynamic antimicrobial chemotherapy (PACT)--which predates the related cancer regimen--is not widely appreciated. Like PDT, PACT utilizes photosensitizers and visible or ultraviolet light in order to give a phototoxic response, normally via oxidative damage. Currently, the major use of PACT is in the disinfection of blood products, particularly for viral inactivation, although more clinically-based protocols are being developed, e.g. in the treatment of oral infection. The technique has been shown to be effective in vitro against bacteria (including drug-resistant strains), yeasts, viruses and parasites. A wide range of photosensitizers, both natural and synthetic, is available with differing physicochemical make-up and light-absorption properties. PACT is proposed as a potential, low-cost approach to the treatment of locally occurring infection.     

Functional pancreatic islet cell tumors with liver metastasis: the role of cytoreductive surgery and transcatheter arterial chemoembolization: a report of five cases

Malignant pancreatic islet tumors are slow-growing tumors. Their relatively benign behavior makes aggressive treatment worthwhile. From January, 1987, to January, 1998, five cases of malignant pancreatic islet tumors with liver metastasis were diagnosed at the Veterans General Hospital-Taipei. Of these, three were gastrinomas and the others were vasoactive intestinal peptide (VIPoma, 1 case) and insulinoma (1 case). Four patients (3 with gastrinomas and 1 with insulinoma) had undergone cytoreductive surgery when the diagnosis of metastasis was made. All five patients underwent transcatheter arterial chemoembolization (TACE). All patients had improved symptoms after cytoreductive surgery and TACE. The survival of patients who underwent combined surgery and TACE was 38 and 17 months in the two gastrinoma cases, more than eight months in one gastrinoma case and more than 20 months in the insulinoma case (these 2 patients are still alive). One VIPoma patient who underwent TACE survived for 12 months. In conclusion, treatment for metastatic pancreatic islet cell tumors require a multidisciplinary approach. Metastasis of the tumor is not a contraindication for aggressive therapy. Combined cytoreductive surgery and TACE can relieve symptoms and are of benefit for patients with pancreatic islet cell tumors with liver metastases.     

Prevalence and disease experience rates in Korean physicians

This study aimed to find out the morbid status of Korean physicians living in Korea, as one part of a feasibility study on the Korean physician cohort. It was performed by mail survey using a self-administered questionnaire from Jan. 1, 1995 through Dec. 31, 1995. Study subjects were 21,552 including 17,877 (81.1%) males and 3,384 (15.5%) females. Person based prevalence rate of disease was 17.7% (18.3% for males and 13.8% for females) with the rate increasing with age. The disease group showing the highest prevalence rate was circulatory diseases (5.16%) for males, and respiratory disease (3.13%) for females. The individual disease showing the highest prevalence rates was hypertension (3.77%) for males and allergic rhinitis (2.25%) for females. The person based disease experience rate was 36.2% (36.9% for males, 32.7% for females) with the rate increasing with age. The disease group showing the highest disease experience rate was digestive disease for both sexes (10.05% for males, 7.42% for females). Individual disease showing the highest disease experience rate was hypertension (5.00%) for males and allergic rhinitis (4.08%) for females. There were different ranks of both prevalence and disease experience rate depending on age in both sexes.