Smallpox: what every otolaryngologist should know.

OBJECTIVE: In light of recent terrorist events and the potential threat of smallpox as a biological agent, we present information concerning smallpox to better inform the otolaryngologist concerning this disease and its prevention. STUDY DESIGN: We performed a review of the smallpox and smallpox vaccination literature over the past 200 years using MEDLINE, PREMEDLINE, Centers for Disease Control and Prevention Internet site, World Health Organization Internet site, and references found in previous publications not found in MEDLINE or PREMEDLINE. Our search focused on the pathogenesis, clinical presentation, course, unique manifestations in the head and neck, diagnosis, and treatment of smallpox, as well as the method of smallpox vaccination, vaccination contraindications, and complications. RESULTS: Smallpox is a viral disease with a high mortality rate. Its clinical course, manifestations, and methods of prevention are carefully analyzed in light of otolaryngology practice. CONCLUSION: Smallpox manifestations in the head and neck often presented as acute airway obstruction and also as long-term sequelae such as ectropion, nasal vestibular stenosis, conductive hearing loss, and blindness. Most chronic sequelae involve the head and neck. Smallpox vaccination is effective but not without potential serious risks.     

Advances in understanding cell interactions in tissue resorption. Relevance to the pathogenesis of periodontal diseases and a new hypothesis

Much of the connective tissue degradation that takes place in periodontal diseases is mediated by proteolytic enzymes. Previous studies have focused on the action of proteinases released by invading polymorphonuclear neutrophils and macrophages, and bacterial enzymes. In view of recent work establishing that resident connective tissue cells can be induced by cytokines to bring about the destruction of their own matrix, we propose a new hypothesis. In this we envisage that a critical step is the interaction of bacterial antigens with inflammatory cells, resulting in the production of a cytokine, interleukin-1. Our interpretation of in vitro evidence is that the loss of connective tissue attachment and bone matrix resorption in periodontal diseases is mediated by metalloproteinases such as collagenase and stromelysin released by cells of the periodontium. Such proteolytic destruction can be induced by interleukin-1, whose production may not be dependent on a specific microbial flora but may be triggered by a number of organisms. It is now clear that interleukin-1 has multiple actions on both immune and non-immune cells; these include the induction of lymphocyte differentiation and proliferation and the stimulation of bone and cartilage resorption, and prostaglandin and metalloproteinase synthesis by connective tissues. It seems likely that further knowledge about the production and function of this cytokine will have an increasing impact in many diseases that involve resorption, particularly since interleukin-1-like molecules can be produced by cell types other than monocytes/macrophages, including keratinocytes and fibroblasts.     

Disappearing hypercalcaemia

Four women presented with symptomatic hypercalcaemia and raised concentrations of serum parathyroid hormone (PTH). In each case, serum calcium returned spontaneously to normal. In two patients serum PTH also fell to the normal range and biochemical relapse has not occurred despite prolonged follow-up. In the others, serum PTH remained elevated and subsequent symptomatic hypercalcaemia necessitated parathyroidectomy. In the first two cases, autoparathyroidectomy is the most likely explanation; the initial fall in serum calcium in the other two patients is unexplained. Large fluctuations in serum calcium may occur in some patients with hyperparathyroidism and prolonged and careful observation is required when this occurs.     

人晶体 γ-晶体蛋白的研究:Ⅳ.近紫外线对胚 γ_2-晶体蛋白的光氧化作用

对人胚胎晶体γ_2-晶体蛋白溶液用近紫外线(γmax 365nm)照射,不同时间取样分析。利用巯基(-SH)特异性试剂 DACM[N-(7-甲基氨基-4-甲基-3-邻羟苯烯基)-马来酰亚胺],经 SDS-聚丙烯酰胺凝胶电泳观察光照射后的γ_2-晶体蛋白及其聚合物的游离巯基,同时检测照射后的蛋白溶液的紫外吸收光谱、光散射强度、色氨酸荧光发射光谱,以及丙烯酰胺对色氨酸荧光的猝灭效应。结果显示:人胚胎γ_2-晶体蛋白经紫外线照射,使其游离-SH 减少,蛋白聚合和分解,蛋白溶液的光散射增强,其二聚体不含游离-SH,γ_2-晶体蛋白的色氨酸荧光减少,这些变化随照射时间的延长而更明显;而对丙烯酰胺对蛋白分子中的色氨酸荧光猝灭效应影响不大。说明人胚胎γ_2-晶体蛋白通过光氧化,损伤及含游离-SH 的氨基酸残基、色氨酸残基,光氧化促使蛋白聚合和分解.提出通过进一步定量分析,可能在较深层次揭示紫外光氧化损伤含-SH 氨基酸、色氨酸残基,进而影响整个蛋白质分子结构的差异。眼科学报 1993;9:85-89。     

Cytokines as immunological adjuvants.

Various cytokines have been shown to be effective immunological adjuvants in a variety of model systems, enhancing protection induced by viral, bacterial and parasitic vaccines, and increasing parameters of immunity in tumour immunization models and in clinical trials. While in most cases cytokine adjuvanticity is not as powerful as that shown by the best experimental adjuvants, such as saponin and Freund's, it can rival that of the adjuvants presently allowed for human use and there are many possible routes to improvement. The use of cytokines may allow for a choice of which immune parameters are enhanced in order to further enhance protective effects and decrease the negative effects of vaccines.     

Hypomagnesaemia causing myopathy and hypocalcaemia in an alcoholic

A well-nourished alcoholic patient developed a subacute myopathy which responded rapidly to correction of severe hypomagnesaemia. The finding of profound hypocalcaemia prompted the measurement of serum magnesium. Magnesium deficiency should be looked for in any alcoholic patient with a myopathy as the prognosis seems better than in many other forms of alcoholic myopathy. Correction of the magnesium deficiency corrects the hypocalcaemia without the need for calcium supplementation.     

Monoclonal antibodies and magnetic microspheres for the depletion of leukaemic cells from bone marrow harvested for autologous transplantation

The use of a panel of monoclonal antibodies and anti-mouse immunoglobulin-coated microspheres is described for the depletion of leukaemic blasts from bone marrow. Marrow treated in this way rapidly reconstitutes haemopoietic function after high-dose consolidation chemoradiotherapy. The recovery of cells from bone marrow is similar but not identical to results obtained on removal of neuroblasts from marrow to be used for autologous transplant. This is probably a reflection of the cross-reactivity of 'anti-leukaemic' antibodies with a variety of haemopoietic progenitor cells. The study described here demonstrates the feasibility of using this method to purge leukaemic cells from bone marrow. A much larger randomised study between patients receiving either purged or non-purged bone marrow would be necessary to validate the need to remove small numbers of tumour cells from bone marrow.