Tonsil cryptolysis usingCO2 Swiftlase

Treatment for inflammation of the tonsils has taken a variety of therapeutic forms over the years, ranging from the application of iodine and massage in the preantibiotic era to the tonsillectomy, which prevails today. The architecture of the cryptic tonsil, its clinical implications, and the rationale for a conservative, yet effective treatment modality focusing on the tonsillar crypts are addressed in this article. Also described are the procedures and results of a retrospective clinical study in which conventional tonsillectomy was compared with CO₂ SwiftLase cryptolysis. Although our observations are not based on a prospective, controlled study, the information disseminated here may be useful to otolaryngologists who routinely perform tonsillectomy in their practice, using conventional surgical dissection methods or the CO₂ laser. According to our experience with a population of 120 patients, cryptolysis offers some clear advantages, particularly when performed with the SwiftLase apparatus. The procedure can be performed safely in an ambulatory surgery or office setting under local anesthesia. The cooperative patient avoids the cost and risks of general anesthesia. Limited tissue destruction significantly reduces operative and postoperative complications, discomfort, and recovery time. To conclude, CO₂ SwiftLase cryptolysis is a safe and cost-effective method of treating tonsil pathology without unnecessary sacrifice of the organ, and undue risks and expenses to the patient.^11,12     

Recurrence of left atrium-pulmonary vein conduction following successful disconnection in asymptomatic patients.

BACKGROUND: The clinical significance of conduction recurrences in isolated pulmonary veins of patients with atrial fibrillation is not established. METHODS: Twenty-two patients with paoxysmal atrial fibrillation underwent successful pulmonary vein isolation. Six months after the procedure, 14 patients were free of atrial fibrillation. Two of these patients were subjected to repeat mapping of the left superior pulmonary vein. RESULTS: There was recurrence of pulmonary vein to left atrium conduction despite complete lack of symptoms or evidence of recurrent atrial fibrillation. CONCLUSION: Successful pulmonary vein isolation with abolition of paroxysmal atrial fibrillation does not confer permanent disconnection of the pulmonary vein musculature from the left atrium.     

The complete sequence of the coding region of the ATM gene reveals similarity to cell cycle regulators in different species

Ataxia-telangiectasia (A-T) is an autosomal recessive disorderinvolving cerebellar degeneration, immunodeficiency, radiationsensitivity, and cancer predisposition. A-T heterozygotes aremoderately cancer prone. The A-T gene, designated ATM, was recentlyidentified in our laboratory by positional cloning, and a partialcDNA clone was found to encode a polypeptide with a PI-3 kinasedomain. We report here the molecular cloning of a cDNA contigspanning the complete open reading frame of the ATM gene. Thepredicted protein of 3056 amino acids shows significant sequencesimilarities to several large proteins in yeast, Drosophilaand mammals, all of which share the PI-3 kinase domain. Manyof these proteins are involved in the detection of DNA damageand the control of cell cycle progression. Mutations in theirgenes confer a variety of phenotypes with features similar tothose observed in human A-T cells. The complete sequence ofthe ATM gene product provides useful clues to the function ofthis protein, and furthers understanding of the pleiotropicnature of the A-T mutations.     

Neurological Manifestations of COVID-19 Feature T Cell Exhaustion and Dedifferentiated Monocytes in Cerebrospinal Fluid

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Avoiding visual tipoffs to face lift surgery. A troubleshooting guide.

As aesthetic surgeons we should look more closely at our finished products. A visible scar, distorted ear lobe or tragus, or unnatural hairline says "face lift" to a patient's friends and creates a self-conscious, unhappy patient. The modifications I have adopted of accepted techniques give a more natural look and less conspicuous scarring. They avoid the most dreaded question a patient's associates may ask: "Have you had a face lift?" The text outlines the areas where tipoffs are most prevalent and makes suggestions to minimize them. It is impossible to do inconspicuous surgery all the time, but it is possible by careful observation to minimize visual tipoffs. An unnatural tragus or bad scar should be considered as severe a complication as nerve damage. We should use as proficient avoidance techniques for one as for the other.     

The response of ataxia-telangiectasia homozygous and heterozygous skin fibroblasts to neocarzinostatin

Skin fibroblast strains from patients with ataxia-telangiectasia(A-T) were recently reported to be hypersensitive to the antitumorantibiotic neocarzinostatin (NCS). In this study, the distinctintermediate degree of NCS sensitivity previously shown withtwo strains of A-T heterozygous fibroblasts was extended andconfirmed in an additional eight strains. A sensitivity baselinefor A-T heterozygous cells has thus been established and mayserve for the laboratory diagnosis of A-T heterozygotes, a cancer-pronepopulation. The response of A-T homozygous and heterozygouscells to NCS was further characterized by two molecular parameters,DNA repair synthesis and inhibition of DNA replication. Thepattern of dose response with regard to DNA repair synthesis,as assayed by the benzoylated naphthoylated DEAE cellulose chromatographymethod, was similar in normal, A-T homozygous and A-T heterozygouscells, although certain variability between strains was observedwith regard to the amount of repair incorporation. This findingcorrelates with a similar observation made with the same cellstrains following -irradiation. Inhibition of DNA synthesisfollowing NCS treatment was reduced in A-T homozygous cells,as compared to normal cells, but the "Inhibition resistant"component of DNA synthesis typically observed following treatmentwith low doses of X-rays or bleomycin was not observed withNCS. A-T heterozygous cells showed somewhat less inhibitionof DNA synthesis than normal cells following NCS treatment,although this difference was small and was not significant enoughto serve as an additional laboratory diagnostic aid. It is concludedthat the reduced inhibition of DNA synthesis, rather than reducedextent of DNA repair synthesis, correlates with the cellularhypersensitivity of A-T homozygous cells. This hypersensitivityseems to be observed primarily, if not exclusively, with DNAbreaking agents.     

Perceived feasibility of an occupation-based telerehabilitation intervention for older adults with chronic health conditions in Israel

AimsOur study explored the perceived feasibility of using a home-based telerehabilitation service for older adults with chronic health conditions in Israel.MethodThis mixed-methods study included two focus groups of registered occupational therapists (n = 10) working in rehabilitation wards in Israel. Participants completed an open-ended questionnaire and Likert scale items so that data could be gathered on their perspectives regarding using an in-home telerehabilitation service for older adults after discharge from rehabilitation units. Thematic analysis with an a priori coding approach was applied to the data.ResultsPerceived advantages included transfer to the natural environment and the overcoming of geographical distance. Caregiver support and patient motivation were recognized as enabling factors. Perceived barriers included lack of hands-on contact and the concern that safety could be impeded by technological challenges and the patients’ cognitive status.ConclusionsFindings from this study can potentially contribute to facilitating the implementation of a home-based telerehabilitation service as a practical alternative for elderly patients after discharge from rehabilitation units in Israel.     

A prospective randomized controlled trial of Wallace and Rocket embryo transfer catheters

The aim of this study was to compare the efficacy of two embryo transfer catheters: Wallace and Rocket Embryon in an IVF programme of a tertiary referral university centre. A total of 308 patients undergoing embryo transfer were prospectively randomized to either a transfer with the Wallace catheter or a transfer with the Rocket catheter. The main outcome measure in this study was the clinical pregnancy rate, and secondary outcome measures included implantation rate, visibility of the catheter under ultrasound, number of retained embryos post transfer, and whether change of catheter was required. In addition, patient discomfort during the procedure was recorded. Pregnancy and implantation rates were similar when Wallace or Rocket catheters were used. However, for the Rocket catheter, the tip was more often clearly seen on ultrasound and it had a lower rate of retained embryos in the catheter after transfer (P < 0.05). Experience with different transfer catheters is recommended for difficult cases.