Technical indications and results of reconstructive laryngectomies

The results of a series of 164 patients operated on using reconstructive laryngectomy, gives satisfaction for this type of operation if the indications are respected after a very specific endoscopic, radiological and per-operative loco-regional and local check-up. The functional results are clearly improved by a pluridisciplinary treatment associating a nursing team, orthophonists and physical therapists.     

Prevention of neonatal macrosomia in gestational diabetes by the use of intensive dietary therapy and home glucose monitoring

This study was undertaken to determine if intensive dietary therapy, home blood glucose monitoring, and the selective use of insulin can be effective in preventing fetal macrosomia. All patients were screened at 24 to 28 weeks' gestation using a modification of O'Sullivan's criteria. The 153 patients diagnosed as gestational diabetics by the study protocol were placed on a 1800 to 2000 Kcal American Diabetes Association diet and taught home glucose monitoring. Insulin therapy was initiated only if blood glucose control was inadequate. There were no significant differences (p greater than 0.05) between the study and reference populations in regard to mean birthweight or the incidence of macrosomia. Since our study criteria for diagnosing gestational diabetes were slightly different from those of the National Diabetes Data Group (NDDG), data from 99 patients meeting the NDDG criteria were analyzed in a similar manner. No significant differences were found between this subgroup and the reference population. Since only 7.2% of our study patients required insulin, we conclude that the incidence of fetal macrosomia in gestational diabetes can be kept equal to that of the general population by a program of intensive dietary therapy and home glucose monitoring, with insulin being used only therapeutically, not prophylactically.     

Laryngeal and tracheal complications of prolonged intubation]

Based on a retrospective study of 595 patients having undergone prolonged intubation, the authors present the main complications encountered and, in particular, the mucous ulceration which appears to be systematic and is itself at the origin of secondary stenosizing or granulomatous sequelae. Research is still needed concerning the follow-up of the intubated patients in order to limit the pressures exerted between the cordal mucosa or the tracheal mucosa in contact with the endotracheal tube. A systematic check upon removal of the tube decreases the secondary sequelae by starting adapted antacid, anti-inflammatory and antibiotic treatments, as well as certain acts of laryngeal microsurgery and, in some cases, laryngeal rehabilitation for both the voice and deglutition.     

Siblings of childhood cancer survivors: How does this “forgotten” group of children adjust after cessation of successful cancer treatment?

Siblings of childhood cancer patients are labelled the “forgotten children” because they experience significant psychosocial distress and are isolated from support systems inside and outside the family. This study investigates the late consequences of the cancer experience for siblings. 60 siblings of cancer survivors were compared with control subjects on measures of psychosocial adjustment. No differences were found between siblings of cancer survivors and controls on emotional and behavioural problems and competence, suggesting that siblings adjust well to the period after cessation of treatment. The effect of demographic, family and disease-related characteristics on the siblings' psychosocial adjustment was limited. Whereas during treatment many psychosocial problems for siblings have been reported, this does not result in a heightened risk of psychological disturbance for siblings as a late effect. The implications for patient care are discussed.     

Coexpression of GSK-3beta corrects phenotypic aberrations of dorsal root ganglion cells, cultured from adult transgenic mice overexpressing human protein tau

Coexpression of constitutively active GSK-3beta[S9A] rescued the axonal pathology induced by overexpression of human tau in transgenic mice (Spittaels et al., (2000) J. Biol. Chem. 275, 41340-41349). We isolated dorsal root ganglion (DRG) neuronal cultures from adult tau4R- and tau4R x GSK-3beta-transgenic mice to define the mechanisms at the cellular and subcellular level. DRG from tau4R-transgenics showed a reduced sprouting capacity while density and stability of microtubules in the axonal processes were significantly increased. Video-enhanced contrast microscopy demonstrated a dramatic inhibition of fast axonal transport. Coexpression of GSK-3beta increased tau phosphorylation and reversed the effects on microtubule stability and saltatory motion. In DRG from GSK-3beta single transgenics, increased tau phosphorylation was evident without any major effects on microtubule stability or axonal transport. These observations support the hypothesis that excess tau competed with motor-proteins for binding to microtubules and/or that a rigid microtubular system inhibits axonal transport.     

Family factors and life events as risk factors for behavioural and emotional problems in children

The aim of this study was to identify groups of children at increased risk of behavioural or emotional problems on the basis of socio-demographic characteristics, family characteristics, and recent life events with a focus on unemployment and divorce or separation. We obtained data on the Child Behavior Checklist (CBCL) from a community-based national sample of 4480 parents of school-aged children and interviewed them about their demographic and family characteristics and about the child's recent life events. Results showed that family characteristics and recent life events were more strongly associated with children's risks of behavioural and emotional problems as measured by the CBCL than other demographic characteristics. Risks were somewhat higher for children who had experienced parental unemployment and divorce or separation recently, as compared to those who had experienced these events in the more distant past. We conclude that children with recent experience of parental unemployment or parental divorce or separation are at a relatively high risk of behavioural and emotional problems as reported by parents. Although relatively high, the risks that were found do not justify restriction of screening for behavioural and emotional problems to these children.     

Prevalence and determinants of minor psychiatric disorder in Turkish immigrants living in the Netherlands

Background The aim of this study was to assess the prevalence of and risk and protective factors for minor psychiatric disorder in a general population sample of Turkish immigrants living in the Netherlands. Methods Minor psychiatric disorder was assessed with the 28-item version of the General Health Questionnaire. Demographic, immigration, social and support, and stress related variables were assessed with the Turkish Immigrant Assessment Questionnaire. The study sample was a randomly selected sample of 262 male and 523 female Turkish immigrants. Results Of all immigrants, 33.4 % experience minor psychiatric disorder with more females (36.1 %) than males (27.9 %) with disorder. For males, unemployment is a strong risk factor, whereas for females the burden of additional tasks (physical illness and inclusion of family members) in the household increases the risk for psychiatric disorder. For both males and females, however, the quality of the relationship with their partner in addition to enduring stresses around housing and finances are associated with elevated risks. Conclusions The incidence of minor psychiatric disorder in this sample of Turkish immigrants living in the Netherlands is higher than the incidence normally found in general population samples. The expression of somatic complaints around ‘tightness’ should alert physicians to further explore symptoms of minor psychiatric disorder and to examine sources of distress stemming from the partner relationship, the family, work and from poor housing and financial conditions. Accepted: 22 November 2001     

Differential expression of stress proteins in human adult astrocytes in response to cytokines

Various lines of evidence suggest a close relationship between heat shock proteins (hsp) and several autoimmune diseases such as arthritis, diabetes and multiple sclerosis. While enhanced expression of hsp in autoimmune diseases is often regarded as a non-specific bystander effect of the inflammatory process, surprisingly little is known on hsp regulation by inflammatory mediators such as cytokines. In this study cytokine-induced expression of hsp60, hsp27 and alphaB-crystallin was studied in cultures of primary human adult astrocytes at the mRNA as well as at the protein level. We show differential hsp expression patterns in response to pro-inflammatory and immunoregulatory cytokines. Hsp60 expression was found to be enhanced in response to cytokines as diverse as IL-1beta, TNF-alpha, IL-4, IL-6 and IL-10. Upregulation of hsp27, however, was primarily induced by immunoregulatory cytokines like IL-4, IL-6 and TGF-beta whereas alphaB-crystallin expression was found to be enhanced by the pro-inflammatory cytokine TNF-alpha only. None of the cytokines studied was able to enhance expression of all three hsp simultaneously. These results show that in human astrocytes induced expression of hsp27 and alphaB-crystallin is dependent on the presence of a defined set of stimuli, while induced expression of hsp60 is a much less selective event. This highly differential pattern of hsp expression in response to inflammatory mediators known to play an important role in the pathogenesis of autoimmune diseases indicates that hsp responses are specific rather than non-specific bystander responses.     

Sonotubometry: eustachian tube ventilatory function test: a state-of-the-art review.

OBJECTIVE: Disturbance of any of the ET functions may contribute to the development of otitis media. Sonotubometry measures the ventilatory function using sound. The qualities of sonotubometry as a test for eustachian tube ventilatory function have been studied by various investigators. The development of the method is described in the review, and a summary of the study results is provided to make an estimate of the diagnostic potential of this eustachian tube function test. DATA SOURCES: The English-language literature on the topic was searched systematically by Medline and Pubmed using the following key words: ventilatory function, eustachian tube, sonotubometry, and function test. There were no limits for the year of publication. STUDY SELECTION: Articles that described the method itself (validity, reproducibility, diagnostic value) were studied in detail. DATA EXTRACTION: All the articles described in study selection were used for this review. CONCLUSIONS: The technique of sonotubometry has been improved gradually over the years. The results of sonotubometry are at least as good as those of other function tests. However, because the results still tend to be ambiguous in children and otitis media is most common in this population, the reproducibility and application of sonotubometry must be evaluated further. Sonotubometry has great advantages over other function tests, but it is not used routinely to assess eustachian tube ventilatory function because its value for clinical practice has not yet been adequately demonstrated. The review showed that sonotubometry can be improved further and that efforts to do so seem justified because it forms a particularly promising method to assess eustachian tube function in children with suspected eustachian tube disease.     

Presentation and outcome of severe anticholinesterase insecticide poisoning.

AIMS: To document the patterns of presentation and outcome of severe anticholinesterase insecticide poisoning in children requiring intensive care. METHODS: Retrospective case note review of all 5541 children admitted to the paediatric intensive care unit (PICU) of a university hospital during the 10 years from January 1990 to May 2000. Fifty four children (1%) with anticholinesterase insecticide poisoning were identified. Presenting features, route of exposure, treatment, complications, and mortality were recorded. Data were analysed by the Fisher's exact and Mann-Whitney tests. RESULTS: More children than expected were from a rural area (46% versus 25%). Decontamination occurred in 50% of children prior to PICU admission. Enteral exposure was most common (n = 27; 50%). Median pseudocholinesterase level was 185 IU/l (range 75-7404). Median total dose of atropine required to maintain mydriasis was 0.3 mg/kg (range 0.03-16.7) over a median of 10 hours (range 1-160). Complications included coma (31%), seizures (30%), shock (9%), arrhythmias (9%), and respiratory failure requiring ventilation (35%). No significant differences were detected in incidence of seizures, cardiac arrhythmias, respiratory failure, mortality, duration of ventilation, or PICU stay, according to route of exposure, or state of decontamination. Four children died (7%). Mortality was associated with the presence of a cardiac arrhythmia (likelihood ratio 8.3) and respiratory failure (likelihood ratio 3.3). CONCLUSION: The mortality and morbidity of severe anticholinesterase insecticide poisoning in childhood is not related to route of exposure, or to delay in decontamination. However, the presence of either a cardiac arrhythmia or respiratory failure is associated with a poor prognosis.