Providence School Asthma Partnership: School-based Asthma Program for Inner-City Families

Over 3 years, 972 families participated in an after-school asthma program at their child's school. Parents and children attended concurrent 2¹/₂ -hour workshops. Parents were 74% Latino; 45% non-English speaking, with 77% of children on Medicaid. Asthma symptoms were significantly reduced, from multiple times per week to less than once per week on average. Oral steroid use decreased to one third of baseline use. Hospital days decreased from 11% to 2%; emergency visits decreased 35% to 4%; and school days missed decreased 48% to 20%. This program has now become sustainable with both private and Medicaid insurance coverage.     

Transdisciplinary approach to restore pancreatic islet function

Immunologic Research - The focus of our research is on islet immunobiology. We are exploring novel strategies that could be of assistance in the treatment and prevention of type 1 diabetes, as well...     

Determination of Crotalus durissus cascavella venom components that induce renal toxicity in isolated rat kidneys.

Envenomation by Crotalus durissus terrificus leads to coagulation disorders, myotoxicity, neurotoxicity and acute renal failure (ARF). The most serious systemic change and primary cause of death is ARF. In this work, we used RP-HPLC to isolate crotoxin, convulxin and gyroxin from venom of the related subspecies Crotalus durissus cascavella and investigated the effects of these toxins on renal function in the isolated rat kidneys perfused with Krebs-Henseleit solution containing 6% of bovine serum albumin. The parameters studied included perfusion pressure (PP), renal vascular resistance (RVR), glomerular filtration rate (GFR), urinary flow (UF), percent of sodium tubular transport (%TNa(+)), percent of potassium tubular transport (%TK(+)) and percent of chloride tubular transport (%TCl(-)). Crotoxin (5 microg/ml) increased the PP, RVR, GFR, UF and decreased %TNa(+), %TK(+) and %TCl(-), with gyroxin (5 micro g/ml) the GFR remained stable during the 120 min of perfusion, whereas PP and RVR increased significantly and the %TNa(+), %TK(+) and %TCl(-) decreased significantly. Convulxin (5 micro g/ml) had no effect on renal function. Crotoxin caused alterations in all renal parameters. Gyroxin produced a minor effect compared to crotoxin. These results indicated that crotoxin is the main componenet responsible for acute nephrotoxicity caused by C. d. cascavella venom.     

Clinical outcome and survival after esophagectomy for carcinoma in elderly patients

Advances in perioperative management have allowed more and more elderly patients to undergo major surgery with postoperative morbidity and mortality rates comparable to those of younger individuals. The aim of this study was to evaluate the impact of age on the clinical outcome and long-term survival of patients with esophageal carcinoma undergoing esophagectomy. Nine-hundred patients with esophageal carcinoma were divided into two groups: A (n = 403) with age > or = 65 years, and B (n = 497) with age < 65 years. One-hundred and fifty three (38%) patients of group A underwent surgery compared to 272 (55%) of group B (P < 0.01). Postoperative mortality, and the prevalence of anastomotic leak and respiratory complications were similar in both groups; conversely, there was a higher prevalence of cardiovascular complications in group A (13% vs 3%, P < 0.01). Five-year survival was about 35% in both groups. In conclusion, advanced age should no longer be considered an absolute contraindication to esophagectomy for carcinoma in selected patients. In fact, the postoperative mortality and long-term survival rates of elderly patients undergoing resection are comparable to that of younger individuals.     

The distally-based radial fasciosubcutaneous flap for soft tissue cover of the flexor aspect of the wrist.

The distally-based radial forearm fasciosubcutaneous flap is based on the distal perforators of the radial artery. We used it in a particularly difficult case involving loss of soft tissue at the wrist with exposure of tendons and nerves after an operation to section the transverse carpal ligament for carpal tunnel syndrome complicated by a chronic fistula.     

Lipoidosis cutis et mucosae

Ohne ZusammenfassungMit 18 Textabbildungen.     

Esophagectomy without thoracotomy as a treatment of esophageal cancer. Indications, technical features and results

Between 1980 and 1989, 229 patients with squamous cell carcinoma of the esophagus underwent esophagectomy without thoracotomy. The tumor was located in cervical and thoracic esophagus in 112 and 117 cases, respectively. Out the patient with a tumor of the thoracic esophagus, the mean age was 63 years (range 32-81). There were 90 males and 27 females. The locations inside the thoracic esophagus were as follows: upper thoracic 39, middle thoracic 40, lower thoracic 38 cases. A complete resection of the tumor was performed in 87 patients and in 30 cases the procedure was palliative. The digestive tract was reconstructed by means of esophago-gastrostomy in 101 patients, esophago-colostomy in 13, esophago-jejunostomy in 2, and pharyngo-colostomy in 1 patient, respectively. The post-operative morbidity was as follows: pulmonary complications 13.6%, anastomotic leak 17.1%, necrosis 5.1%, recurrent laryngeal nerve injuries 10.2%. The overall hospital mortality was 7.6%. Actuarial survival rates after curative and palliative resection were 82.4% and 47.1% at 7 year, 46.3% and 8.1% at 2 years, 39.0% and 0% at 3.5 and 6 years. In our experience, esophagectomy without thoracotomy is an excellent technique, with low morbidity but with oncologic limitations. Patients with carcinomas of the thoracic esophagus in whom thoracotomy is contraindicated can be resected with this technique with morbidity and mortality rates comparable to those of patients undergoing transthoracic esophagectomy.     

Enhanced oxygenation promotes beta-cell differentiation in vitro

Despite progress in our knowledge about pancreatic islet specification, most attempts at differentiating stem/progenitor cells into functional, transplantable beta cells have met only with moderate success thus far. A major challenge is the intrinsic simplicity of in vitro culture systems, which cannot approximate the physiological complexity of in vivo microenvironments. Oxygenation is a critical limitation of standard culture methods, and one of special relevance for the development of beta cells, known for their high O(2) requirements. Based on our understanding of islet physiology, we have tested the hypothesis that enhanced O(2) delivery (as provided by novel perfluorocarbon-based culture devices) may result in higher levels of beta-cell differentiation from progenitor cells in vitro. Using a mouse model of pancreatic development, we demonstrate that a physiological-like mode of O(2) delivery results in a very significant upregulation of endocrine differentiation markers (up to 30-fold for insulin one and 2), comparable to relevant in vivo controls. This effect was not observed by merely increasing environmental O(2) concentrations in conventional settings. Our findings indicate that O(2) plays an important role in the differentiation of beta cells from their progenitors and may open the door to more efficient islet differentiation protocols from embryonic and/or adult stem cells. Disclosure of potential conflicts of interest is found at the end of this article.