Ambulatory powered intracapsular tonsillectomy and adenoidectomy in children younger than 3 years

OBJECTIVES: (1) To assess the safety and efficacy of outpatient intracapsular tonsillectomy, which has been recently described as a less invasive means of treating obstructive tonsillar hypertrophy, in children younger than 3 years; and (2) to challenge the standard dictum that children younger than 3 years should be admitted to the hospital after tonsil and adenoid surgery. DESIGN: Retrospective cohort study via medical chart review and telephone interview. SETTING: Pediatric otolaryngology group practice with academic affiliation.Patients Children with symptomatic tonsillar and adenoid hypertrophy (n = 226) who underwent microdebrider-assisted intracapsular tonsillectomy between September 1, 2000, and October 1, 2002. METHODS: Comparison of study group (children <3 years old, n = 38; mean age, 30.3 months; 20 boys and 18 girls) with control group (children > or =3 years, n = 188), measuring pain, oral intake, analgesic requirements, complications, need for readmission, and relief of symptoms. RESULTS: There were no statistically significant differences in pain, oral intake, or analgesic requirements. All children, regardless of age, were discharged home within 4 hours of surgery. No child in either group required readmission, and there were no complications related to the time of discharge. Younger children experience equivalent symptomatic improvement. CONCLUSION: Children younger than 3 years may undergo intracapsular tonsillectomy as outpatients without sacrificing safety or efficacy.     

Magnitude and impact of treatment delays on weeknights and weekends in patients undergoing primary angioplasty for acute myocardial infarction (the cadillac trial)

In 2,082 patients in the CADILLAC trial, the outcomes of patients presenting during peak hours were compared with those presenting during peak hours (Monday to Friday 8a.m. to 8 p.m., n = 1,047, 51%) were compared with those of patients presenting during off-peak hours (weeknights from 8 p.m. to 8 a.m. and weekends, n = 989, 49%). Although treatment times to percutaneous coronary intervention (PCI) were delayed approximately 21 minutes, in patients with acute myocardial infarctions occurring on weeknights and weekends, this modest delay did not adversely affect procedural success, myocardial recovery, or survival after PCI.     

Predicting mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PAMI risk score)

We performed a pooled analysis of the Primary Angioplasty in Myocardial Infarction (PAMI) trials to examine predictors of death after primary percutaneous coronary intervention. Using these data, we developed a risk score with a range of 0 to 15 points. The PAMI risk score was found to be a strong predictor of late mortality.     

E-cadherin and catenins in early squamous cervical carcinoma

OBJECTIVES: To examine the prognostic significance of the protein expression of E-cadherin, alpha-, beta-, and gamma-catenin in early squamous cervical carcinoma (SCC). METHODS: We studied 219 patients who underwent radical hysterectomy and bilateral lymphadenectomy at our institution for stage IB SCC between 1987 and 1993. Immunohistochemistry using monoclonal antibodies against E-cadherin, alpha-, beta-, and gamma-catenin was used to examine protein expression. Ten patients who underwent hysterectomy for uterine prolapse served as controls. RESULTS: Membrane expression for E-cadherin, alpha-, beta-, and gamma-catenin was decreased and low expression (< or =50% positive cells) was found in 198/219 (90%), 154/219 (70%), 157/219 (72%), and 181/219 (83%) tumors, respectively, and high (>50% positive cells) in 21/219 (10%), 65/219 (30%), 62/219 (28%), and 38/219 (17%) tumors, respectively. In univariate analysis, all classical clinicopathological parameters but none of the investigated proteins were associated with prognosis. In multivariate analysis, only deep stromal invasion was independently related to survival. CONCLUSION: E-cadherin, alpha-, beta-, and gamma-catenin were not independently associated with prognosis in stage IB SCC.     

T-cell-mediated mechanisms involved in resolution of genital herpes simplex virus type 2 (HSV-2) infection of mice

Resolution of a HSV-2 infection of the female genital tract has been shown to be T-cell dependent. The T-cell populations and mechanisms involved in clearance of virus from the genital epithelium were examined in this study. T lymphocytes expressing either alphabeta or gammadelta T-cell receptors (TCR) have been detected in the vaginal epithelium of mice. The involvement of gammadelta T cells in HSV-2 clearance was tested by intravaginal (ivag) challenge of mice depleted of alphabeta T cells by administration of specific antibodies and of mice lacking gammadelta T cells due to specific deletion of the delta TCR gene. The results of these studies strongly suggest that gammadelta T cells are not required for or involved in clearance of HSV-2 from the genital epithelium. Mechanisms of virus clearance employed by alphabeta T cells were also examined. Although HSV-specific lytic activity could be demonstrated ex vivo in populations of vaginal exudate cells from HSV-infected mice, clearance of virus did not require either perforin- or Fas/Fas ligand (FasL)-dependent cytolytic pathways. In contrast, virus resolution was significantly impaired following neutralization of interferon-gamma (IFN-gamma), but not tumor necrosis factor-alpha (TNF-alpha). Together, these results suggest that non-lytic mechanisms mediated by alphabeta T cells were responsible for resolution of a genital HSV-2 infection.     

Anaerobic transformation of compounds of technical toxaphene. 2. Fate of compounds lacking geminal chlorine atoms

The major toxaphene metabolites in sediment and soils (2-exo,3-endo,6-exo,8,9,10-hexachlorobornane [B6-923] and 2-endo,3-exo,5-endo,6-exo,8,9,10-heptachlorobornane [B7-1001]) were incubated with the isolated gram-negative bacterium Dehalospirillum multivorans. Within 14 d, biotransformation of B7-1001 was nearly quantitative, resulting in two penta- and six hexachlorobornanes, as well as one unsaturated hexachloro compound of technical toxaphene. The major transformation product (approximately 50% of all metabolites) was identified as 2-exo,3-endo,5-exo,8,9,10-hexachlorobornane (B6-903). Abiotic dehydrochlorination of B7-1001 with methanolic KOH resulted in the formation and subsequent identification of the lone unsaturated compound as 2,5-endo,6-exo,8,9,10-hexachloroborn-2-ene. Thus, dehydrochlorination was found to be a minor process of the anaerobic transformation of toxaphene. Biotransformation of 70% of amended B6-923 within 14 d demonstrated that reductive dechlorination was not exclusively associated with geminal Cl atoms, as previously suggested. Three pentachlorobornanes were identified as transformation products, one of which was identical with a transformation product of B7-1001. This commonality unequivocally proves this metabolite to be 2-exo,3-endo,8,9,10-pentachlorobornane. Fifteen previously unknown metabolites of B6-923, B7-1001, and other toxaphene compounds identified in this study were detected in sediment from Lake Ontario (Canada), underscoring the importance of microbial toxaphene transformation in natural, aquatic environments.     

Age-related mineralization heterogeneity changes in trabecular bone of the proximal femur

Although there is extensive documentation in the literature regarding the importance of trabecular bone for proximal femoral integrity and fracture resistance, there remain gaps in our understanding of the basic mineral changes that may occur in trabecular bone attributable to aging. It is unclear what age-related changes take place in the trabecular bone of the proximal femur, a common fracture site in the elderly. It has been suggested that some explanation for conflicting reports on cancellous bone may be found at a microscopic level. The goal of this study was to document age-related changes in micromineralization in the proximal femur of Caucasian females using backscattered electron imaging technology. Proximal femurs were obtained from 11 young and 11 elderly females. Sections of bone from the superior and inferior neck and superior and inferior trochanter were analyzed in a scanning electron microscope using the backscatter technique to determine ash percent. Mean ash percent did not change with age in any of the four regions (P > 0.05). However, while the mean ash percent did not change, there was a dramatic increase in variability elderly age group and loss of mineral heterogeneity. This indicates that there are subpopulations with higher or lower ash percents than the mean in the elderly study group in this investigation. While variance changed dramatically, variance within individuals did not change significantly with age (P > 0.05). The results of this study suggest that changes in micromineralization may occur within an individual, adding a possible new dimension to our understanding of fracture risk in the elderly. Future studies should examine a longer population base to confirm this observation.