Neodymium YAG contact laser in the treatment of cancer of the mobile tongue

The aim of this study was to evaluate the usefulness of a contact neodymium YAG laser for the treatment of squamous cell carcinoma (SCC) of the mobile tongue in 35 patients. The TNM stage and histologic grade were as follows: T1, n = 20; T2, n = 11; T3, n = 4; and N0, n = 33; N1, n = 2; G1, n = 20; G2, n = 10; and G3, n = 5. The surgical treatment consisted of a hemiglossectomy or resection with adequate margins in 28 cases, and an ipsilateral neck dissection was also performed in 7 patients. Radiotherapy to a mean tumor dose of 62-64 Gy and an elective dose of 50 Gy to the cervical lymph nodes was given to 14 patients. The radiotherapy was preoperative in 12 patients and postoperative in 2. Tongue resection was easily performed using the contact neodymium YAG laser, with a mean operation time of 31 min and intraoperative bleeding varying from negligible to 100 cm3. During postoperative follow-up no major complications occurred: cases with minor hemorrhage were easily controlled on the ward and 1 patient had a bleed on the 14th postoperative day necessitating hospitalization. The resection was histologically radical in all cases. During follow-up one patient had a local recurrence (T2N0, G3) and four failed in the neck (T1N0 G2, T1N0 G2, T1N0 G2, T2N0 G2), three of whom were successfully salvaged with a neck dissection and radiotherapy. One patient with osteoradionecrosis was diagnosed and treated curatively. Two patients died of their tongue cancer (T2N0 G3, T2N0 G2), 1 died from a second primary tumor (T2N0 G1) and 2 of intercurrent disease with no evidence of cancer; 30 patients (86%) are still alive with no evidence of disease. The function of the tongue in all patients in this sample was good to satisfactory. The major complaint was xerostomia in the irradiated patients. In conclusion, the contact neodymium YAG laser appears to be suitable for resection of T1-T2 SCCs of the oral tongue. In this limited patient sample T stage or grade did not predict failures in the neck. Biologic predictive markers need to be evaluated.     

Diagnostic concordance of ICD-10 personality and comorbid disorders: a comparison of standard clinical assessment and structured interviews in a clinical setting

OBJECTIVE: The diagnosis of personality disorders is one of the most problematic areas in psychiatric diagnosis. Diagnoses are usually made by standard clinical interview, but they have poor reliability. The aim of this study was to compare the concordance in diagnosis between structured assessment tools and assessment as usual in a clinical setting. METHOD: Diagnosis of 33 patients on the International Personality Disorder Examination (IPDE) and the Mini International Neuropsychiatric Interview (MINI) was compared to diagnosis made by standard assessment through clinical interview. RESULTS: There was poor concordance between structured measures and standard assessment by clinical interview, and poor levels of diagnostic sensitivity and specificity on standard assessment. CONCLUSION: Structured measures were more comprehensive, sensitive and specific in diagnosis than standard clinical assessment. Increased diagnostic accuracy is needed for effective understanding and treatment planning for personality disorders.     

Retinal endothelial cells are more susceptible to oxidative stress and increased permeability than brain-derived endothelial cells

Increased vascular permeability and oxidative stress are important in diabetic retinopathy. Because the cerebral microcirculation is much less affected in diabetes, our objectives are to compare: (1) glutathione peroxidase activity, (2) superoxide dismutase levels, (3) superoxide production, and (4) junctional protein (ZO-1) levels between retinal and brain-derived endothelial cells. Bovine brain and retinal endothelial cell cultures are incubated in medium containing either mM or 30 mM glucose for 5 days. Superoxide is measured in the medium and endothelial cells are then lysed and analyzed for glutathione peroxidase activity as well as levels of superoxide dismustase and ZO-1. The results demonstrate that, compared to brain-derived endothelial cells, retinal endothelial cells release high levels of superoxide, have less glutathione peroxidase activity and lower levels of superoxide dismutase, and ZO-1. Also, unlike brain-derived endothelial cells where ZO-1 levels increased in response to glucose, in retinal endothelial cells, ZO-1 levels are unaffected by glucose. These findings suggest that greater oxidative stress and lower junctional protein levels in retinal endothelial cells may contribute to blood/retinal barrier dysfunction in diabetic retinopathy.     

Are self-reports of breathing effort and breathing distress stable and valid measures among persons with asthma, persons with COPD, and healthy persons?

BACKGROUND: Breathing is a subjective experience that includes physical sensations, such as effort to breathe, and an affective element, such as breathing distress. OBJECTIVE: The overall purpose of this investigation was to evaluate whether measurement of the physical sensations (breathing effort) and affective response to these sensations of breathing (breathing distress) are consistent and valid. DESIGN: A longitudinal repeated measures design was used to evaluate a 2-week daily breathing with a sub-sample (n = 43) who also recorded their daily breathing during 4 weeks. SUBJECTS: Age-matched, stable subjects (n = 92) with an average age of 62 were evaluated. The sample consisted of 32 subjects with chronic obstructive pulmonary disease, 27 subjects with asthma, and 33 healthy subjects. MEASURES: Visual Analogue Scales for breathing effort (VAS-E) and breathing distress (VAS-D) were scored daily. RESULTS: The VAS-E and VAS-D mean, highest, and lowest scores were found to be stable over time in the sub-sample and a significant difference (F = 2.56, P <.05) between VAS-E and VAS-D was found. Differences were found in mean and highest VAS-E and VAS-D by group, with the COPD group reporting the highest values. CONCLUSIONS: This investigation provided initial evidence of the stability and validity of daily VAS-E and VAS-D measures and preliminary support for the use of daily VAS logs to evaluate differences in breathing effort and breathing distress.     

Characteristics and prognosis of idiopathic solar urticaria: a cohort of 87 cases

BACKGROUND: As little has been published on the course of idiopathic solar urticaria (SU) patients cannot receive comprehensive prognostic advice. OBJECTIVE: To determine the prognosis and photobiological characteristics of idiopathic SU. DESIGN: Historical cohort study, with inception cohort followed up from time of diagnosis. Follow-up for a median of 4 years (range, 3 months to 26 years) after diagnosis. SETTING: Tertiary referral center for the investigation of photodermatoses in Scotland. PATIENTS: The study included 87 patients, 61 (70%) of whom were female, with phototest-confirmed idiopathic SU between 1975 and 2000. Sixty patients (69%) were followed up clinically, and 25 patients (29%) were phototested on 2 or more occasions. INTERVENTIONS: Investigations at time of diagnosis included monochromator phototesting. Further monochromator phototesting was performed in those patients in whom it was clinically indicated (select subgroup), and all patients who could be traced received a follow-up questionnaire. MAIN OUTCOME MEASURES: Characteristics of SU, responsible wave bands, and prognosis for clinical resolution. RESULTS: The prevalence of idiopathic SU in Tayside, Scotland, is estimated to be 3.1 per 100 000. Action spectra were typically broad, with 63% reacting to more than 1 wave band, and the most common provoking wavelengths were the longer UV-A and the shorter visible ones. The majority of subjects were affected perennially (68%), by radiation transmitted through glass (83%) and thin clothing (76%). Coexistent polymorphic light eruption occurred in 20 patients (23%), and another photodermatosis occurred in 6 patients, 3 of whom had chronic actinic dermatitis. In those with SU alone, the mean age at onset was 41 years. The probability of clinical resolution at 5 and 10 years after diagnosis was 0.12 (95% confidence interval, 0.06-0.24) and 0.26 (95% confidence interval, 0.15-0.43), respectively. CONCLUSION: Idiopathic SU is a chronic disease. The majority of this cohort was still affected after 5 and 10 years.