Preservation of anal function after total excision of the anal mucosa for Bowen''s disease

Six women with Bowen's disease of the anogenital area were treated by total excision of the anal mucosa, perianal skin and, in some cases, partial vulvectomy. Two patients had foci of microinvasive squamous carcinoma. Adequate tumor margins were determined by frozen sections. The resulting mucosal and cutaneous defects were grafted with medium split-thickness skin grafts applied to the anal canal and sutured circumferentially to the rectal mucosa. Grafts were held in place by a finger cot inserted in the anal canal and stuffed with cotton balls. Patients were constipated five or six days with codeine. The skin grafts healed per primam. One additional patient was similarly treated for a chronic herpetic ulceration of the anus and healed. Contrary to dire predictions, all patients were able to distinguish between gaseous and solid rectal contents and sphincter function was preserved. In one patient, Bowen's disease has recurred in the grafted perianal skin.     

Hepatitis B surface antigen and polymerized albumin binding activity in sheep serum.

Sera from sheep and other domestic animals contain a substance that gives a strongly positive test for antibody to hepatitis B virus surface antigen by the accepted radioimmunoassay procedure. We have purified this substance from sheep serum to near homogeneity by ion-exchange, affinity, and molecular exclusion chromatography and have identified it to be an IgM. We present evidence that this sheep IgM is an antibody to polymerized sheep albumin. This antibody may arise due to infection by hepatitis B virus, hepatitis B virus-like viruses, or other pathological agents and may react with hepatitis B virus surface antigen by combining with polymerized albumin bound to the hepatitis B virus receptor for this polymer.     

STRUCTURAL STUDIES OF HUMAN IMMUNOGLOBULINS : DIFFERENCES IN THE FD FRAGMENTS OF THE HEAVY CHAINS OF G MYELOMA PROTEINS

1. Comparison of peptide maps of the Fc fragments of normal G immunoglobulins and 11 G myeloma proteins of the We (b) type showed them to be very similar except for differences associated with the Gm type. Some additional differences were noted, however, in the Fc fragments of three Vi (c) myeloma proteins. 2. Peptide maps of heavy chains from the same G myeloma proteins differed from each other and from normal heavy chains. In general, the myeloma chains contained a larger number of well defined spots; some of these were common to normal heavy chains while others were unique to each protein. Others, present in normal heavy chains, were lacking in the myeloma proteins. 3. Comparison of the heavy chains and Fc fragments from the same protein suggests that much of the variability of different myeloma proteins and, presumably, antibodies resides in the Fd fragment. 4. Further support for this is given by the finding that the antigenic specificity of 3 myeloma proteins also appeared to reside in the Fd fragments.     

Adult asthma severity in individuals with a history of childhood asthma

BACKGROUND: Childhood asthma can have a range of outcomes in adulthood. OBJECTIVE: To identify clinical features and exposures associated with persistence and severity of childhood asthma in adulthood. METHODS: Eighty-five of 121 subjects previously enrolled in a study of immunotherapy for childhood allergic asthma (age 5-12 years) were re-evaluated with allergy skin testing, spirometry, and interviews about asthma symptoms and medications. These young adults (age 17-30 years; 74% male) all had moderate to severe childhood asthma. Adult asthma severity was scored by using a modified version of National Heart, Lung, and Blood Institute severity categories. RESULTS: Thirteen (15.3%) of 85 adult subjects were in remission despite persistent childhood asthma. Another 19 subjects (22.4%) had only intermittent asthma. The remaining 53 had persistent asthma, of whom 12 (14.1%) had mild asthma, 25 (29.4%) had moderate asthma, and 16 (18.8%) had severe asthma. Subjects in remission, compared with subjects with intermittent or persistent asthma, had lower total serum IgE in childhood (412 ng/mL vs 1136 ng/mL vs 968 ng/mL; P = .02) and fewer positive allergy skin tests (7 vs 9 vs 10 from panel of 18; P = .02). Subjects in remission also had milder childhood asthma, indicated by lower average daily medication usage scores (1.6 vs 3.5 vs 4.4; P = .005) and lower percentage of days on inhaled corticosteroids (13.7% vs 24.7% vs 40.9%; P = .008). No significant association was found between current asthma severity and childhood immunotherapy ( P = .46). CONCLUSION: The prognosis of childhood allergic asthma in adulthood is largely determined early in life. The degree of atopy appears to be a critical determinant of asthma persistence.     

Breaking the smoking habit: behavioral aspects of tobacco cessation

The development of a smoking habit is unique to each individual. Any smoking cessation effort should also be tailored to the individual. The dentist in clinical practice should be familiar with the 5 A's, with dosages and forms or nicotine replacement therapy, and with counselors and community resources for possible referral. The dentist who is trying to assist his/her patient to stop smoking must be supportive, positive, patient and encouraging and relaize that it might take multiple attempts before a smoker is able to quit once and for all.     

Common and unique components of response inhibition revealed by fMRI

The ability to inhibit inappropriate responses is central to cognitive control, but whether the same brain mechanisms mediate inhibition across different tasks is not known. We present evidence for a common set of frontal and parietal regions engaged in response inhibition across three tasks: a go/no-go task, a flanker task, and a stimulus-response compatibility task. Regions included bilateral anterior insula/frontal operculum and anterior prefrontal, right dorsolateral and premotor, and parietal cortices. Insula activity was positively correlated with interference costs in behavioral performance in each task. Principal components analysis showed a coherent pattern of individual differences in these regions that was also positively correlated with performance in all three tasks. However, correlations among tasks were low, for both brain activity and performance. We suggest that common interference detection and/or resolution mechanisms are engaged across tasks, and that inter-task correlations in behavioral performance are low because they conflate measurements of common mechanisms with measurements of individual biases unique to each task.     

Effectiveness of percutaneous intervention for patients with obstructive hypertrophic cardiomyopathy and coronary artery disease

Seven patients with obstructive hypertrophic cardiomyopathy and single-vessel coronary artery disease underwent percutaneous revascularization of the coronary lesion in addition to alcohol septal ablation therapy for dynamic outflow tract obstruction. One year later, there was a significant reduction of dynamic left ventricular outflow tract obstruction and no clinical evidence of restenosis.     

Anatomic distribution of myocardial ischemia as a determinant of exercise-induced ST-segment depression

Cardiac single-photon emission computed tomographic correlates of ST depression were examined in 129 subjects who had inducible ST depression of > or =0.1 mV and reversible perfusion defects. Patients were separated on the basis of single-photon emission computed tomographic defect distribution into a group with anatomically contiguous ischemia (anterior or posterior/inferior defects, n = 68) and a group with anatomically opposed ischemia (anterior and posterior/inferior defects, n = 61). ST depression in the contiguous ischemia group correlated with defect size (r = 0.40, p = 0.001) and severity (r = 0.38, p = 0.002); multivariate regression demonstrated each to be independent determinants of ST-depression magnitude (r = 0.51, p <0.001). In the opposed ischemia group, ST depression did not significantly correlate with defect extent or severity. After adjusting for differences in perfusion indexes, ST depression was paradoxically greater in the contiguous than in the opposed group (2.82 +/- 1.15 vs 2.44 +/- 1.15 mm, p <0.001). In conclusion, these findings demonstrate that the anatomic distribution of ischemia can alter the relation between ST depression and functional indexes of ischemia and may confound the accuracy of assessments of coronary artery disease based on ST-depression magnitude alone.     

Anticoagulation in special patient populations: are special dosing considerations required?

Optimal dosing of low-molecular-weight heparin (LMWH) therapy has not yet been established for patients with morbid obesity or renal insufficiency or for pregnant women. Monitoring of anti-Xa levels appears to be helpful in guiding LMWH dosing in all of these patient groups. Use of fondaparinux in these populations has yet to be defined. Cancer patients are at particular risk of venous thromboembolism and generally require escalated and/or prolonged anticoagulation with intense monitoring of therapy.