Horner syndrome

Horner syndrome is an uncommon but important clinical entity, representing interruption of the sympathetic pathway to the eye and face. Horner syndrome is almost always diagnosed clinically, though pharmacological testing can be used to confirm the diagnosis. Imaging modalities such as PET, CT and MRI are important components of work‐up for patients presenting with acquired Horner syndrome. Our patient’s presentation with Horner syndrome unmasked the causative superior sulcus squamous cell carcinoma and a coincidental lower lobe adenocarcinoma. Successful radical treatment of these cancers resulted in complete resolution of the syndrome and disease‐free survival at 18 months. We review the anatomy and pathophysiology underlying this and other causes of Horner syndrome.     

DSA—Control of implanted devices for arterial hepatic perfusion

In contrast to conventional film angiography, the perfusion pattern of hepatic arterial chemotherapy was consistently visualized by DSA in 40 patients with implanted Infusaid pump or Port-A devices. Incomplete perfusion of a liver region by the cytotoxic agent was recognized by DSA as accurately as by nuclide scintigraphy. Furthermore, DSA appeared to be more sensitive in determining aberrantly perfused extrahepatic regions; this was especially true when there was a nonligated right hepatic artery. Specific details of vascular lesions and associated complicating events also could be satisfactorily analyzed by DSA only.     

HLA-DR7 predicts the response to alkylating agents in steroid-sensitive nephrotic syndrome

There is a lack of reliable predictors of the response to alkylating agents in children with idiopathic nephrotic syndrome (NS). HLA-DR7 is strongly associated with the frequency of relapses in steroid-sensitive NS before cytostatic therapy. We therefore examined retrospectively the time to the first relapse and the incidence of subsequent relapses in 54 HLA-typed children with frequently relapsing NS, after treatment with cyclophosphamide (n = 49) or chlorambucil (n = 5) for 8 or 12 weeks; 38 patients were HLA-DR7 positive and 16 negative with 80% in both groups being steroid dependent. HLA typing was performed using serological or DNA typing methods. Renal biopsy showed minimal glomerular changes. A lower proportion of HLA-DR7 positive than negative patients remained in remission after 3 years (36% vs. 81%, P<0.02) and 5 years (36% vs. 72%, P<0.03). In the first 3 years after cytostatic therapy the mean number of prednisone-treated relapses was 1.3/patient per year in HLA-DR7-positive patients compared with 0.4 in negative patients (P<0.025). There was no statistically significant difference in the proportion of relapse-free patients with and without steroid dependency. The HLA status predicts the response of NS patients to alkylating agents better than the rate of previous relapses. Received September 19, 1995; received in revised form and accepted April 16, 1996     

The Frictional Behavior of Coated Guiding Archwires

Background: The vast range of orthodontic wires made of different alloys makes it increasingly difficult for orthodontists to judge them. Coated orthodontic wires form a group of innovative guiding archwires. Material and Methods: In the present in vitro study the frictional behavior of eight coated wires of different dimensions was investigated in archwire-guided canine retraction in the upper jaw. For this purpose five superelastic nickel titanium alloy wires (Titanol^/reg; Low Force River Finish Gold and Gold 2: Forestadent^®, Pforzheim Germany; Titanol^® Superelastic tooth Sentalloy Ionguard™: GAC, Central Islip, NY, USA; NITI Imagination™: GAC, Central Islip, NY, USA), two #-titanium wires (TMA^® Low Friction Ionguard: Ormco, Glendora, CA, USA; TMA^® Low Friction Ionguard Purple: Ormco, Glendora, CA, USA) and one steel wire (Stainless steel Imagination™: GAC, Central Islip, NY, USA) were selected. The coatings were made of Teflon^® or polyethylene, and by ion implantation. Three uncoated archwires (Rematitan^® Lite Dimple; Dentaurum, Pforzheim, German; Titanol^® Low Force River Finish: Forestadent^®, Pforzheim, Germany; BioForce Sentalloy™: GAC, Central Islip, NY, USA) were used for comparison purposes. The force losses due to friction were measured using the Orthodontic Measurement and Simulation System (OMSS). Results: The results indicated that all coatings can reduce frictional losses compared with an uncoated reference wire by the same manufacturer. Measured frictional losses ranged from 48.3-6.1% with the Teflon^® coatings reducing the frictional losses to less than 10% in some cases. Conclusion: An unequivocal correlation between the surface roughness and frictional forces of the wires could not be verified by scanning electron microscopy. Zusammenfassung Hintergrund: Die Vielzahl an orthodontischen Drähten aus diversen Legierungen macht es die Kieferorthopäden immer schwerer, sie zu beurteilen. Eine Gruppe von neu angebotenen Führungsbögen stellen die beschichteten orthodontischen Drähte dar. Material und Methode: In der vorliegenden In-vitro-Studie wurde das Reibungsverhalten von acht beschichteten Drähten unterschiedlicher Dimension bei den bogengeführten Eckzahnretraktion im Oberkiefer untersucht. Neben fünf Nickel-Titan-Drähten (Titanol^® Low Force River Finish Gold und Gold 2: Fa. Forestadent^®; Titanol^® Superelastic zahnfarben: Fa. Forestadent^®; BioForce Sentalloy Ionguard™: Fa. GAC; NiTi Imagination™: Fa. GAC) wurden zwei #-Titan- (TMA Low Friction Iongard: Fa. Ormco; TMA Low Friction Ionguard Purple: Fa. Ormco) und ein Stahldraht (Stainless Steel Imagination™: Fa. GAC) ausgewählt. Die Beschichtungen bestanden aus Teflon^®, Polyethylen oder Ionenimplantation. Als Referenz wurden drei unbeschichtete Drähte (Rematitan^® Lite Dimple: Fa. Dentaurum; Titanol^® Low Force River Finish: Fa. Forestadent^®; BioForce Sentalloy™: Fa. GAC) in die Untersuchung einbezogen. Die Reibungsverluste wurden mit dem Orthodontischen Mess- und Simulations-System (OMSS) bestimmt. Ergebnisse: Die Ergebnisse zeigten, dass alle Beschichtungen, verglichen mit einem unbeschichteten Referenzdraht desselben Herstellers, eine Reduktion der Reibungsverluste bewirken. Die gemessenen Reibungsverluste lagen zwischen 48,3% und 6,1%, wobei bei Teflon^®-Beschichtungen der Reibungsverlust zum Teil auf unter 10% sank. Schlussfolgerung: Ein eindeutiger Zusammenhang zwischen der Oberflächenrauheit und den Friktionswerten der Drähte konnte anhand von rasterelektronenmikroskopischen Aufnahmen nicht bestätigt werden.     

Different proliferative activity of the glandular and myoepithelial lineages in benign proliferative and early malignant breast diseases.

The aim of the present study was to explore cell biological characteristics of normal breast, benign proliferative breast diseases and noninvasive breast malignancies based on the recently published adult progenitor cell concept from our group. Here, we investigated the proliferative activity of CK5/14(+), CK8/18/19(+) and alpha-smooth muscle actin(+) cellular phenotypes encountered in normal mammary gland, in a series of usual ductal hyperplasias and early malignant breast diseases, such as atypical ductal and lobular hyperplasias, as well as ductal and lobular in situ carcinomas. Immunohistochemical double labeling was performed on frozen sections from diagnostic breast biopsies by using antibodies to basal cytokeratins (CK5/14), glandular cytokeratins (CK8/18/19), smooth muscle actin and the Ki-67 antigen (MIB1). Normal breast tissues and usual ductal hyperplasias were characterized by a heterogeneous cellular composition of the growth fraction. The proliferative cell compartment consisted of CK8/18/19(+) glandular and, in a variable proportion, CK5/14(+) progenitor phenotypes. In contrast, noninvasive breast malignancies were composed of a monotonous proliferation of CK 8/18/19(+) neoplastic glandular cells. These findings indicate a significant role of progenitor cells in the development of benign proliferative breast diseases and lend support to the view that malignant transformation in the human breast usually occurs in a cell committed to the glandular lineage. Our results provide cell kinetic support to the functional progenitor cell hypothesis, and we propose this concept as an operative model for understanding benign proliferative and malignant breast diseases.     

Adhesion of human platelets to albumin is synergistically increased by lysophosphatidic acid and adrenaline in a donor-dependent fashion.

Lysophosphatidic acid (LPA) and adrenaline are weak platelet activators considered important for thrombus formation, and were previously shown to synergistically increase platelet aggregation. Here we investigate synergistic activation by LPA and adrenaline when measuring platelet adhesion. Platelet-rich plasma from healthy blood donors together with adrenaline and/or LPA were added to protein-coated microplates. Platelets were allowed to adhere and the amount of adhesion detected enzymatically. The LPA and adrenaline combination induced a synergistic increase of platelet adhesion to a normally non-adhesive albumin surface. The degree of synergy varied markedly between individuals; these variations could not be explained by age, gender, blood type or different amounts of platelets, oxidized low-density lipoprotein, insulin or glucose in plasma. There was a trend indicating increased synergistic effect for platelets sensitive to adrenaline stimulation. The synergistic effect was blocked by the alpha2-adrenoceptor antagonist yohimbine and inhibited by the ADP scavenger system creatine phosphate/creatine phosphokinase and antibodies against alphaIIbbeta3. Furthermore, platelets adhering to albumin after adrenaline and LPA treatment expressed P-selectin. In conclusion, LPA and adrenaline act synergistically to increase alphaIIbbeta3-mediated platelet adhesion to albumin, dependent on alpha2-adrenoceptor signalling and platelet secretion. We also confirm that synergistic platelet activation achieved with LPA and adrenaline is highly donor dependent.     

Correlates of the DSM-III-R global assessment of functioning scale in patients attending a child and adolescent psychiatric service

Sex, socioeconomic status, intelligence, a clinical symptom score, and an index of abnormal psychosocial situations as proposed by a recent WHO draft were studied as correlates of the Global Assessment of Functioning Scale (GAFS), which comprises Axis V of theDSM-III-R. Whereas all parameters correlated significantly with the GAFS score, only total symptom domain score displayed a meaningful association. It was concluded that the GAFS contributes significantly to clinical information as an independent source.

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Zusammenfassung Es wurden ein klinischer Symptomwert, ein Index für abnorme psychosoziale Situationen gemäß einem unlängst erschienenen WHO-Dokument, Geschlecht, sozioökonomischer Status und Intelligenz als Korrelate der Global Assessment of Functioning Scale (GAFS) untersucht, welche die Achse V des DSM-III-R bildet. Während alle Parameter

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Résumé Le sexe, le statut socio-économique, l'intelligence, le score des symptômes cliniques, et un index de situations psychosociales anormales proposés par un récent projet del'OMS furent étudiés en corrélation avec l'évaluation globale de l'échelle de fonctionnement (Global Assessment of Functioning Scale G.A.F.S.) qui correspond à l'axe V du DSM III R. Tandis que tous les paramètres sont corrélés significativement avec un score GAFS, seul le score symptomatique total n'offre pas d'association significative. Les auteurs ont conclu que le GAFS contribue significativement à l'information clinique en tant que source indépendante.