Practical and technical considerations in establishing an intraoperative radiation therapy program in the community practice

The Radiation Oncology Center in Sacramento, California, has developed a procedure for establishing an intraoperative radiation therapy facility in a community practice. The logistics pertaining to personnel, equipment, physical measurements, and quality assurance are presented. Particular emphasis is given to the most effective means of acquiring the large quantity of data needed to ensure a program of acceptable quality.     

Botulinum toxin A as a treatment for excessive drooling in children

Drooling is problematic for some neurologically impaired children. Botulinum toxin A injection to salivary glands has effectively reduced drooling in adults but has only recently been used to treat children. This was a preliminary study to determine the efficacy and safety of botulinum toxin in children. Children identified as having severe daily drooling were enrolled. The preinjection assessment included measurement of the amount and frequency of drool. Each parotid gland was injected with 5 U of botulinum toxin A. Follow-up was for a minimum of 16 weeks. Nine children were enrolled, 4-17 years of age. All children had moderate or severe mental retardation. At week 4, all patients had a reduced drooling frequency and eight of nine patients had a reduction in the weight of saliva. Overall, five of nine parents (55%) deemed the treatment successful. This preliminary study demonstrates that botulinum toxin A is a relatively effective treatment for some children with significant drooling without serious side effects.     

Prekallikrein-Kallikrein conversion rate as a predictor of contrast material catastrophies

An in vitro is described that attempts to detect patients with a potential for adverse systemic reactions to contrast material. This test involves measuring the rate of conversion of prekallikrein to kallikrein under certain standard conditions. In a preliminary retrospective study, the test could be used to identify such patients with a sensitivity of 88%, a specificity of 82%, and a predictive value of 79%.     

Evidence for a dual pathway of activation in CD43-stimulated Th2 cells: differential requirement for the Lck tyrosine kinase

CD43 is the most abundant cell surface-expressed sialoglycoprotein on T lymphocytes. Despite evidence demonstrating the activation of some signaling components by CD43, the exact function of CD43 in T cell biology remains controversial. In this study, we demonstrate that the sole ligation of CD43 in cloned Th2 cells resulted in cytokine production, cellular proliferation, and upregulation of CD25 and CD69 activation markers. Similarly, cross-linking of CD43 on naive splenic T cells led to a significant proliferative response and an enhancement of the expression of CD25 and CD69 markers. These responses required no additional signals from other T cell molecules, including TCR. In Lck-deficient Th2 cells, however, CD43 ligation led to IL-4 production and an increase in the expression of CD25 and CD69 antigens but, surprisingly, no proliferation. Analysis of signaling pathway components revealed that CD43 associates with the adaptor protein SLP-76 within 30 s of activation. This induces the tyrosine phosphorylation of SLP-76 and promotes the recruitment and phosphorylation of another adaptor, Shc. The formation of this multi-component complex was strictly dependent on Lck. In contrast, comparison of tyrosine phosphorylated proteins in whole extracts of normal and Lck-deficient cells revealed a strikingly similar pattern of phosphorylation involving two major protein bands at 26 and 78 kDa. This suggests that tyrosine kinases other than Lck are activated by CD43 ligation. Taken together, the data support the notion that CD43 ligation may induce a dual pathway leading to the activation of different effector functions in Th2 lymphocytes.     

The expanding role of the otolaryngologist in managing infants and children with hearing loss

Universal newborn hearing screening will increase the number of very young children requiring care from an otolaryngologist. Although the otolaryngologist is the perceived expert in managing hearing loss, he or she must collaborate with a team of specialists to provide comprehensive treatment for the newly diagnosed child and its family. Working within a team that includes a pediatrician, audiologist, otolaryngologist, speech pathologist, teachers, and care coordinators allows each professional to contribute significantly to the well-being of the child and parents. Group cooperation and parental support can increase the chances of normal speech and language development in an infant with hearing loss. By identifying related or syndromal associations, the otolaryngologist can prevent complications related to other organ systems such as the heart and eyes. Most importantly, parents and patients look up to the validation of the care plan by the ear physician.