American Academy of Dermatology patch testing survey: Use and effectiveness of this procedure

The results of an American Academy of Dermatology (AAD)-sponsored survey on the use and effectiveness of patch testing are presented. Academy members' responses indicate that 27% do not patch test at all. Reasons given for not testing included (1) the patient history was adequate for diagnosis, (2) patch testing was too time-consuming, and (3) reimbursement was not sufficient. Dermatologists in residency training programs who responded to a similar survey are testing frequently and report a high degree of positivity and relevancy among tests applied. Recommendations are presented with a focus toward increasing interest in patch testing among the membership.     

Mangement of a cheek fistula associated with false ankylosis

A 14-year-old boy presented with a Grade II left cheek fistula and inability to open the mouth following gangrenous stomatitis in early childhood. The treatment of the patient by multistaged reconstruction of the cheek defect is discussed. A large turnover flap was used for the lining, a technique which obviates the need for a second lining flap, and thus eliminates the disfigurement of a donor site. Also, it uses the healthy skin that would otherwise have been discarded in the creation of mucosal flaps.     

The clinical significance of bradycardic rhythms in acute myocardial infarction

The clinical significance of bradycardic rhythms as they pertain to patients developing acute myocardial infarctions is reviewed. Proper therapy of the arrhythmia frequently is predicated on an understanding of (1) the pathophysiologic mechanisms responsible for the production of the bradyarrhythmia, (2) the hemodynamic and electrophysiologic consequences of the slow ventricular rate, and (3) the exact electrocardiographic interpretation of the bradycardic rhythm. These three points are discussed in detail and illustrated by appropriate electrocardiographic examples. The factors responsible for the production of the bradycardic rhythm as well as the consequences of the slow heart rate may be unique in a patient with an acute myocardial infarction. The advent of artificial pacing has made it mandatory to be able to predict initially which bradyarrhythmia is likely to be progressive—in terms of further, more severe disturbance in impulse formation or conduction, or hemodynamic or electrophysiologic consequences—and may not respond to a medical approach. Artificial pacing must be instituted early in patients with these disturbances.     

Dietary patterns and asthma in the E3N study

The aim of the present study was to determine dietary patterns and investigate their association with asthma incidence, current asthma and frequent asthma exacerbations. Dietary habits and asthma data were collected from the large E3N study (of French females, mostly teachers). Of the 54,672 females followed-up in 2003, 2,634 reported ever-adulthood asthma, 1,063 reported current asthma, 206 reported frequent asthma attacks (one or more a week), and 628 reported asthma onset between 1993 and 2003. Using principal component analysis, three dietary patterns were identified: the "prudent" pattern (fruits and vegetables); the "Western" pattern (pizza/salty pies, dessert and cured meats); and the "nuts and wine" pattern. Pattern scores were categorised into tertiles, and the incidence and prevalence of asthma was compared between tertiles. After adjustment for confounders, no association of dietary patterns was observed with asthma incidence, ever-asthma or current asthma. The Western pattern was associated with an increased risk of reporting frequent asthma attacks (highest versus lowest tertile odds ratio (OR) 1.79, 95% confidence interval (CI) 1.11-3.73). Increasing scores of the nuts and wine pattern were associated with a decreased risk of reporting frequent asthma attacks (highest versus lowest tertile OR 0.65, 95% CI 0.31-0.96). The results of the present study suggest that overall diet could be involved in frequent asthma exacerbations, one aspect of asthma severity.     

Control of enteric neuromuscular functions by purinergic A3 receptors in normal rat distal colon and experimental bowel inflammation

Background and purpose:

Elephantopus scaber L. (Asteraceae) is a traditional herbal medicine with anti-cancer effects. We evaluated the in vitro and in vivo efficacy of a major sesquiterpene lactone constituent of E. scaber, deoxyelephantopin (DET), against mammary adenocarcinoma and the underlying molecular mechanism.

Experimental approach:

A variety of cellular assays, immunoblotting and immunohistochemistry, as well as both orthotopic and metastatic TS/A tumour models in BALB/c mice, were used. Test mice were pretreated and post-treated with DET or paclitaxel and mammary tumour growth evaluated.

Key results:

DET (≤2 µg·mL⁻¹) significantly inhibited colony formation, cell proliferation, migration and invasion of TS/A cells and induced G₂/M arrest and apoptosis in TS/A cells. c-Jun N-terminal kinase-mediated p21^Waf1/Cip1 expression and caspase activation cascades were up-regulated by DET, effects suppressed by N-acetyl-L-cysteine. Moreover, tumour necrosis factor α-induced matrix metalloproteinase-9 enzyme activity and expression and nuclear factor-kappa B activation were abolished by DET. Pretreatment with DET was more effective than paclitaxel, for profound suppression of orthotopic tumour growth (99% vs. 68% reduction in tumour size) and lung metastasis of TS/A cells (82% vs. 63% reduction in metastatic pulmonary foci) and prolonged median survival time (56 vs. 37 days, P < 0.01) in mice. The levels of cyclooxygenase-2 and vascular endothelial growth factor in metastatic lung tissues of TS/A-bearing mice were attenuated by DET.

Conclusions and implications:

Our data provide evidence for the suppression of mammary adenocarcinoma by DET with several mechanisms and suggest that DET has potential as a chemopreventive agent for breast cancer.     

Intraluminal biopsy of the small intestine

Summary 1. An instrument for obtaining intraluminal biopsies of the intestinal mucosa has been described. It consists of a capsule containing a rotating knife which is spring-activated and triggered by suction. The suction first draws a bit of mucosa into the capsule before the knife is sprung. The capsule is held captive by a polyethylene tube 2 mm. in diameter, which also serves to transmit suction and to retrieve the capsule.2. Although the instrument was devised for jejunal biopsy it can be used to obtain specimens from any site between the oropharynx and the ileocecal valve.3. The method is safe and reliable. It is technically uncomplicated and it imposes a minimum of hardship on the subject.We are indebted to Colonel Benjamin H. Sullivan who obtained the biopsies and to Major Carl M. Russell for fluoroscopy and roentgenograms.