A single center 14 years study of infectious complications leading to hospitalization of patients with primary antibody deficiencies

Primary antibody deficiencies (PADs) are a heterogeneous group of disorders, characterized by hypogammaglobulinemia and increased susceptibility to bacterial infections, leading to hospitalizations. This study was performed to determine the main infectious causes of hospital admissions in selective Iranian patients with PADs. Forty patients with PADs, who were admitted to the Infectious Ward of Children's Medical Center Hospital during a 14-year period, were reviewed in this study. There were 115 documented episodes of hospital admission during a 14-year period. The average length of hospital stay was 33.30 ± 25.72 days. Pneumonia was the most prominent infection leading to hospitalization among these patients (n = 48), followed by gastroenteritis (n = 23). Other less frequent causes of hospitalization were fever and neutropenia, septic arthritis, encephalitis, orbital cellulitis, sepsis, urinary tract infection, meningitis, oral ulcer, and lung abscess. The most common causative organisms of diarrhea were: Giardia lamblia, followed by Candida albicans, and Salmonella sp. Many patients with PADs suffer from repeated infections leading to hospitalization, in spite of immunoglobulin replacement therapy. Respiratory tract infections were the prominent cause of hospitalization among studied patients, followed by gastrointestinal infections.     

Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County,Minnesota, study

Subacute thyroiditis (SAT), or granulomatous thyroiditis, is an inflammatory thyroid condition associated with pain and systemic symptoms. Few community studies are available. We studied the 160 patients with SAT in Olmsted County, Minnesota, seen between January 1, 1960, and December 30, 1997. Subjects were identified through the medical diagnostic index of the Rochester Epidemiology Project. The overall age- and sex-adjusted incidence from 1960 through 1997 was 4.9 cases per 100,000/yr. In the most recent 28-yr period (1970-1997), 94 patients were identified. In this group, pain was the presenting symptom in 96%. SAT recurred in 4% of the patients 6-21 yr after the initial episode. Corticosteroid therapy was given to 36%. Early-onset hypothyroidism occurred both in patients receiving corticosteroid therapy (29%) and in those not receiving corticosteroid therapy (37%). At latest follow-up, significantly more patients who had received corticosteroid therapy had a diagnosis of hypothyroidism than the group without corticosteroid therapy (25% vs. 10%, P < 0.05; overall rate of hypothyroidism, 15%). Early transient hypothyroidism is common in SAT. Permanent hypothyroidism is less common, and only 15% of the patients are receiving T(4) therapy after 28 yr of follow-up. Symptomatic relief is achieved with corticosteroid therapy, but such therapy does not prevent early- and late-onset thyroid dysfunction.     

Benefits of Early Surgical Repair in Fixed Subaortic Stenosis

Objectives. We sought to determine whether early resection can improve outcome in fixed subaortic stenosis.

Background. The diagnosis of subaortic stenosis (SAS) is often made before significant gradients occur. Whereas resection is the accepted treatment, it remains uncertain whether surgical intervention at this early stage can reduce the incidence of recurrence or influence the progression of aortic valve damage.

Methods. Follow-up was available for 75 of 83 consecutive patients operated on for fixed SAS; the average duration of follow-up was 6.7 years. The lesion was discrete in 68 patients (91%) and of a tunnel type in 7, with associated ventricular septal defect in 28 (37%). All underwent transaortic resection.

Results. There were no deaths. There were 18 recurrences of SAS in 15 patients (20%). Thirteen patients (17%) underwent 17 reoperations for recurrence or aortic valve disease. The cumulative hazard of recurrence was 8.9%, 16.1% and 29.4% ± 2.3% (mean ± SEM), and the hazard of events, including recurrence and reoperation, was 9.2%, 18.4% and 35.1% ± 3.5% at 2, 5 and 10 years, respectively. Residual end-operative left ventricular outflow tract (LVOT) gradients (>10 mm Hg, n = 8) and tunnel lesions were univariate predictors of recurrence (p = 0.0006 and p = 0.003, respectively). Multivariate predictors included higher preoperative LVOT gradient (p < 10⁻⁴) and younger patient age (p = 0.002). Only two recurrences (0.87 per 100 patient-years of follow-up) were noted in patients with a preoperative peak LVOT gradient ≤40 mm Hg (n = 40), whereas higher gradients (n = 35) were associated with a greater than sevenfold recurrence rate (6.45 events per 100 patient-years, p = 0.002). The aortic valve required concomitant repair in 17 cases in the high gradient group (48.6%) but in only 8 in the low gradient group (20%, p = 0.018). Despite relief of the obstruction, progressive aortic regurgitation was noted at follow-up after 14 procedures in the high gradient group (40%) but after only 5 procedures in the low gradient group (12.5%, p = 0.014).

Conclusions. The data suggest that surgical resection of fixed subaortic stenosis before the development of a significant (>40 mm Hg) outflow tract gradient may prevent recurrence, reoperation and secondary progressive aortic valve disease.     

Four Modalities of Single Implant Treatment in the Anterior Maxilla: A Clinical,Radiographic, and Aesthetic Evaluation

Purpose: To document the outcome of single implants in the anterior maxilla following four routine treatment modalities when performed by experienced clinicians in daily practice using the same implant system and biomaterials. Material and Methods: A retrospective study in patients who had been treated by two periodontists and two prosthodontists in 2006 and 2007 was conducted. The four treatment modalities practically covered every clinical situation and included standard implant treatment (SIT), immediate implant treatment (IIT), implant treatment in conjunction with guided bone regeneration (GBR), and implant treatment in grafted bone (BGR) harvested from the chin. All implants were installed via flap surgery. Patients were clinically and radiographically examined. Complications were registered and the aesthetic outcome (pink esthetic score [PES] and white esthetic score [WES]) was rated. A blinded clinician who had not been involved in the treatment performed all evaluations. Patient's aesthetic satisfaction was also registered. Results: One hundred four out of 115 eligible patients (44 SIT, 28 IIT, 18 GBR, and 14 BGR) received at least one single NobelReplace tapered TiUnite® (Nobel Biocare, Göteborg, Sweden) implant in the anterior maxilla and were available for evaluation. Clinical parameters (implant survival: 93%, mean plaque level: 24%, mean bleeding on probing: 33%, and mean probing depth: 3.2 mm) and mean bone level (1.19 mm) did not differ significantly between treatment modalities. Postoperative complications were more common following GBR/BGR (>61%) when compared with SIT/IIT (<18%) (p < .001). BGR was in 4/14 patients associated with permanent sensory complications at the donor site. Technical complications occurred in 9/104 patients. SIT and IIT showed similar soft tissue aesthetics (PES: 10.07 and 10.88, respectively), however major alveolar process deficiency was common (>15%). PES was 9.65 for GBR. BGR showed inferior soft tissue aesthetics (PES: 9.00; p = .045) and shorter distal papillae were found following GBR/BGR (p = .009). Periodontal disease (odds ratio [OR]: 13.0, p < .001), GBR/BGR (OR: 4.3, p = .004), and a thin‐scalloped gingival biotype (OR: 3.7, p = .011) increased the risk for incomplete distal papillae. WES was 7.98 for all patients considered. Poor agreement was found between objective and subjective aesthetic ratings. Conclusions: All treatment modalities were predictable from a clinical and radiographic point of view. However, advanced reconstructive surgery, especially BGR, increased the risk for complications and compromised aesthetics. Research is required on the prevention and minimally invasive treatment of buccal bone defects at the time of tooth loss to avoid complex therapy.     

Ito-cell gene expression and collagen regulation

Ito cells are perisinusoidal cells thought to be a major source of collagen in normal and fibrotic livers. These cells appear to have features similar to several cell types but when cultured assume a fibroblast-like morphology. In this study we evaluated the phenotype of both freshly isolated and cultured Ito cells by examining their gene expression. To better define the modulators of Ito-cell collagen synthesis, we also examined the effect of transforming growth factor-beta 1, tumor necrosis factor-alpha and dexamethasone on collagen synthesis by these cells. Northern hybridization analysis revealed that cultured Ito cells expressed different types of procollagen mRNAs than did freshly isolated cells. Cultured cells contained large amounts of type I procollagen mRNA and lesser amounts of types III and IV, whereas freshly isolated cells contained more type IV procollagen mRNA than types I and III. Treatment of cultured cells with either transforming growth factor-beta 1 or tumor necrosis factor-alpha resulted in a greater than three-fold increase in total collagen content, and the effects of these cytokines on Ito-cell collagen synthesis involved different levels of gene regulation. Transforming growth factor-beta 1-treated cells had an approximately threefold increase in their type I procollagen mRNA levels, whereas no increase in this mRNA level was found in tumor necrosis factor-alpha-treated cells. Transforming growth factor-beta 1 treatment induced a twofold increase in transforming growth factor-beta 1 mRNA content in cultured cells.(ABSTRACT TRUNCATED AT 250 WORDS)     

The Mucosal Scarring Index: reliability of a new composite index for assessing scarring following oral surgery

Clinical Oral Investigations - A critical and uniform assessment of mucosal scarring following oral surgery is needed to refine surgical decision-making. For that purpose, the Mucosal Scarring...     

Conductance of GABAA Channels Activated by Pentobarbitone in Hippocampal Neurons from Newborn Rats

Neurons were obtained from the CA1 region of the hippocampus of newborn rats and maintained in culture. Channels were activated by pentobarbitone in cell-attached, inside-out or outside-out patches, normally by applying pentobarbitone in flowing bath solution. Currents were outwardly rectifying and blocked by bicuculline, properties of GABA_A channels in these cells. Maximum channel conductance increased as pentobarbitone concentration was increased to 500 μ m but conductance then decreased as pentobarbitone concentration was raised further. The best fit of a Hill-type equation to the relationship between maximum channel conductance and pentobarbitone concentration (up to 500 μ m ) gave an EC₅₀ of 41 μ m , a maximum conductance of 36 pS and a Hill coefficient of 1.6. Bicuculline decreased the maximum conductance of the channels activated by pentobarbitone, with an IC₅₀ of 224 μ m . Diazepam increased channel conductance, with a maximum effect being obtained with 1 μ M diazepam. Diazepam (1 μ M ) decreased the EC₅₀ of the pentobarbitone effect on channel conductance from 41 μ M to 7.2 μ M and increased maximum conductance to 72 pS. We conclude that GABA_A channel conductance is related to the concentration of the allosteric agonist pentobarbitone.     

Sperm quality before treatment in patients with early stage Hodgkin’s lymphoma enrolled in EORTC-GELA Lymphoma Group trials

Background

Although widely recommended, cryopreservation of sperm is sometimes not performed for patients with Hodgkin’s lymphoma because of presumed poor sperm quality related to the disease. We investigated sperm quality and factors determining it in untreated patients with early stage Hodgkin’s lymphoma.

Design and Methods

Of 2362 males who participated in EORTC H6–H9 trials, 474 (20%) had data available. Sperm quality was defined according to World Health Organization guidelines. Determining factors were studied by logistic regression analysis.

Results

The median sperm concentration was 40×10⁶/mL (range, 0–345×10⁶/mL) and the median motility 50% (range, 0–90%). Sperm quality was good (concentration ≥20×10⁶/mL and motility ≥50%), intermediate (concentration ≥5×10⁶/mL) and poor (concentration <5×10⁶/mL but >0) in 41%, 49% and 7% of patients, respectively. Three percent of the patients were azoospermic. No relation was found between sperm quality and age or clinical stage of the Hodgkin’s lymphoma, but B-symptoms and elevated erythrocyte sedimentation rate predicted poor sperm quality. The odds ratios for the association of poor sperm quality with the variables examined were: presence of B-symptoms, 2.77 (95% CI, 1.50–5.12; p=0.001); erythrocyte sedimentation rate of 50 mm/h or greater, 2.35 (95% CI, 1.24–4.43; p=0.009); fever, 3.22 (95% CI, 1.41–7.33; p=0.005), and night sweats, 3.78 (95% CI, 1.97–7.26; p<0.001). There was no relation between sperm quality and pre-treatment follicle stimulating hormone level.

Conclusions

In this large study of males with Hodgkin’s lymphoma, 90% had good or intermediate sperm quality. Three percent were azoospermic. There was an association between sperm quality and the presence or absence of B-symptoms, in particular fever and night sweats. With modern fertilization techniques, in most patients with early-stage Hodgkin’s lymphoma sperm quality before treatment is good enough for future fatherhood.