Time course and calcium dependence of sustained bronchoconstriction induced by deep inhalation in asthma.

We studied six asthmatic patients who showed a progressive decrease in FEV1 when successive forced expiratory maneuvers were performed at 1-min intervals. We determined the time course of changes in specific airway conductance following a single deep inhalation (DI) and the ratio of maximum expiratory flow at 40% of FVC from maximal and partial flow-volume curves (MEF40M/P) during a series of forced expiratory maneuvers. Specific airway conductance measured 3 s after DI was increased by 11 +/- 6 (SE)%, which was not significantly different from an increase of 23 +/- 8% observed in six healthy control subjects. Later (i.e., 10 to 40 s after DI) specific airway conductance was significantly less than the pre-DI value in asthmatic but not in healthy subjects. Mean FEV1 decreased significantly by 28% from the first to the eighth forced expiratory maneuver performed during a period of 15 min, whereas MEF40M/P was not significantly changed and remained always significantly greater than 1. The voltage-dependent calcium channel antagonist nifedipine significantly prevented the reduction of FEV1 without affecting MEF40M/P. We conclude that, in some asthmatic individuals, DI may induce a transient bronchodilatation followed by a calcium-dependent sustained bronchoconstriction. We suggest that the initial bronchodilatation is due to the mechanical interdependence between airways and lung parenchyma, whereas the sustained bronchoconstriction is due to contraction of the airway smooth muscle.     

CO2 laser therapy of the Bartholin's gland cyst: surgical data and functional short- and long-term results

The Bartholin's gland cyst is a condition that occurs in approximately 2% of women, most of whom are of reproductive age. Although benign, it is associated with significant patient discomfort. Definitive treatment involves the surgical removal of the entire cyst. The objective of this study was to describe an alternative conservative surgical technique with CO(2) laser adopted in our institution and to evaluate the feasibility, complication rate, and results obtained with this technique in an office setting. Our study showed that CO(2) laser treatment of the Bartholin's gland cyst can be carried out safely in an outpatient setting, with minimum patient discomfort and high long-term cure rates.     

Ultrasound properties of liver with and without particulate contrast agents

Basic acoustic parameters are examined in rabbit liver with and without a solid contrast agent used for tumor detection. In normal liver, backscatter, attenuation, and sound speed are found to decrease with increasing water content. The addition of micron-sized particles made from iodipamide ethyl ester (IDE) can increase backscatter and attenuation depending on size and concentration. A discrepancy of the increased backscatter from theoretical predictions based on random scatterers is attributed to the particle's biodistribution in the liver.     

Relationship between repetitive work and the prevalence of carpal tunnel syndrome in part-time and full-time female supermarket cashiers: a <Emphasis Type="Italic">quasi</Emphasis>-experimental study

Objectives To investigate the prevalence of Carpal Tunnel Syndrome (CTS) in full-time and part-time supermarket cashiers exposed to a different weekly duration of biomechanical load. Methods All the 269 cashiers and 127 office workers were asked to participate. The protocol included ergonomic risk assessment, collection of personal and clinical data and bilateral electrodiagnostic study of the median nerve. CTS symptoms were defined as past and/or current nocturnal and/or diurnal numbness, tingling, burning or pain involving at least one of the first three fingers. Results were evaluated according to two case definitions based on current symptoms and on the combination of current symptoms and slowing of sensory conduction velocity from wrist to palm, respectively. Difference in proportions of CTS symptoms and cases was evaluated by the Pearson’s chi-square (χ²) test, univariate and multivariate logistic regression analyses were performed to determine the impact of weekly exposure. Results The final female study population included 71 full-time cashiers, 155 part-time cashiers and 98 office workers. Ergonomic risk level was rated 5 for hand activity level and 4 for peak of force according to ACGIH. The intersection of the two values fell on the threshold limit value line, confirming the possible exposure to biomechanical risk factors for CTS. The prevalence of current CTS symptoms was higher among full-time (31.0%) than in part-time cashiers (19.3%) or controls (16.3%) (p = 0.055). A similar pattern was found for CTS past symptoms and cases. Univariate analysis showed that full-time cashiers had a 2.3 fold increased risk for CTS specific current symptoms than control subjects. A similar trend also emerged for CTS cases but was not significant (Odds ratios 1.23). Multivariate logistic regression analysis confirmed the increased risk for CTS current symptoms in full-time cashiers. Conclusions Intensive manual work associated with inadequate recovery time might have generated an impairment of the median nerve at the wrist level proportionally increasing with duration of hand use. Our study can provide useful information both for ergonomic risk assessment and work organization.     

Clinical,imaging, and molecular findings in a sample of Mexican families with pantothenate kinase‐associated neurodegeneration

Pantothenate kinase‐associated neurodegeneration (PKAN) is an autosomal recessive disorder characterized by iron accumulation in the brain, because of mutations in the PANK2 gene. Phenotypic and genotypic characteristics of 11 patients from five Mexican families with PKAN disease are reported. Sequencing of PANK2 confirmed the diagnosis. The 11 patients had dysarthria associated with dystonia and Parkinsonism in six. Brain magnetic resonance imaging (MRI) showed the ‘eye‐of‐the‐tiger’ sign in all patients. Three different mutations were identified, a novel one (p.A469P) and two (p.G219V and p.N404I) very rare. Homozygous sibs for the p.G219V mutation had a severe disease progression with early death. Dystonia predominated in the p.A469P/p.N404I compound heterozygous patients. Homozygous for p.N404I showed Parkinsonism, tics and personality and speech disorders. Early and late disease onset and variable expression was present in carriers of the different identified mutations. The ‘eye‐of‐the‐tiger’ is an excellent neuroimaging hallmark to predict PANK2 mutations. We detected a ‘cluster’ of patients harboring the p.N404I mutation, strongly suggesting a founder effect for this mutation. This is the first familial clinical‐genetic PKAN disease study accomplished in Mexico.     

Iwo Jima: 50th anniversary surprise

Retained metal fragments frequently are visualized in x-ray examinations of wounded combat veterans. Retained projectiles (bullets) are seen less often because of surgical removal.