Assessing potential determinants of positive provocation tests in subjects with NSAID hypersensitivity

Background Provocation tests (PTs) with the suspected compounds are considered the ‘gold standard’ for establishing or excluding a diagnosis of hypersensitivity to non‐steroidal anti‐inflammatory drugs (NSAIDs). However, only a few studies have evaluated the potential determinants of positive responses to PTs. Objective The aims of this study are to assess the reliability of clinical histories as indicators of NSAID hypersensitivity, as well as the risk factors for a positive PT. Methods Two hundred and seventy‐five subjects with an unequivocal history of NSAID hypersensitivity reactions underwent PTs with the suspected drugs. To establish the potential determinants of positive PTs, we examined the following variables: gender, age at the time of reaction (<40 or 40 years), family and personal histories of atopy, patients who had reacted to one or more NSAIDs, time interval between drug intake and symptom onset (immediate or non‐immediate reactions), time interval between the last drug reaction and the allergologic examination (12 or >12 months), and inclusion in a category of the Stevenson et al. classification. Results Two hundred and fourteen (77.8%) subjects tolerated the suspected drugs and 61 (22.2%) reacted. Age <40 years, male gender, immediate reactions, and time interval 12 months were significant risk factors for a positive PT. Conclusions and Clinical Relevance Our study confirms that clinical histories are not reliable tools for diagnosing NSAID hypersensitivity. Therefore, we recommend that suspected cases should undergo drug PTs. However, further studies on large samples of NSAID‐sensitive patients are necessary to establish the risk factors that allow the number of candidates for PTs to be reduced. Cite this as: M. Viola, G. Rumi, R. L. Valluzzi, F. Gaeta, C. Caruso and A. Romano, Clinical & Experimental Allergy, 2011 (41) 96–103.     

Surgery for acute aortic dissection: an easy and cheap method to reinforce the anastomosis

Abstract   Bleeding from the anastomotic site is a frequent complication of surgery for acute aortic dissection. Many methods have been devised in order to avoid this problem. We report a simple, easy technique to reinforce the anastomotic sites. One small 4-mm-high ring is cut from the same prosthesis and placed circumferentially inside the aorta edge. Another ring of the same width is opened in a "C" shape, and placed outside the aorta. The conduit was eventually sutured to the aorta in a standard fashion using a running 3-0 polypropylene suture. The final result appeared good with no bleeding, and the rim lines appear clearer and the edges easier to suture because the Dacron is thinner than other used materials (that is, Teflon). In our opinion, this technique is a simple method to reinforce the anastomosis for both proximal and distal aorta.     

Caries frequency and distribution in an early medieval Avar population from Austria

Objective:  The aim of this study was to determine frequency and distribution of dental caries in an early medieval Avar population from Central Europe, namely Vienna.
Methods:  The evaluation of caries was carried out in an anthropological sample consisting of the remains of 136 individuals and included 2215 permanent teeth. Age and sex estimations were based on dental development and on skeletal ageing methods. The presence of dental caries was determined according to clinical aspects using a dental probe.
Results:  The frequency of ante mortem tooth loss in the sample was 23.8%; the total caries frequency was calculated as 14.9%. The highest caries rate was recorded in the second mandibular molar (34.6%). The most affected tooth surface was found to be the root with 12.7%, followed by the approximal surface with 8.6%, but only 7.7% of the occlusal surfaces were affected by caries.
Conclusion:  This study revealed that Avars suffered from higher caries rates than most other medieval European populations, but experienced a similar dental caries distribution. Attrition of the occlusal surface resulting from a diet containing abrasive particles with accompanying posteruptive tooth movement is considered the major factor causing this premodern caries pattern.     

Type A aortic dissection involving the carotid arteries: carotid stenting during open aortic arch surgery

Aortic dissection involving the arch can be complicated by extension to the supra-aortic branches. Carotid dissection may be symptomatic or asymptomatic at the time of surgery. Dissection or re-dissection of repaired carotid may happen later, with symptoms occurring days after the surgical repair, increasing the morbidity and mortality of those patients. We report a case of a patient with type A aortic dissection involving the aortic arch and extending to the supra-aortic branches. During surgery the dissection was seen extending to the distal carotid arteries with tears in the inner wall. After use of surgical glue as a sealant, seeing the persistent fragility and the presence of spiral form tears in the internal wall of the carotid arteries, intraoperative stenting of the common carotid arteries was performed using two stents to prevent carotid re-dissection and ischemic stroke in the postoperative period. In patients with aortic dissection and extension into the carotid arteries, especially with presence of tears of the inner wall, after use of a glue as a sealant of the two dissected layers, if the repaired artery wall results are still fragile, use of intraoperative carotid stenting may be of help in preventing late re-dissection.     

血管成形术和支架辅助血管成形术治疗颅内动脉粥样硬化的报告标准（下）

本刊经Philip M．Meyers博士代表写作组授权,将“ Reporting standards for angioplasty and stent-assisted angioplasty for intracranial atherosclerosis”译为中文在本刊刊登。标准中对患者的选择、颅内动脉狭窄程度的判断、最佳内科治疗、围手术期处理、血管内治疗、术后并发症等,进行了规范化总结,拟为今后的临床试验和研究的规范化确定标准,以保证结果的可比性,对神经介入医师具有重要的指导意义。     

Sensitivity of <Emphasis Type="Italic">Eisenia andrei</Emphasis> (Annelida,Oligochaeta) to a commercial formulation of abamectin in avoidance tests with artificial substrate and natural soil under tropical conditions

Obtaining ecotoxicological data on pesticides in tropical regions is imperative for performing more realistic risk analysis, and avoidance tests have been proposed as a useful, fast and cost-effective tool. Therefore, the present study aimed to evaluate the avoidance behavior of Eisenia andrei to a formulated product, Vertimec^® 18 EC (a.i abamectin), in tests performed on a reference tropical artificial soil (TAS), to derive ecotoxicological data on tropical conditions, and a natural soil (NS), simulating crop field conditions. In TAS tests an adaptation of the substrate recommended by OECD and ISO protocols was used, with residues of coconut fiber as a source of organic matter. Concentrations of the pesticide on TAS test ranged from 0 to 7 mg abamectin/kg (dry weight—d.w.). In NS tests, earthworms were exposed to samples of soils sprayed in situ with: 0.9 L of Vertimec^® 18 EC/ha (RD); twice as much this dosage (2RD); and distilled water (Control), respectively, and to 2RD: control dilutions (12.5, 25, 50, 75%). All tests were performed under 25 ± 2°C, to simulate tropical conditions, and a 12hL:12hD photoperiod. The organisms avoided contaminated TAS for an EC_50,48h = 3.918 mg/kg soil d.w., LOEC = 1.75 mg/kg soil d.w. and NOEC = 0.85 mg/kg soil d.w. No significant avoidance response occurred for any NS test. Abamectin concentrations in NS were rather lower than EC_{50, 48h} and LOEC determined in TAS tests. The results obtained contribute to overcome a lack of ecotoxicological data on pesticides under tropical conditions, but more tests with different soil invertebrates are needed to improve pesticides risk analysis.