Penetration of selected Dead Sea minerals through a healthy rabbit skin, from a sustained-release transparent varnish, as a prospective treatment for psoriasis

Bathing in the Dead Sea is an established treatment for psoriasis. Penetration of Dead Sea minerals into psoriatic skin is an effective factor in this treatment, but applying it clinically requires frequent bathing in the Dead Sea or in its bath-salt solution. We tested an ethyl-cellulose-based transparent varnish with a sustained-release property, for its penetrability of such minerals. Minerals tested were MgBr₂, and KBr, known for their relevance in psoriatic proliferation. They were applied for up to three weeks. We could demonstrate that two weekly applications of the salt-containing varnish on healthy rabbit skin are enough to obtain elevated levels of magnesium and potassium in their plasma. We propose the application of Dead Sea minerals containing varnish as a clinical treatment for psoriasis.     

Repair of pig dura in vivo using temperature controlled CO(2) laser soldering

BACKGROUND AND OBJECTIVES: The purpose of this study was to demonstrate that laser soldering might be successfully used for closing holes or cuts in the dura layer, which encapsulates the brain. STUDY DESIGN/MATERIALS AND METHODS: A temperature controlled fiberoptic CO(2) laser system and albumin solder were used for spot soldering of fascia patches to holes in the dura of farm pigs, in vitro and in vivo. RESULTS: The mean burst pressure of the soldered patches in the in vitro experiments was 190 +/- 88 mm Hg-significantly higher than typical maximum CSF pressure of 15 mm Hg. In the in vivo experiments the pigs showed no postoperative complications. Histopathological studies exhibited an accepted level of inflammatory reaction and showed no thermal damage to the underlying brain tissue. CONCLUSIONS: It has been clearly demonstrated that temperature controlled laser soldering is a very useful technique for the repair of the dura. It provides significant advantages over standard closure techniques: it is easy to apply, the bond is strong and watertight and the procedure is likely to be much faster than suturing. This research work will lead to clinical trials.     

Clindamycin in dentistry: more than just effective prophylaxis for endocarditis?

Clindamycin is a broad-spectrum antibiotic with activity against aerobic, anaerobic, and beta-lactamase-producing pathogens. This antibiotic has been used for many years as prophylactic treatment during dental procedures to prevent endocarditis. However, the spectrum and susceptibility of the bacteria species involved in dental infections indicate that clindamycin would also be an effective treatment option for these conditions. In addition to its antiinfective properties, clindamycin has high oral absorption, significant tissue penetration, including penetration into bone, and stimulatory effects on the host immune system. This review discusses the microbiologic and clinical evidence supporting the efficacy and safety of clindamycin for the successful management of dental infections.     

Microbiology of acute exacerbation of chronic sinusitis

OBJECTIVES: We undertook to evaluate the microbiology of acute exacerbation of chronic sinusitis (AECS). METHODS: Repeated aspirations of maxillary sinus secretions by endoscopy were performed in 7 patients over a period of 125 to 242 days. RESULTS: Bacteria were recovered for all 22 aspirates, and the number of isolates was between 2 and 4. A total of 54 isolates were isolated: 16 aerobic and facultative bacteria and 38 anaerobic bacteria. The aerobic bacteria were Haemophilus influenzae (7 isolates), Streptococcus pneumoniae (3), Moraxella catarrhalis (3), Staphylococcus aureus (2), and Klebsiella pneumoniae (1). The anaerobic bacteria included pigmented Prevotella and Porphyromonas spp (19), Peptostreptococcus spp (9), Fusobacterium spp (8), and Propionibacterium acnes (2). A change in the types of isolates was noted in all consecutive cultures obtained from the same patients as different organisms emerged and previously isolated bacteria were no longer recovered. An increase in antimicrobial resistance was noted in 6 instances. CONCLUSIONS: This study illustrates the microbial dynamics of AECS in which anaerobic and aerobic bacteria prevail, and highlights the importance of obtaining cultures from patients with AECS for guidance in selection of proper antimicrobial therapy.     

The role of anaerobic bacteria in tonsillitis

This review summarizes the information that supports the potential importance of anaerobic bacteria in tonsillitis. Some anaerobic bacteria possess interfering capability with Group A beta-hemolytic streptococci (GABHS) and other pathogens. The possible role of anaerobes in the acute inflammatory process in the tonsils is supported by several observations: anaerobes have been isolated from the cores of tonsils of patients with recurrent GABHS and non-GABHS tonsillitis (NST); the recovery of anaerobes as predominant pathogens in abscesses of tonsils, in many cases without any aerobic bacteria; their recovery as pathogens in well-established anaerobic infections of the tonsils (Vincent's angina); the increased recovery rate of encapsulated pigmented Prevotella and Porphyromonas spp. in acutely inflamed tonsils; their isolation from the cores of recurrently inflamed NST; and the response to antibiotics in patients with NST. Furthermore, immune response against Prevotella intermedia is present in patients with recurrent NST, and an immune response can also be detected against P. intermedia and Fusobacterium nucleatum in patients who recovered from peritonsillar cellulitis or abscesses, infectious mononucleosis and acute non-streptococcal and GABHS tonsillitis. Although more studies are needed, these findings support the possible pathogenicity of Gram-negative anaerobic bacilli in tonsillitis.     

Partial inferior turbinectomy using the microdébrider

BACKGROUND: A microdébrider was selected to accomplish partial inferior turbinectomy, allowing for controlled and rapid removal of hypertrophic soft tissue while preserving the general turbinate form. OBJECTIVE: To assess the clinical outcome, healing, and any adverse consequences from the microdébrider partial turbinectomy procedure. SETTING: A public hospital in north-central Israel. DESIGN: A nonrandomized prospective study of 35 adults who were referred for nasal airway surgery, including turbinectomy. METHODS: All patients underwent bilateral inferior turbinate reduction with the microdébrider, with removal of mucosa from the medial and inferior portions of the inferior turbinates. Detailed follow-up was accomplished at 4 or more months postoperatively, including a visual analogue scale questionnaire and videoendoscopy. For seven patients, pre- and postoperative mucosal biopsies were available to evaluate healing and epithelial regeneration. RESULTS: Nasal endoscopy showed well-healed turbinate membranes and preservation of the turbinate form, with widening of the inferomedial nasal airway space. Subjective nasal patency improved after surgery, p < .01, and the subjective sense of smell was improved, p < .01, without associated crusting, pain, irritation, sneezing, or dryness. Postoperative biopsies showed subepithelial fibrosis and regenerated epithelium, generally of respiratory differentiation. CONCLUSION: Inferior turbinate reduction can be accomplished efficiently with the microdébrider device, without undue side effects. SIGNIFICANCE: Further experience and long-term follow-up with this technique are warranted.     

Cholesterol granulomas in antrochoanal polyps: a clinicopathologic study

The purpose of this study was to investigate antrochoanal polyps with cholesterol granuloma (CG), which is a granulomatous reaction to cholesterol crystals that has been precipitated in the tissue. It is usually associated with chronic middle ear disease, common in the mastoid air cells, less common in the orbit and rarely found in the paranasal sinuses. The aim of this study was to analyze the etiology and pathological findings of antrochoanal polyps associated with cholesterol granuloma. This is a retrospective study of five cases of antrochoanal polyp with cholesterol granuloma, (four males and one female between 15 and 77 years of age) who presented with nasal obstruction, rhinorhea and snoring. The cases were clinically and histologically reviewed. Four patients were treated endoscopically and one by intranasal polypectomy without endoscope. There was no recurrence during the follow-up between 24 to 36 months (mean 31.2 months). Five uncommon cases with antrochoanal polyp with cholesterol granuloma are presented. The cholesterol granulomas consist of fibrous granulation tissue containing cholesterol crystals with surrounding foreign body giant cells. The pathogenesis of antrochoanal polyp with cholesterol granuloma is unclear, and further investigations are needed.