Diffuse cutaneous reticulohistiocytosis

The reticulohistiocytoses make up a heterogeneous group of diseases whose origin lies in an accumulation of cells of histiocytic lineage in different tissues and primarily in the skin. Three main clinical forms have been described (multicentric, solitary, diffuse cutaneous), which present with identical histological, ultrastructural and immunohistochemical characteristics. We present a case of diffuse cutaneous reticulohistiocytosis, which is the least common clinical pattern in the spectrum of this disease.     

Management of cutaneous tuberculosis

ABSTRACT:   Cutaneous tuberculosis (TB) is an extrapulmonary form of tuberculosis, which may be classified based on the immunologic state of the host. Chemotherapy still remains the treatment of choice. The management of cutaneous TB follows the same guidelines as that of TB of other organs, which can be treated with a short course four-agent chemotherapeutic regimen given for 2 months followed by a two-drug regimen for the next 4 months. This chapter highlights current treatment recommendations for cutaneous TB. The important factors to consider in the choice of optimal treatment includes the type of cutaneous involvement, stage of the disease, level of immunity, and general condition of the patient. The highest priority in any cutaneous TB control program is the proper, accurate, and rapid detection of cases and the availability of chemotherapy to all tuberculosis patients until cure. Contact tracing is also an important component of efficient tuberculosis control.     

Estimation of individual neonatal survival using birthweight and gestational age: a way to improve neonatal care

The study was conducted to determine the combined effect of birthweight and gestational age at birth on neonatal mortality using individually-identified livebirths. Logistic regression was used for studying the interactive effect of birthweight and gestational age on the individual probability of neonatal death. All livebirths from Chile in 2000 were included in a linked file. Odds ratio models for birthweight and gestational age were developed for each sex. The probability of neonatal death by sex was presented using contour plots. The models were statistically significant, and odds ratios were different and non-linear for the effects of birthweight and gestational age. Contour plots of constant neonatal mortality according to birthweight and gestational age were presented; they were similar for each sex. A single graph for both sexes that estimates the survival potential of infants born too early or too small would improve neonatal care in developing countries.     

Smoking cessation rates in the United States: a comparison of young adult and older smokers

Objectives. We compared smoking quit rates by age in a nationally representative sample to determine differences in cessation rates among younger and older adults.Methods. We used data on recent dependent smokers aged 18 to 64 years from the 2003 Tobacco Use Supplement to the Current Population Survey (n=31625).Results. Young adults (aged 18–24 years) were more likely than were older adults (aged 35–64 years) to report having seriously tried to quit (84% vs 66%, P<.01) and to have quit for 6 months or longer (8.5% vs 5.0%, P<.01). Among those who seriously tried to quit, a smoke-free home was associated with quitting for 6 months or longer (odds ratio [OR]=4.13; 95% confidence interval [CI]=3.25, 5.26). Compared with older smokers, young adults were more likely to have smoke-free homes (43% vs 30%, P<.01), were less likely to use pharmaceutical aids (9.8% vs 23.7%, P<.01), and smoked fewer cigarettes per day (13.2% vs 17.4%, P<.01).Conclusions. Young adults were more likely than were older adults to quit smoking successfully. This could be explained partly by young adults, more widespread interest in quitting, higher prevalence of smoke-free homes, and lower levels of dependence. High cessation rates among young adults may also reflect changing social norms.A key goal of tobacco control is to increase smoking cessation among young adults, because quitting at an early age increases the chances that a smoker will avoid the more serious health consequences of smoking.1 During the 1980s and 1990s, older smokers (50 years and older) were the most successful quitters,2^,3 and annual rates of successful quitting increased for all age groups.2 However, increases in cessation rates in the 1990s were greatest among young adults aged 20 to 34 years.2 Furthermore, among young adult smokers, but not older smokers, the increase in cessation rates was higher in states with higher cigarette prices and highest of all in California, which had a comprehensive statewide tobacco control program,2 suggesting that environmental factors may especially influence cessation rates among young adults. Projecting these national trends, we hypothesized that by 2003, young adults may have been the most successful quitters of any age group. Understanding recent changing influences on successful quitting could help increase the effectiveness of public health programs that aim to encourage cessation.Rates of successful quitting can differ between age groups because of differences in the proportion of smokers who try to quit, or because of differences in success rates among those who try. There is evidence that changes in the social norms surrounding smoking can lead to changes in the proportion of smokers who try to quit and that these norms can be influenced by tobacco-related news coverage4 and mass media advertising campaigns,5 both of which increased in the United States in the late 1990s with the Master Settlement Agreement and with the start of the American Legacy Foundation campaign.6 Young people (aged 0–29 years) may be particularly responsive to such influences,7 and throughout the 1990s, California’s tobacco control program used targeted media campaigns to specifically influence social norms about smoking.8Changes in social norms can also influence behavior associated with success in quitting. In particular, a decrease in levels of nicotine dependence among recent cohorts of smokers could partly explain higher rates of successful quitting among younger adults. Less-dependent smokers are more likely to successfully quit, presumably because of less-intense withdrawal symptoms.9^–11 Following the 1992 Environmental Protection Agency report classifying environmental tobacco smoke as a carcinogen,12 there was a rapid increase in social norms supporting restrictions on smoking,13 and increased restrictions on smoking at work and in public places have been associated with reduced levels of daily cigarette consumption.14^,15During the 1990s, an increasing proportion of smokers, particularly parents, banned smoking in the home.16 There is a strong association between smoke-free homes and successful quitting,17^,18 perhaps in part because a lapse, for example after a meal, is less likely. It is possible that recent birth cohorts who took up smoking under these restrictions at home and work may develop lower levels of dependence than previous cohorts,19 and they may themselves be more likely to live in a smoke-free home.During the 1990s, pharmaceutical aids became available to help overcome withdrawal symptoms, and these aids were associated with quitting success.20^,21 However, once these aids became easily available over the counter in 1996, their apparent effectiveness in population studies disappeared.22^,23 More in-depth analysis has suggested that effective use of pharmaceutical aids may be limited to smokers who are motivated to quit, such as those with a smoke-free home.24 Thus, differences in patterns of use of pharmaceutical aids between age groups may also contribute to recent differences in quitting success rates.We used a large nationally representative survey to compare US smoking cessation rates and associated tobacco-related behaviors between age groups. We compared attempted quitting rates across age groups each year as well as success rates among those who tried to quit smoking and explored whether there were important differences between age groups in prevalence of known correlates of cessation. We used multivariate logistic regression to establish whether differences in such correlates could account for differences in cessation rates, or whether younger smokers were quitting at higher rates than might be predicted by, for example, lower levels of addiction and a higher prevalence of smoke-free homes.     

Morphological sequence of Plastipore extrusion in experimental otitis media

OBJECTIVES: Plastipore prostheses are still used by many surgeons, although the functional results are controversial. The aim of this study was the morphological analysis of Plastipore material performance in the middle ear of rats, with special attention to extrusion. METHODS: Twenty-four Wistar rats were given implants made of commercially available Plastipore and assigned to 3 groups: group A, with implantation in a healthy middle ear; group B, with implantation and cauterization of the nasopharyngeal orifice of the eustachian tube (hypoventilation); and group C, with implantation, cauterization of the eustachian tube, and bacterial inoculation with Pseudomonas aeruginosa. RESULTS: The pathological study showed in nearly all cases the disintegration of the biomaterial. Adhesion between the biomaterial and bone could be seen in 1 rat from group C (hypoventilation and infection). In group C, the Plastipore was in contact with the tympanic membrane in 1 case and was extruding in 2 animals. Different phases of extrusion were defined. No extrusion was observed in the other groups. CONCLUSIONS: The sequential stages of Plastipore extrusion are demonstrated. Infection seems to be the most important factor in Plastipore extrusion in our model.     

Utility of the surgical treatment for severe epistaxis by endoscopic approach of sphenopalatine and ethmoidal arteries

Introduction:To evaluate the efficacy and cost-effectiveness of the treatments used for controlling epistaxis, particularly compared with the surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoid (AE) arteries, a intervention prospective-retrospective study is presented with the aim of assessing the feasibility of these surgical techniques as an alternative to conventional treatments.Patients and methods:184 consecutive patients admitted in the ENT ward between the years 1997 and 2005 were included in the study, and distributed into three groups depending on the last treatment applied to control their bleeding: AP group.- anterior packing (n=98); PP group.- posterior packing (n=66), and ES group.- endoscopic ligation and/or cauterization of SP or AE (n=20).Results:Highly significant differences were found between the groups, not only regarding the efficacy (90% for surgical treatment compared with 41.3% for AP and 63.1% for PP), but also the length of postreatment hospital stay (AP.- 4.92 days; PP.- 6.3 days; ES.- 2.15 days).Discussion and conclusions:the lack of efficacy of conventional treatment and the increasing risk factors that condition nasal bleeding, together with the advance of endoscopic and anesthesic procedures have brought along the possibility of a surgical solution for these patients. Our results demonstrate the feasibility of these techniques as alternative for nasal packing in the treatment of posterior epistaxis, and even its ethical and economical convenience as a substitutive to posterior packing.     

Expression profile of Eph receptors and ephrin ligands in healthy human B lymphocytes and chronic lymphocytic leukemia B-cells

Increasing information relates some Eph receptors and their ligands, ephrins (EFN), with the immune system. Herein, we found that normal B-cells from peripheral blood (PB) and lymph nodes (LN) showed a differential expression of certain Eph/EFN members, some of them being modulated upon in vitro stimulation including EFNA1, EFNA4, EphB6 and EphA10. In contrast, PB CLL B-cells showed a more heterogeneous Eph/EFN profile than their normal PB B-cell counterparts, expressing Eph/EFN members frequently found within the LN and activated B-cells, specially EFNA4, EphB6 and EphA10. Two of them, EphB6 and EFNA4 were further related with the clinical course of CLL patients. EphB6 expression correlated with a high content of ZAP-70 mRNA and a poor prognosis. High serum levels of a soluble EFNA4 isoform positively correlated with increasing peripheral blood lymphocyte counts and lymphadenopathy. These findings suggest that Eph/EFN might be relevant in normal B-cell biology and could represent new potential prognostic markers and therapeutic targets for CLL.     

Cisplatin-induced hearing loss does not correlate with intracellular platinum concentration

CONCLUSION: Inductively coupled plasma mass spectrometry (ICP-MS) can be applied to organic tissues obtained from experimental animals. Hearing loss does not correlate with the platinum (Pt) concentration found in the inner ear. Drug structure and affinity to inner ear proteins could explain ototoxicity caused by cisplatin. OBJECTIVES: To analyse Pt affinity for brain and ear tissues (of similar embryologic origin) in the Wistar rat and clearance gradient after a single dose, and to correlate these findings with hearing changes. MATERIALS AND METHODS: Thirty-two Wistar rats were intraperitoneally injected with cisplatin at a dose of 5 mg/kg. Animals were sacrificed after obtaining auditory brain responses (ABRs) at 3, 7, 30 and 90 days (nine, seven, seven and nine animals, respectively). Brain and both temporal bones were extracted from each animal and analysed by ICP-MS to determine the absolute concentrations of the metal. Eight non-treated animals were employed as a control group. RESULTS: The ABR thresholds were significantly elevated in animals from all groups after cisplatin treatment. A maximum accumulation of Pt for inner ear and brain was revealed around the first week: 3.175 (57%) and 0.342 (72%), respectively. Pt significantly accumulated in greater quantities in ear than in brain (p<0.01) and was cleared at a higher rate in brain than in ear (p<0.01) following cochlea/brain ratio analysis. No statistically significant correlation was found between amounts of Pt and hearing loss in the study animals.