What have studies of non‐industrialized countries told us about the cause of allergic disease?

The increase in allergic diseases that was observed in countries that had experienced rapid economic growth since the mid‐20th century initiated a search for environmental exposures that may explain these phenomena that continues to the present day. Societies that are in the earlier stages of the process of industrialization provide an opportunity to compare the initial stages of economic development and the lifestyle changes that may accompany this, with other communities whose way of life may not have changed appreciably for centuries. These studies have consistently demonstrated higher levels of allergic disease in the relatively affluent populations compared with those who maintain a more traditional lifestyle. Environmental changes that have emerged from these studies that may modify the risk of allergic disease include microbial exposures including parasite infection, pollution, diet and obesity. In addition, food and drug allergies represent a neglected area of research in these countries that may be causing a relatively high burden of disease.     

Treatment of Acquired Bilateral Nevus of Ota-Like Macules (Hori''s Nevus) with a Combination of the 532 nm Q-Switched Nd:YAG Laser Followed by the 1,064 nm Q-Switched Nd:YAG Is More Effective: Prospective Study

BACKGROUND: Acquired bilateral nevus of Ota-like macules (Hori's nevus) is a common dyschromatosis among Asian women. Q-switched lasers have been used successfully as a treatment modality. OBJECTIVE: The purpose of this study was to compare the efficacy of using the Q-switched 532 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser followed by the 1,064 nm laser versus the Q-switched 1,064 nm Nd:YAG laser alone in the treatment of Hori's nevus. METHODS: This is a prospective left-right comparative study. Ten women with bilateral Hori's nevus were recruited and treated with a combination of the Q-switched 532 and 1,064 nm Nd:YAG lasers on the right cheek and the Q-switched 1,064 nm Nd:YAG laser alone on the left cheek. Only one laser treatment session was performed. The degree of pigmentation was objectively recorded with a mexameter. Subjective assessment was made by both patients and two blinded, nontreating dermatologists. RESULTS: At 6 months, there was a statistically significant difference (p = .009) of 35.10 points using objective mexameter measurements between the two sides, favoring the side treated with a combination of 532 and 1,064 nm laser treatment. Subjective grading by the patients and blinded dermatologists also confirmed that combination therapy was more successful after one treatment. Although combination treatment had a higher incidence of mild postinflammatory changes, this disappeared within 2 months. CONCLUSIONS: Concurrent use of the Q-switched 532 nm Nd:YAG laser in combination with the 1,064 nm laser is more effective in pigment clearance than the Q-switched 1,064 nm Nd:YAG laser alone for Hori's nevi.     

Puncture wound related pseudomonas infections of the foot in children

Eleven children with Pseudomonas aeruginosa infection complicating foot puncture wounds were reviewed. Delay in presentation (mean 2 days) and diagnosis (mean 9 days) due to a paucity of clinical signs of deep infection was characteristic of this condition. Septic arthritis (5 patients) and osteomyelitis (3 patients) were frequent complications. Treatment involved multiple surgical debridements and prolonged intravenous antibiotic therapy. The clinical outcome was good although long-term radiographic changes were common.     

Cyclosporin-A nephrotoxicity and acute cellular rejection in renal transplant recipients: correlation between radionuclide and histologic findings

Serial radionuclide studies using both Tc-99m DTPA (perfusion) and I-131 hippuran (tubular function) were correlated with histologic findings in 25 patients with renal transplants. These cases included 15 cases of cyclosporin-A nephrotoxicity (CsA-NT) and ten cases of acute cellular rejection that were retrospectively selected on the basis of biopsy findings and favorable clinical response to therapy specific for each of these conditions. The serial radionuclide studies enabled the correct diagnosis in 12 of 15 cases of CsA-NT and eight of ten cases of acute rejection. Posttherapy radionuclide studies, furthermore, demonstrated improvement consistent with clinical response. In all cases, the radionuclide results were available at least 24 hours before biopsy findings. These results indicate that serial radionuclide studies evaluating interval changes in both perfusion and tubular function are of significant value in the diagnosis and follow-up of CsA-NT and acute cellular rejection in transplant recipients. This initial experience suggests a sensitivity of 80%.     

Laparoscopic nephron-sparing surgery for the small exophytic renal mass.

OBJECTIVES: Nephron-sparing surgery has emerged as the treatment of choice for the incidentally detected small renal mass, especially those less than 4 cm in size. We describe our technique and experience with the laparoscopic excision of these lesions. METHODS: Between June 2001 and October 2003, 20 patients underwent nephron-sparing surgery at our institution. Twenty-one laparoscopic partial nephrectomy procedures were performed. All tumors were detected incidentally by cross-sectional imaging. All patients had a solid renal mass or a complex cystic renal mass of Bosniak category III or greater. All solid tumors were exophytic and less than 4cm in diameter. Both transperitoneal and retroperitoneal approaches were used. Hemostasis was achieved without hilar control in 20 of the 21 cases. RESULTS: Twenty renal units were approached transperitoneally, and 1 retroperitoneally. Mean tumor size was 2.6 cm (range, 1.2 to 4). Mean estimated blood loss was 211 mL (range, 50 to 500), and mean operative time was 165 minutes. Pathology revealed renal cell carcinoma in 14 (70%). No intraoperative complications occurred. Two patients required blood transfusions postoperatively. CONCLUSION: Carefully selected patients with small, exophytic renal masses can safely undergo laparoscopic excision. When achievable, this procedure can be a more logical alternative to ablative techniques for the minimally invasive management of such lesions.