Evaluating oronasal flow with temperature (thermistor) and obstructive pressure (prongs)

The measurement of oronasal flow during sleep studies using thermistors is internationally well accepted. As an alternative the possibility exists to measure the pressure at the nose by means of nasal prongs. Our objective was to compare and evaluate the methods to detect respiratory events in clinical routine, namely O2-saturation by pulse oxymetry oronasal flow by thermistors thoraco-abdominal effort by belts oronasal flow by prongs, 8 consecutive patients suspected of sleep apnoea syndrome (7 m, 1 f), mean age 56.5 +/- 9.5 years, height 173 +/- 6.4 cm, BMI 28.7 +/- 2.6 kg/m2, Epworth sleepiness scale score 9.1 +/- 3.2, AHI 24.9 +/- 13.7 h-1, lowest SaO2 86 +/- 4.9%, were examined. Between nose and mouth we fixed an oronasal 3-point thermistor and oronasal prongs (2 openings at the mouth and 2 openings at the mouth applying a common tube). During breathing the resulting pressure was registered with a pressure transducer parallel to the signal of the thermistors and the other polysomnographic data. We defined a respiratory event if at least one of the 4 signals met the criteria of a respiratory disturbance (for exact definitions see method). The detection rate of the 4 signals was calculated in relation to the sum of all events. Of the 1824 events (100%) only 52.3% were detected by an O2-desaturation of more than 4%, but 61.0% by thermistors. An acceptable detection rate was found measuring effort with 83.4%, only nasal prongs detected 95.1% of all events. We conclude that with regard to the detection rate of respiratory events the measurement of pressure by nasal prongs is superior to the use of thermistors.     

Pathology and behavior of small breast carcinomas.

Mammographic screening and increased public awareness have changed the clinical spectrum of breast carcinoma with important implications for therapy. Small invasive breast carcinomas T1a,b, defined as 1.0 cm or less in maximum diameter, now comprise 22% of invasive carcinomas in our institution, enabling comparison of 273 T1a,b with 563 T1c (1.1 to 2.0 cm), 447 T2 (2.1 to 5.0 cm), and 40 T3 (>5 cm) carcinomas. Nuclear measurements were made with calibrated ocular grids. Hormone receptors were measured in cytosol or immunohistochemically. S-phase fraction (SPF) was measured prospectively on all carcinomas by counting cells in histologic preparations after vitro labeling with tritiated thymidine or 5-bromo-2'deoxyuridine. T1a (0.2 to 0.5 cm) carcinomas were similar to T1b (0.6 to 1.0 cm) in histologic and biologic features, but T1b carcinomas had higher detection rates of axillary metastasis (0% v 10%). The latter may reflect longer duration of metastases, permitting growth to detectable size. Low-grade carcinoma types (mucinous, tubular, cribriform) became less frequent as T stage increased, with the major decrease occurring at T1b (0.6 to 1.0 cm)/T1c (1.1 to 2.0 cm) boundary. T1a,b carcinomas preponderantly had low-grade histologic and biochemical characteristics and low SPF. SPF increased significantly with increasing tumor size from T1b through T2 but not beyond T2. Increases in proportion of patients with axillary metastases occurred over each T transition. Estrogen and progesterone receptor (ER, PgR) positivity decreased with increasing stage. Larger tumors were significantly associated with younger patient age. While this may reflect ease of diagnosing small carcinomas after the menopause, young age was also associated with predictors of aggressive tumor behavior (high SPF, negative assays for ER, PgR). T1a,b patients with mid or high SPF or axillary metastases were more likely than others to have received cytotoxic adjuvant therapy. Conclusions are: (1) Development of cell lines that have metastatic capability appears to occur near the T1b/T1c interface, but they exist very early in some carcinomas. (2) T1a carcinomas may be managed without axillary dissection. When T1b patients are candidates for adjuvant therapy, we advocate sentinel node biopsy with intensive study for micrometastases. (3) Accurate determination of size is very important in prognosis of small breast carcinomas. (4) Prognostic efficacy of proliferation and other prognostic markers in retrospective studies, but not in our patients who often received adjuvant therapy, suggest that micrometastases from small breast carcinomas are highly responsive to adjuvant chemo/hormonal therapy.     

Treatment options for spontaneous and postoperative sclerosing mesenteritis

Sclerosing mesenteritis is a rare pathology with only a few described cases in the literature. The etiology is unclear; however, several potential triggers, including abdominal surgery and abdominal trauma, have been discussed. The pathology includes a benign acute or chronic inflammatory process affecting the adipose tissue of the mesenterium. Despite it being a rare disease, sclerosing mesenteritis is an important differential diagnosis in patients after abdominal surgery or patients presenting spontaneously with signs of acute inflammation and abdominal pain. We present here three cases with sclerosing mesenteritis. In two cases, sclerosing mesenteritis occurred postoperatively after abdominal surgery. One patient was treated because of abdominal pain and specific radiological signs revealing spontaneous manifestation of sclerosing mesenteritis. So far there are no distinct treatment algorithms, so the patients were treated differently, including steroids, antibiotics and watchful waiting. In addition, we reviewed the current literature on treatment options for this rare disease.     

Role of NK,NKT cells and macrophages in liver transplantation

Liver transplantation has become the treatment of choice for acute or chronic liver disease. Because the liver acts as an innate immunity-dominant organ, there are immunological differences between the liver and other organs. The specific features of hepatic natural killer(NK), NKT and Kupffer cells and their role in the mechanism of liver transplant rejection, tolerance and hepatic ischemia-reperfusion injury are discussed in this review.     

Novel proton MR spectroscopy findings in adenylosuccinate lyase deficiency

Adenylosuccinate lyase (ADSL) deficiency is a rare inborn error of metabolism resulting in accumulation of metabolites including succinylaminoimidazole carboxamide riboside (SAICAr) and succinyladenosine (S‐Ado) in the brain and other tissues. Patients with ADSL have progressive psychomotor retardation, neonatal seizures, global developmental delay, hypotonia, and autistic features, although variable clinical manifestations may make the initial diagnosis challenging. Two cases of the severe form of the disease are reported here: an 18‐month‐old boy with global developmental delay, intractable neonatal seizures, progressive cerebral atrophy, and marked hypomyelination, and a 3‐month‐old girl presenting with microcephaly, neonatal seizures, and marked psychomotor retardation. In both patients in vivo proton magnetic resonance spectroscopy (MRS) showed the presence of S‐Ado signal at 8.3 ppm, consistent with a prior report. Interestingly, SAICAr signal was also detectable at 7.5 ppm in affected white matter, which has not been reported in vivo before. A novel splice‐site mutation, c.IVS12 + 1/G > C, in the ADSL gene was identified in the second patient. Our findings confirm the utility of in vivo proton MRS in suggesting a specific diagnosis of ADSL deficiency, and also demonstrate an additional in vivo resonance (7.5 ppm) of SAICAr in the cases of severe disease. J. Magn. Reson. Imaging 2013;37:974–980. © 2012 Wiley Periodicals, Inc.     

Sexual dysfunction in male alcohol addicts: Prevalence and treatment

Study 1 examined the prevalence of sexual dysfunction in 101 male alcohol addicts. Inpatients at a clinic for alcoholism were investigated by questionnaire about their sexual functioning and by hormonal data. Three-quarters had erectile dysfunction, loss of libido, and premature or delayed ejaculation. A follow-up study was done 9 months after the end of treatment. No significant differences in the prevalence of sexual dysfunction were found between the two points of measurement. All patients had normal levels of plasma testosterone at the beginning and end of inpatient treatment. These findings suggest psychological causes for the sexual problems and a need for therapeutic intervention. Study 2 reports on a group of addicts with sexual dysfunction who were treated by a behavioral treatment format. Follow-up results indicate that the treatment group showed significantly less sexual dysfunction than an untreated control group.