Docosahexaenoic acid inhibits PAF and LTD4 stimulated [Ca2+]i-increase in differentiated monocytic U937 cells

We investigated the effects of different polyunsaturated fatty acids (PUFAs) of the n-6 and n-3 family on the PAF and LTD4 stimulated increase in cytosolic free Ca(2+)-concentration [Ca2+]i in retinoic acid (RA) differentiated, human monocytic U937 cells. Docosahexaenoic acid (10 microM DHA) reduced the PAF induced increase in [Ca2+]i from 455 +/- 25 nM to 319 +/- 24 nM (P less than 0.01). DHA also significantly attenuated the LTD4 induced increase in [Ca2+]. However [Ca2+]i-increase stimulated by f-MLP, ATP, or ionophore A 23187 was not affected by DHA. Other PUFAs like eicosapentaenoic acid (EPA), alpha-linolenic acid (LnA), arachidonic acid (AA) or gamma-linoleic acid (LA) were ineffective. Cellular differentiation as assessed by nitrobluetetrazolium reduction and enhanced expression of specific PAF binding sites in RA treated cells were not altered by DHA. Fatty acid composition in cellular phospholipids revealed effective incorporation of each PUFA. The DHA-effect on [Ca2+]i was time dependent and occurred at 48 h, whereas the DHA-content in phospholipids reached a plateau already at 24 h. The antioxidant vitamin E, the lipoxygenase inhibitor NDGA and the cytochrome P-450 inhibitor SKF 525A completely prevented the DHA induced reduction of PAF stimulated [Ca2+]i-increase. In contrast, the cyclooxygenase inhibitor indomethacin had no effect. Our results indicate that DHA selectively reduces intracellular [Ca2+]i-increases induced by PAF and LTD4 in RA-treated U937 cells, presumably involving an oxidative modification of DHA.

[Longitudinal changes in the acoustic temporomandibular symptoms due to different procedures of orthognathic surgery]

A longitudinal study of TMJ sounds prior to and after combined orthodontic-orthognathic surgical procedures was carried out. The relative frequency of such sounds two days prior to operation (T0) and three months (T1), eight months (T2), 14.5 months (T3), and 25.5 months (T4) postoperatively remained--treatment-independently--largely unchanged. Chances in frequency between T0 and T4 showed only a nonsignificant tendency to differ in comparison with changes seen after orthodontic treatment (A) only. An analysis of individual changes revealed that after Le Fort I osteotomy (B) and bimaxillary procedures/posterior mandibular repositioning (D), no change in the preoperative sounds is to be expected. In contrast, following mandibular advancement (C) TMJ sounds first disappeared, in particular in the period immediately following operation (T0-T1), but also subsequently reappeared. The difference vis-a-vis group B (Le Fort I osteotomies) was statistically significant (group B vs. group C: p less than or equal to 0.01.

[Catheterization of the jugular venous bulb in comatose children]

Ischemia and hypoxia are frequent potential sources of secondary brain damage after a variety of brain injuries. Cerebral oxygen extraction may be altered by coma as well as therapeutic interventions. In consequence, monitoring of cerebral O2 availability and utilization has become an important challenge for clinicians. However, measurement of cerebral oxygen extraction in children currently is not included into routine clinical care. This paper describes the measurement of O2-saturation in the jugular bulb in four comatose infants and children (in one continuously) following cardiac arrest or head injury. Our data demonstrate that this procedure served as a valuable tool in the management of those patients. Arterio-jugular oxygen content and lactate differences were used for the establishment and adjustment of therapeutic procedures and moreover, provided relevant information for the interpretation of other cerebral surveillance parameters.

Positioning control of the upper incisors in orthognathic surgery. Pre-operative planning with the Model Positioning Device and intra-operative application of the Sandwich Splint

In orthognathic surgery a three-dimensional positioning of the maxilla is possible by means of the Le Fort I osteotomy and subsequent maxillary movement. In treatment planning and at the time of surgery it is very important to achieve an exact positioning of the upper incisors in relation to the upper lip and the rest of the skull. The Model Positioning Device described here allows three-dimensional positioning of the upper incisors in one- or two-jaw surgery. The reference plane is the upper surface of the upper part of a semi-individually adjustable articulator. The application of the Sandwich Splint enables the three-dimensional positioning of the maxilla in relation to the rest of the skull. The Sandwich Splint ensures that the vertical position of the mandible in relation to the rest of the skull above the osteotomy plane is exactly reproducible in the pre- and post-operative situation in both model surgery and at time of surgery. To this mandibular position the maxilla is positioned in three dimensions, as preplanned. The vertical dimension, which is identically reproducible before and after surgery is measured with a caliper. After surgery the mandible can be rotated into the planned new intercuspidation.

[Successful lysis of a septic thrombosis of the superior vena cava using recombinant tissue-plasminogen activator]

Recombinant human tissue-type plasminogen activator (rt-PA) was successfully given via central vein to a 1.7 year old child with angiographically documented septic vena cava superior thrombosis Thrombolytic therapy with rt-PA was started with 0.2 mg/kg as a slow bolus injection followed by an infusion of 0.8 mg/kg over 60 min. rt-PA was applicated 12 hours after an urokinase bolus in a dosage of 8000 E/kg and heparin infusion of 500 E/kg/die. No clinical side effects or alterations in the plasmatic coagulation profile were noted. The prompt clinical response suggests that the use of rt-PA in thrombotic disease should be investigated further to establish efficacy, dosing guidelines, complication rates, and contraindications in childhood.

Adjunctive lithium carbonate in nortriptyline-resistant elderly depressed patients

Recent reports supporting the use of lithium carbonate as an adjunct to tricyclic antidepressants for the treatment of refractory depression have not utilized standardized tricyclic antidepressant therapy, nor have they addressed the efficacy of lithium augmentation in a geriatric population. A 3-week open trial was added to the medication regimen of 15 elderly depressed inpatients who had already failed 4 weeks of therapeutic levels of nortriptyline. Treatment response was determined by the 17-item Hamilton Rating Scale for Depression (HAM-D). Two of 15 partial responders before lithium augmentation became complete responders. Of the remaining 13 "nonresponders" before lithium augmentation, one had a complete response, 7 had a partial response and 5 remained nonresponders. Although there was a mean HAM-D change of 8.3 points after lithium augmentation (24.7 +/- 5.9 to 16.4 +/- 6.8, p less than .001), when considering the previously reported similar efficiency of extended nonaugmented nortriptyline, these data do not strongly support lithium augmentation in elderly subjects who fail to respond after 4 weeks of nortriptyline. Further study is needed to determine what role, if any, lithium augmentation should play in the treatment of geriatric depression.

[Changes in opening mobility due to surgical advancement of the mandible]

A prospective follow-up study of 21 class-II patients, who were treated with a combination of orthodontics and orthognathic surgery, revealed typical postoperative changes in opening mobility. Their characteristics were: a strong initial loss of mobility and a regeneration period of about one year. Because the increase of mobility could not completely compensate for the initial reduction, a significantly reduced mobility was detected 25.5 months postoperatively. This reduction was considered as clinically acceptable, since former studies showed more unfavorable developments. However, individual changes of mobility are worth of notice. The comparison of condylar-related axiographic measurements with incisal measurements showed that the reduction of the length of axiographic tracings was more prominent than the "clinical-effective" reduction of the combined condylar rotation and translation.

Comparison of 'normal' TMJ-function in Class I, II, and III individuals

Fifty-seven non-orthodontically treated young adults, judged as either clinically healthy or with only mild symptoms of TMJ-dysfunction, were divided into groups according to their sagittal molar relationship (Class I-, Class II-, and Class III-group). All underwent a standardized clinical and axiographic examination with an axiographic recording device (SAS-SYSTEM). The comparison of the lengths of the axiographical protrusive curves showed significantly higher values in the Class II group than in the Class I (P less than 0.01) and in the Class I group than in the Class III group (P less than 0.001). Analogous differences could be found in clinical protrusive measurements at the incisal point and in lateral excursions. It was concluded that the protrusive condylar movement capacity coincides with the dental sagittal relationship. In opening, significant differences were seen axiographically (Class I v. Class III: P less than 0.001; Class II v. Class III: P less than 0.01), but not clinically. Since axiographic measurements show only condyle translation, but not rotation in contrast to measurements at the incisal point, it can be concluded that the differences in opening are also translatory and not rotational. Measurements of the average change of curvature of axiographic tracings showed significantly less curved protrusive tracings in Class III than in Class I (P less than 0.001) and Class II individuals (P less than 0.01), supporting the concept that in the Class III group condyle movement is restricted to the straight posterior slope of the tubercle.(ABSTRACT TRUNCATED AT 250 WORDS)

The Charles Bonnet syndrome. Visual perceptive dysfunction in sensory deprivation

We present a series of four patients with the Charles Bonnet syndrome, which is characterized by recurrent vivid visual hallucinations in the presence of normal cognition and insight. It usually occurs in elderly people with ophthalmic pathology causing severe visual sensory deprivation. Our experience suggests that this syndrome is frequently overlooked or misdiagnosed by both ophthalmologists and psychiatrists. To our knowledge this is only the second series of cases of the syndrome in the American literature.

[Axiographic irregularities in patients with different clinical function statuses]

A group (n = 20) of young, clinically symptom-free subjects (Helkimo Di = 0) was compared with a group (n = 22) of TMJ-patients (Di greater than 2) regarding the frequency and the amount of axiographic findings of malfunction. 5 different mandibular movements were monitored using the SAS-system with tenfold magnification in 2 planes of recording. An analysis of these results showed significant effects in several parameters. According to these findings the highest reliability to detect functionals differences is at the maximum distance between the ex- and incursive tooth-guided protrusive path in the sagittal-vertical plane. Although other parameters showed only slight discrepancies, a cautious interpretation of axiographic tracings must be recommended.

[Scanning electron microscopic research on the clinical use of interdental stripping]

The morphology of approximal enamel that has been stripped for therapeutic reasons was evaluated under the scanning electron microscope (SEM) twelve weeks and one year after treatment. In part one of the study the teeth were extracted before evaluation, in the second part replica were taken. For comparative reasons the morphology of the natural approximal enamel surface was evaluated under the SEM, too. After twelve weeks the edges of the furrows were seen to be smoother and plaque accumulations were found in the depths of the furrows. One year after there was found essentially no difference. In some of the specimens there was found a certain levelling of the edges in the approximal contact area, but not in the cervical region of the artificially abraded tooth surface. The natural enamel surface of the contact area showed excavations of similar size as the furrows that remain after stripping and finishing. But our study shows that the therapeutic approximal abrasion leaves furrows in the cervical region that even after one year had not undergone repair. The question is discussed, if thus predispositions for periodontal pathologies and caries could be created.

Purification and amino-terminal sequence analysis of the complement-fixing and precipitin antigens from Coccidioides immitis

Two proteins (21 and 48 kilodaltons) purified from endospore-spherule culture filtrates of Coccidioides immitis are identified as precipitin and complement-fixing antigens, respectively. To allow specific structural comparison to antigens identified by other investigators and as a first step to eventual serodiagnostic antigen production by recombinant DNA technology, amino-terminal amino acid sequences were determined for these antigens.

[Changes in the functional status of the stomatognathic system due to orthodontic multiband treatment in the adult]

Ten patients who undergo an orthodontic therapy with a full-band modified straight-wire-appliance were examined clinically and by means of an electronic axiographic device (SAS-system) at the beginning of treatment and after an average of 12.6 months, respectively. While the clinical functional status showed only minor changes, alterations of all examined axiographic parameters could be detected. This finding reemphasizes the necessity of modern axiographic means to get additional information about the functional status of the TMJ. The alterations point to a shift in the functional pattern of articular and muscular components during orthodontic treatment. In the majority of cases, axiographic parameters remained constant, however. In that respect, it might be of special interest that even uncoordinated tracings, mainly in the horizontal plane, kept up its characteristic appearance. These findings show clearly, that alterations of occlusal relationships must not influence articular functional patterns immediately.

Platinum-based combination chemotherapy in advanced non-small cell lung cancer: a randomized phase II trial of the Cancer and Leukemia Group B

The Cancer and Leukemia Group B (CALGB) utilized a randomized phase II trial design to evaluate two cisplatin-based combinations, cisplatin-cytarabine (ara-C) and cisplatin-vinblastine, in 151 patients with advanced non-small cell lung cancer. Patients entered on study had not received prior chemotherapy. Platinum doses were equivalent in the two treatment programs. The total response rate (complete response, partial response, regression of evaluable disease) for the cisplatin-vinblastine group was 22% (16/73). Failure-free survival at six months for this group was 41%, survival at six months was 63%. The cisplatin-ara-C group had a total response rate of 9% (7/78) with a failure-free survival at six months of 14% and a six-month survival of 47%. Severe or life-threatening toxicity was seen in 73% of cisplatin-vinblastine cases and 59% of cisplatin-ara-C patients. Neither regimen is active enough to warrant designation as "standard therapy" for patients with M1 disease.

[Differences of clinical and axiographic function parameters in patients with skeletal Class II and Class III anomalies]

21 young individuals with skeletal and dental class II-relationships were compared to an analogous group of class III individuals as to their mandibular range of motion. The measurements of clinical movements in pro- and laterotrusion as well as the lengths of axiographic tracings showed a significantly reduced capacity of motion in the class III group. Because all examined individuals exhibited undisturbed TMJ-function or, at most, had mild symptoms (Helkimo-indexes 0 or 1), the reported findings cannot be interpreted as signs of pathology, but seem to demonstrate the broad range of normality.

[Studies on the reliability of axiographic recordings using the SAS system]

The objective of this study was to compare the differences in the electronic axiographic tracings within one axiographic examination and the differences between two axiographies, with respect to the reliability of their length, curvature and inclination values. 22 patients with varying degrees of TMJ dysfunction were examined using the SAS system after Meyer/Dal Ri. The results indicated a high degree of reliability within one axiography, but a remarkably reduced reliability when comparing two axiographies. In both comparisons maximal mouth opening was significantly less reliable than protrusive and lateral movements, irrespective of whether these movements were occlusally guided or TMJ-guided. No significant differences could be found between occlusally and TMJ-guided movements and between patients with different functional status values (Helkimo dysfunction index 0 and 1 as against 2 and 3).

[Results of cardiopulmonary resuscitation in children]

We retrospectively evaluated the outcome from cardiopulmonary resuscitation (CPR) in 149 children of all age groups. Only 7 children experienced ventricular fibrillation. 47 children (31.5%) died immediately. Further 47 children died within 24 hours of their arrest, 24 (16.1%) survived longer than 24 hours after CPR but not until discharge. Only 31 children (20.8%) survived to discharge, 5 with severe neurologic sequelae, attributable to the arrest or resuscitation efforts. Cardiopulmonary arrests in the Pediatric Intensive Care Unit carried the worst prognosis. Better results were obtained out-of-hospital, in the OR or on the pediatric floor. Long-term survival rate did not correlate with age, or type of administered catecholamine. None of the children receiving calcium survived. This large study confirms the poor outcome of CPR in children.

[Value of electronic measuring instruments for optimizing functional TMJ diagnosis]

In order to get additional information about the significance of electronic axiographic recordings in TMJ-diagnosis, 34 patients, who showed 47 clicking TMJs, were examined by use of an electronic axiographic instrument (SAS-system). The frequency of the detected findings emphasize the value of electronic axiographic devices for differential diagnosis. In detail the following conclusions could be drawn: examination of different types of movement is recommended because clicking must not exist in all types, recording in more than one plane is necessary in order to detect the (prevailing) plane of dislocation, a magnification of tracings provides addition information concerning different types of clicking.