Assessment of adenoid size in children by fibreoptic examination

In order to investigate the relationship between the size of the adenoid and upper respiratory symptoms in children, fibreoptic examination of the nasal cavity and nasopharynx was performed in 817 children. The size of the adenoid was classified into three categories according to the distance between the vomer and the adenoid tissue. There was a significant relation between the size of the adenoid and the complaints of nasal obstruction (P < 0.001) and of snoring (P < 0.001), but not with the presence of purulent sinusitis. In the whole population, the size of the adenoid correlated well with the results of tympanometry (P < 0.001), but this does not hold in all age groups. This study has confirmed adenoid hypertrophy as a common aetiological factor in children with the complaints of nasal obstruction and snoring. The enlargement of the adenoid only partially explains the occurrence of otitis media with effusion. The introduction of the flexible fibrescope in the examination of the nasal cavity and nasopharynx in children is of great clinical value, especially in the selection of children for adenoidectomy. It is a minor invasive examination well tolerated by most children, giving more information than a lateral skull radiograph and avoiding unnecessary radiation.

Pathological and epidemiological aspects of skin lesions in histoplasmosis. Observations in an AIDS patient and badgers outside endemic areas of histoplasmosis

As a consequence of HIV infection, histoplasmosis is increasingly occurring as an opportunistic infection with a systemic course outside histoplasmosis-endemic areas, e.g. in Europe. Accordingly, questions concerning the epidemiology of this mycosis arise. Two incidents involving histoplasmosis in man and badgers with prevailing involvement of the skin encouraged us to review the pathogenesis and epidemiology of this mycosis in Germany, where so far Histoplasma capsulatum has not been endemic. With a view to prevention, attention is drawn to the avoidance of microfoci of H. capsulatum in the newly introduced concept of biowaste and its composting plants in countries with modern waste management.

The SF-36 questionnaire: a convenient way to assess quality of life in angina pectoris patients

Over 4400 stable angina pectoris patients were followed for six months, after the addition of nitroglycerin patches to their usual treatment. Qol items were assessed by means of the SF-36 questionnaire and some clinical parameters were followed as well: during the study, the frequency of attacks decreased regularly and significantly (from 3.49/ week to 0.99/week), as did the amount of sublingual nitroglycerin tablets (from 2.65/day to 0.50/day). All 8 items of the SF-36 questionnaire improved significantly. Moreover, there was a modest, but significant correlation between the decrease in attacks and rescue-medication and the improvement in the Qol. The SF-36 questionnaire appears to be an adequate tool to follow the changes in Qol in stable angina pectoris patients over time.

Sleep anomalies in the chronic fatigue syndrome. A comorbidity study

Polysomnographic findings were compared between a group of patients with the chronic fatigue syndrome (CFS; n = 49) and a matched healthy control (HC) group (n = 20). Sleep initiation and sleep maintenance disturbances were observed in the CFS group. The percentage of stage 4 was significantly lower in the CFS group. A discriminant analysis allowed a high level of correct classification of CFS subjects and HC. Sleep-onset latency and the number of stage shifts/hour contributed significantly to the discriminant function. The presence of these anomalies as well as the decrease in stage 4 sleep were not limited to the patients also diagnosed with fibromyalgia or with a psychiatric disorder. No association was found between sleep disorders and the degree of functional status impairment. The mean REM latency and the percentage of subjects with a shortened REM latency were similar in CFS and HC.

Recombinant Coccidioides immitis complement-fixing antigen: detection of an epitope shared by C. immitis, Histoplasma capsulatum, and Blastomyces dermatitidis

We undertook an investigation to assess the utility of a recombinant Coccidioides immitis complement-fixing (CF) antigen for detecting CF antibody in sera from patients with coccidioidomycosis. Enzyme-linked immunosorbent assays established that recombinant CF antigen and, for comparison, a commercially available coccidioidin were reactive with 19 of 19 sera from patients with active coccidioidomycosis. The recombinant antigen was significantly more sensitive than coccidioidin. The median titer obtained when patients' sera were assayed against recombinant CF antigen was 1:51,200 compared to 1:25,600 with coccidioidin (P < 0.027). The recombinant antigen was also more effective in distinguishing the antibody levels in sera from patients with pulmonary coccidioidomycosis than in sera from those with disseminated disease. Whereas patients with pulmonary disease showed a median antibody titer of 1:25,600, those with multifocal disease showed a median titer of 1:102,400 (P < 0.028). The recombinant CF antigen was found, however, to express an epitope(s) that reacted with sera from 6 of 12 patients with histoplasmosis and 2 of 12 patients with blastomycosis.

Basidiobolomycosis: an unusual fungal infection mimicking inflammatory bowel disease

Basidiobolus ranarum is a fungus belonging to the Entomophthoraceae family and is mainly associated with subcutaneous soft tissue infection. The disease is usually characterized by an insidious onset of massive induration of the subcutaneous tissue involving the limbs, trunk, or buttocks. Most cases of basidiobolomycosis have been reported from Africa, South America, and tropical Asia. Visceral involvement is extremely rare. Only 4 cases with involvement of the gastrointestinal tract, including 1 fatal case originating in the United States, have been well documented in the English-language literature. This case report describes the first successfully treated patient residing in the United States who had B. ranarum infection involving the gastrointestinal tract.

Healing of full-thickness wounds in pigs: effects of occlusive and non-occlusive dressings associated with a gel vehicle

This study, based upon a pig model, was conducted to investigate the effects of moist and dry healing conditions on wound closure (epithelialization, granulation tissue, contraction) of full-thickness wounds. Thirty-two full-thickness square wounds (3 cm x 3 cm) covered with either an occlusive polyurethane dressing (Tegaderm) or a non-occlusive dressing (Melolin) were evaluated. The effect of the presence or the absence of a gel (3% Idroramnosan) was also investigated with both dressings. The dressings were renewed twice a week. The time required for wound closure was 19.2 +/- 1.6 days for Tegaderm and 26.6 +/- 3.0 days (means +/- SD) for Melolin, respectively. The healing time of the full-thickness porcine wounds was significantly (P < 0.001) reduced by the occlusive dressing. Equivalent results were found with the 3% gel, indicating that the gel can be used as a neutral vehicle. The healing rate, calculated according to Gilman's method, was also significantly (P < 0.001) enhanced by the occlusive dressing. This progression was 0.073 +/- 0.004 cm/day and 0.050 +/- 0.009 cm/day (means +/- SD) for Tegaderm and Melolin, respectively. The contribution of contraction to wound closure was similar in all wounds, indicating that the occlusive dressing did not have an effect on wound contraction. Histological evaluation was performed on full-thickness skin biopsies of whole wound harvested from the time of wound closure to 3 months after. At any time point, no significant histological variations were observed between the different treated wounds. This study demonstrates in a porcine model that for full-thickness wounds, as for split-thickness wounds, occlusive dressing enhances healing rate and shortens the time for wound repair. The shortened healing time is a function primarily of the effect of occlusive dressing on epithelialization, especially the third phase of wound resurfacing.

Chronic localized osteomyelitis caused by atypical infection with Blastomyces dermatitidis in a dog

A 4-year-old male Golden Retriever was evaluated because of chronic non-weight-bearing lameness of the right hind limb associated with penetrating tarsal wounds. Arthritis of the tarsal joint and osteomyelitis of the talus were initially evident. Tarsal arthrodesis was performed 7 months after initial injury, but the lameness persisted. Ten months later, blastomycosis was diagnosed on the basis of results of histologic examination of bone biopsy specimens and serologic tests. No other site of involvement was detected. The limb was amputated, and Blastomyces dermatitidis was isolated from the affected bone. Adjuvant antifungal treatment was not given. Ten months after amputation, the dog was in good health, and the antibody titer for B dermatitidis was low, indicating resolution of the infection. Localized bone infection with B dermatitidis is rare in dogs. In this dog, it was believed that blastomycosis was contracted through direct inoculation of the organism, because the lesion was associated with puncture wounds and other sites of involvement were not found.

Diagnostic antigenemia tests for penicilliosis marneffei

Disseminated penicilliosis marneffei is an emerging opportunistic mycosis seen in severely immunocompromised human immunodeficiency virus (HIV)-infected patients and is caused by the dimorphic fungus Penicillium marneffei. Early diagnosis and treatment improve clinical outcome. Proper diagnosis is complicated by nonspecific signs and symptoms and by difficulties in histologic recognition and species identification of the pathogen. Since no established immunodiagnostic methods for penicilliosis marneffei are available, we attempted to develop separate immunodiffusion tests to detect P. marneffei antigens and antibodies in patient serum specimens and a latex agglutination test for antigenemia. Antigens consisted of 2-week-old fission arthroconidial filtrates produced in Pine's broth at 37 degrees C. Rabbit antisera were prepared against the 10 x -concentrated filtrate antigens. Studies were carried out with 17 serum specimens from HIV-seropositive adult Thai patients with penicilliosis marneffei and 15 control serum specimens from Thai persons free of HIV and P. marneffei infection. The immunodiffusion tests detected P.marneffei antigenemia in 10 (58.8%) of 17 patients, whereas the latex agglutination test detected antigenemia in 13 (76.5%) of the 17 patients. Antibody was demonstrated in only 2 of the 17 patient sera. All of the tests appeared to be highly specific, since none were positive with sera from 15 Thai control patients, six serum samples containing cryptococcal antigen, or six urine specimens positive for Histoplasma polysaccharide antigens.

Mucus entrapment of particles by a suspension-feeding tilapia (Pisces: Cichlidae)

A miniature fiberoptic endoscope was used to observe the processes of particle encounter and retention inside the buccopharyngeal cavity of suspension-feeding tilapia. Small particles (38 &micro;m to 1.0 mm in diameter) were trapped in strands and aggregates of mucus, which usually slid posteriorly on the ceratobranchials of arches I&shy;IV towards the esophagus while the fish pumped water through the buccopharyngeal cavity. During stage 1 of periodic reversals of water flow inside the buccopharynx, mucus-bound particles usually lifted off the arch surfaces and travelled a short distance in an anterior or anterodorsal direction. During stage 2 of a reversal, the mucus usually resumed travel in a posterior or posteroventral direction and exited the field of view. Mucus was present less often during feeding on large particles (3&shy;10 mm in diameter) than on small particles, and large particles were rarely observed to be attached to mucus. We discuss the advantages to suspension-feeding fishes of using aerosol filtration by mucus entrapment rather than sieving, and predict that many cichlid and cyprinid suspension feeders that consume bacteria and phytoplankton use mucus for aerosol filtration.

Diagnosis of systemic mycoses by specific immunohistochemical tests

Immunohistochemistry has proved to be a powerful tool for the accurate diagnosis of a number of important mycoses in humans and animals, such as aspergillosis, candidosis, cryptococcosis, blastomycosis, coccidioidomycosis, histoplasmosis capsulati and duboisii, paracoccidioidomycosis, fusariosis, pseudallescheriosis (scedosporiosis), sporotrichosis, trichosporonosis, penicilliosis, and zygomycosis (mucormycosis). These techniques are also applicable to pneumocystosis and to non-mycotic infections caused by algae such as protothecosis. Apart from the specificity of immunohistochemistry, the application of fluorochromes is highly effective for the localization of typical or atypical fungal elements in lesions with only few organisms present. Occasionally, a dual aetiology of fungal infections may be suspected on the basis of morphological study, and dual staining techniques have the capacity for resolving this question by simultaneous and differential staining of two fungal species present in a tissue specimen.

PET regularization by envelope guided conjugate gradients

The authors propose a new way to iteratively solve large scale ill-posed problems and in particular the image reconstruction problem in positron emission tomography by exploiting the relation between Tikhonov regularization and multiobjective optimization to obtain iteratively approximations to the Tikhonov L-curve and its corner. Monitoring the change of the approximate L-curves allows the authors to adjust the regularization parameter adaptively during a preconditioned conjugate gradient iteration, so that the desired solution can be reconstructed with a small number of iterations.

Comparison of 99m Tc HMPAO SPECT scan between chronic fatigue syndrome, major depression and healthy controls: an exploratory study of clinical correlates of regional cerebral blood flow

An explorative analysis of the relationship between symptomatology and cerebral blood flow in the chronic fatigue syndrome (CFS) as assessed with 99mTc HMPAO SPECT scan reveals statistically significant positive correlations between frontal blood flow on the one hand and objectively and subjectively assessed cognitive impairment, self-rating of physical activity limitations and total score on Hamilton Depression Rating Scale on the other. A pathophysiological role of frontal blood flow in the cognitive impairment and physical activity limitations in CFS is hypothesized. A comparison of cerebral blood flow between CFS, major depression (MD) and healthy controls (HC) has been performed. A lower superofrontal perfusion index is demonstrated in MD as compared with both CFS and HC. There is neither a global nor a marked regional hypoperfusion in CFS compared with HC. Asymmetry (R > L) of tracer uptake at parietotemporal level is demonstrated in CFS as compared with MD.

Nasal resistance--a reliable assessment of nasal patency?

This study was undertaken to determine the distribution of nasal resistance in a healthy white population. One hundred subjects without nasal complaints were selected for the investigation. The test subjects were divided into two groups on the basis of anterior rhinoscopy. Group 1 included 60 subjects with rhinoscopically normal noses. Group 2 included 40 subjects with rhinoscopically abnormal noses. The pressure-flow data were recorded via active anterior mask rhinomanometry. The analogue pressure and flow signals were sampled and digitized by a computer system according to the time averaging method. Nasal resistance was calculated according to the recommendations of the International Committee on Standardization of Rhinomanometry. The normality of unilateral nasal resistance data distributions was assessed by the Kolmogorov-Smirnov Goodness of Fit Test at inspiratory and expiratory corresponding pressures of 50 Pa, 75 Pa, 100 Pa, and 150 Pa. The distributions of the calculated total resistance data were estimated at inspiratory and expiratory reference pressures of 75 Pa and 100 Pa. The data distributions of the two groups were compared using the Mann-Whitney U-test. Distributions for unilateral resistance were frequently found to deviate from normality. The distributions of total nasal resistance data never showed significant deviation from normality. More non-normal distributions were observed in Group 2 than in Group 1. Significant differences were determined between the two sub-groups for the non-decongested data. The entire group of subjects was homogeneous for the decongested data. The subjective assessment of nasal patency appeared not to be a sufficient criterion for the selection of subjects for normative studies in rhinomanometry. The presence of anatomical abnormalities and the influence of the nasal cycle could be responsible for the skewness of nasal resistance data in the normative studies in rhinomanometry.

An exoantigen test for the rapid identification of medically significant Fusarium species

The accurate identification of Fusarium species can take 2-3 weeks. Preliminary exoantigen studies indicate that a mature culture suspected of being a Fusarium species may be immunologically identified 48 h after receipt. Exoantigen extracts of 10-day-old slant cultures of Fusarium chlamydosporum, Fusarium moniliforme (= Fusarium verticilloides), Fusarium oxysporum, Fusarium proliferatum and Fusarium solani and partially purified reference homologous and heterologous shake culture extracts (6-week-old) were reacted against rabbit anti-F. chlamydosporum, F. moniliforme, F. oxysporum, F. proliferatum and F. solani sera, in a micro-immunodiffusion procedure. The results indicated that all the strains belonging to a given species produced 1-3 bands of identity only when tested against its homologous antiserum and reference antigen. No cross-reactions were observed with the heterologous antisera. Furthermore, extracts from isolates of Fusarium dimerum, Fusarium equiseti, Fusarium roseum complex, Acremonium species, Cylindrocarpon, Fonsecaea pedrosoi and Trichoderma species did not react with any of the prepared Fusarium species' antisera. Our data suggest that the exoantigen procedure is a rapid and reliable tool for the accurate immuno-identification of the medically important Fusarium species studied.

MRI findings in subjects with breast implants

One-hundred and nineteen implants were imaged in an open-sided low-field magnetic resonance imaging system. Thirty-four of these implants were removed, and postoperative reports were made available. We found a variety of signs associated with the implants, including internal structures, loss of saline in double-lumen implants, intracapsular and extracapsular fluid accumulations, signal dropout regions most likely associated with calcifications, and debris and fluid in the silicone, as well as degradation of the silicone, disruptions of the capsule and bulging, and extracapsular silicone. Conclusions of intact versus ruptured were made on the basis of these findings and found to be confirmed in 32 of 34 cases, with 1 false-positive and 1 false-negative result. Based on MRI criteria for a broad sample of the population, 27 percent of the implants were considered ruptured.

Prognostic factors in advanced prostatic carcinoma treated with total androgen blockade. Flutamide with orchiectomy or with LHRH analogues. A Belgian multicentric study of 546 patients

Prognostic factors were evaluated in advanced loco-regional (M0) or distant metastatic (M1) prostatic carcinoma treated with total androgen blockade (flutamide with either orchiectomy of LHRH-analogues), in 546 patients from a Belgian multicentric study. After a mean follow-up of 16.5 months (maximum 37 months) 113 (21%) patients had progressed (90 were patients with M1 disease (31%)). The estimated median progression-free survival exceeded 37.5 months. The results of a univariate analysis show that the following parameters are important prognostic factors with respect to progression-free survival in these patients: M stage, G grade, ECOG performance status, weight loss, concomitant disease, pain, dysuria and haemoglobin (Lee-Desu test, p < or = 0.01). From a multivariate analysis (Cox regression) the following prognostic factors were indicative of a decrease in progression-free survival: M1 stage, high initial G grade, ECOG performance status > I, high serum PSA, presence of concomitant disease, presence of pain and absence of dysuria. Age did not appear to be a statistically significant prognostic factor.

Development of specific fluorescent-antibody test for tissue form of Penicillium marneffei

The diagnosis of penicilliosis marneffei can be difficult because the clinical manifestations mimic those of tuberculosis, histoplasmosis, and other mycotic infections. Furthermore, the tissue form of Penicillium marneffei can be confused with those of Histoplasma capsulatum and Cryptococcus neoformans. To facilitate the rapid detection and identification of P. marneffei in clinical materials, we sought to develop a specific indirect fluorescent-antibody (IFA) reagent for this dimorphic pathogen. Preliminary IFA studies with yeast-like cells (fission arthroconidia) of P. marneffei indicated that these cellular elements stained with antiglobulins against culture filtrate antigens and whole yeast-like cellular antigens. Both types of antiglobulins reacted with the yeast-like cells of P. marneffei and with H. capsulatum, but not with their respective mycelial forms. The antiglobulins also failed to react with the yeast and hyphal forms of a variety of other heterologous fungi. Specific antiglobulins useful in an IFA test for identifying P. marneffei yeast-like cells in culture or in clinical materials were produced by adsorptions with yeast-form cells of H. capsulatum. The yeast-like culture filtrate antigens of P. marneffei are preferred for use in the production of the specific antiglobulins because they stained P. marneffei yeast-like elements more intensely than antiglobulins produced against intact yeast-like cells.

Deletion of tp53 exon-1 in human epithelial ovarian-cancer

In ovarian cancer, allelic loss within 17p 13.1-13.3, which contains the tumor suppressor TP53, occurs with a frequency of 66%, and mutations within conserved TP53 exons are reported in approximately 50% of cases. We examined DNA from 26 Stage III/IV ovarian carcinomas and 7 non-malignant ovaries by Southern blot hybridization and PCR for gene rearrangement or deletion within the,TP53 locus. Deletion specifically involving loss of the transcription-regulatory exon 1/intron 1 region on at least one allele was detected in 24/26 (92%) cases, and 0/7 noncancerous ovaries. Immunocytochemical analysis confirmed absence of expression of mutant p53 protein in those tumors where loss of the exon 1 region involved both alleles.