Large Sternocleidomastoid Haematoma after Minor Trauma in a Postradiation Neck

Sternocleidomastoid (SCM) muscle haematoma after minor blunt injury is rare. Radiation therapy as a treatment for head and neck tumours e.g. nasopharyngeal cancer can result in complications, including fibrosis, scarring, and atrophy. We report a 51-year-old man suffering from massive haematoma of SCM muscle after minor blunt injury to a postradiation neck. Signs of haematoma were absent during his first visit to the emergency department. Emergency physicians need to be aware that bleeding from a postradiation neck, even after minor trauma, may be life threatening.

Quantitative analysis of gains and catch-up saccades of video-head-impulse testing by age in normal subjects

OBJECTIVES

To evaluate video-head-impulse test (vHIT) results in normal subjects, to determine the normative values of vHIT for the vestibulo-ocular reflex (VOR) and to characterise the catch-up saccades (CSs).

DESIGN

Prospective cohort study.

SETTING

Tertiary care academic referral centre.

PARTICIPANTS

Fifty healthy subjects with no history of vestibular impairment, ten each in their 20's, 30's, 40's, 50's and 60's, underwent vHITs in the lateral semicircular canal plane.

MAIN OUTCOME MEASURES

vHIT gains and the incidence and amplitudes of covert and overt CSs.

RESULTS

The mean vHIT gain was 1.02 ± 0.07, and the mean gain asymmetry was 2.39 ± 1.96%, with no significant differences among age groups. CSs were observed during 22.6% of the trials and in 49% of the ears. The incidence of CSs was not associated with age. The mean velocity of CSs was 55.5 ± 16.9°/s, and its mean interaural difference was 11.8 ± 10.7°/s.

CONCLUSIONS

vHIT gains were consistently equal to 1.0 in all age groups (20's to 60's), suggesting that abnormal criteria for vHIT gain (e.g. 0.8) and gain asymmetry (e.g. 8%) can be used, regardless of age. CSs were observed in about half of normal ears, suggesting that VOR is a hypometric system. The amplitudes and interaural difference of CSs were also similar in all age groups, suggesting that abnormal criteria for CS amplitude (e.g. 100°/s) and interaural difference (e.g. 40°/s) can be used, regardless of age.

An assessment of oropharyngeal airway position using a fibreoptic bronchoscope

Selecting the appropriate oropharyngeal airway for safe and effective airway management is important in clinical practice. In this prospective observational study, we examined the position of the distal end of oropharyngeal airways using a fibreoptic bronchoscope. We enrolled 149 adults (72 men and 77 women). The correct airway size was determined by inserting four adult sizes Guedel airway (Hudson RCI; Teleflex Medical, Research Triangle, Park, NC, USA) (sizes 8, 9, 10 and 11) sequentially in anaesthetised patients. The 'best fit' airway was size 10 in 45 (62%) men, and size 9 in 58 (75%) women. However, when these airways were inserted, the distal end of the airway either touched or passed beyond the epiglottis tip in 20 (27%) men and six (8%) women, respectively. When a size-9 airway was inserted in men and a size-8 airway inserted in women, the distal ends were obstructed by the tongue in three (2%) patients. In conclusion, a size-9 airway in men and a size-8 airway in women are the most acceptable sizes for adults of average height.

Cubic SiC nano-thin films and nano-wires: high vacuum metal-organic chemical vapor deposition, surface characterization, and application tests

Single-crystalline and epitaxial cubic silicon carbide (beta-SiC) nano-thin films have been deposited on Si(100) substrates at a sample temperature of approximately 900 degrees C using single source precursors by the thermal metal-organic chemical vapor deposition (MOCVD) method. Diethylmethylsilane and 1,3-disilabutane, which contain Si and C atoms in the same molecule, were used as precursors without any carrier or bubbler gas. Upon increasing the deposition temperature from 900 to 950 degrees C, beta-SiC nano-thin films with relatively small crystals and smoother surfaces were created on Si(100) substrates. Moreover, beta-SiC nano-wires with 40 approximately 100 nm in diameter have also been grown selectively on nickel catalyzed Si(100) substrates with dichloromethylvinylsilane by the MOCVD method. The deposition temperature in this case was as low as 800 degrees C under the pressure of 5.0 x 10(-2) Torr. It is worth noting that the initial growth rates of deposited beta-SiC nano-thin films and nano-wires strongly depend on the deposition temperature rather than the time. In order to test the possibility of applications of these materials for electronic components such as field emitter, MEMS, and high-power transistor, we fabricated the nanoelectronic devices using both beta-SiC nano-wires and nano-thin films. With these preliminary application tests, it is expected that SiC nanowires can be used as field emitter and nanoelectronic high-power transistor, and application of the SiC nano-thin films to MEMS is promising as well.

High-performance liquid chromatographic analysis and pharmacokinetics of terazosin in healthy volunteers

A high-performance liquid chromatographic (HPLC) analysis of terazosin in 1 ml of human plasma was developed using prazosin as an internal standard. The plasma sample was extracted with dichloromethane and ethylether and a 100-microl aliquot was injected onto the reversed-phase column. The mobile phase, 0.02 M sodium phosphate buffer:acetonitrile:tetrahydrofuran = 720:220:60 (v/v/v), was run at a flow rate of 0.8 ml/min and the column effluent was monitored using a florescence detector set at 370 and 250 nm for the emission and excitation wave numbers, respectively. The retention times for terazosin and prazosin were approximately 6.4 and 9.8 min, respectively, and the coefficients of variation of terazosin were generally low, below 6.4%. The present HPLC method was successful for the pharmacokinetic study of terazosin in healthy volunteers. Following oral administration of terazosin, 2 mg, to 20 healthy male volunteers, the area under the plasma concentration-time curve from time zero to time infinity was 421 +/- 71.8 ng h/ml and terminal half-life was 9.83 +/- 1.29 h.

A comparative study on cockroach and ovalbumin sensitizations and challenge responses in Hartley guinea-pigs

The role of allergens in asthmatic inflammation is not clearly understood. To elucidate the mechanism of cockroach allergen (CRa)-induced airway disease, we studied three groups of Hartley guinea-pigs sensitized to control, ovalbumin (OA) or CRa. Parameters measured were anaphylactic antibodies by allergy skin test (AST), PCA assay and Western blot, changes in specific airway resistance (SRaw), analysis of bronchoalveolar lavage (BAL) and contracture responses of tracheal muscle (TSM) to non-specific and specific stimuli, in vitro. Both OA and CRa animals showed a similar allergic sensitization (AST and PCA), while Western blot identified several reaginic bands in CRa group compared to a single band in OA group. SRaw illustrated that CRa induce dual-asthmatic responses (4/6) in the CRa group, whereas OA induce only an early asthmatic response (3/6) in the OA group (P<0.01). The average total leukocytes in BALF of the CRa were 27.0x10(6), mostly neutrophils and eosinophils, while those of the OA showed 3.5x10(6), mostly eosinophils, respectively (P<0.0001). TSM responses to non-specific stimuli were similar in both groups (P>0.1), while the antigen-specific TSM contractions were more brisk in the OA group than those of CRa group (P<0.001). Thus, the study indicates that both CRa and OA sensitize guinea-pigs, yet CRa induces more severe and persistent late-phase inflammation than OA. This appears to be related to an influx of neutrophils rather than anaphylactic bronchospasm.

US and CT findings of tuberculosis of the thyroid: three case reports

With two ultrasonographic and two CT films of three cases of thyroid tuberculosis, we evaluate the ultrasonographic and CT findings and correlate them with the pathologic findings. They are demonstrated as heterogeneous hypoechoic mass on ultrasonogram and peripheral-enhancing low-density abscess on CT scan with regional lymphadenopathy. Ultrasonography (US) and CT can help the diagnosis of thyroid tuberculosis.

Preventive effect of epicatechin and ginsenoside Rb(2) on the inhibition of gap junctional intercellular communication by TPA and H(2)O(2)

The anticarcinogenic effects of epicatechin (EC) and ginsenoside Rb(2) (Rb(2)), which are major components of green tea and Korea ginseng, respectively, were investigated using a model system of gap junctional intercellular communication (GJIC) in WB-F344 rat liver epithelial cells. 12-O-tetradecanoylphorbol-13-acetate (TPA) and hydrogen peroxide, known as cancer promoters, inhibited GJIC in the epithelial cells as determined by the scrape loading/dye transfer assay, fluorescence redistribution assay after photobleaching, and immunofluorescent staining of connexin 43 using a laser confocal microscope. The inhibition of GJIC by TPA and H(2)O(2) was prevented with treatment of Rb(2) or EC. The effect of EC on GJIC was stronger in TPA-treated cells than in H(2)O(2)-treated cells, while the effect of Rb(2) was opposite to that of EC. EC, at the concentration of 27.8 microg/ml, prevented the TPA-induced GJIC inhibition by about 60%. Rb(2,) at the concentration of 277 microg/ml, recovered the H(2)O(2)-induced GJIC inhibition by about 60%. These results suggest that Rb(2) and EC may prevent human cancers by preventing the down-regulation of GJIC during the cancer promotion phase and that the anticancer effect of green tea and Korea ginseng may come from the major respective components, EC and Rb(2).

Pancreatic serous cystadenoma associated with islet cell tumour

We report the case of a 29-year-old female patient with a diffuse type of serous cystadenoma involving the entire pancreas except for part of the head, which was replaced by islet cell tumour. Ultrasound and CT showed multiple cysts in the entire pancreas and a solid mass with calcification in the head. MRI characterized the fluid content of the cysts and the extent of disease.

Value of the dynamic and delayed MR sequence with Gd-DTPA in the T-staging of stomach cancer: correlation with the histopathology

BACKGROUND

To evaluate the usefulness of dynamic and delayed magnetic resonance (MR) imaging in the T-staging of stomach cancer and to compare the enhancement pattern of the cancerous lesion and the normal wall.

METHODS

We performed MR imaging in 46 patients with stomach cancer (including four early gastric cancers and 42 advanced gastric cancers). Axial, sagittal, or coronal two-dimensional fast low-angle shot) MR images for the water-distended stomach were obtained with dynamic protocol, including precontrast images and images obtained 30, 60, 90, and 240-300 s after intravenous injection of the 0.1 mM Gd-DTPA/kg solution. We evaluated the thickness, interruption (or not) of the low signal intensity bands, and enhancement pattern of the cancerous wall and normal gastric wall. We prospectively evaluated the depth of cancer invasion, perigastric infiltration (extraserosal invasion), perigastric organ invasion, and regional lymph nodes and determined tumor staging on MR images. These MR evaluations including MR-determined staging were correlated with the surgicopathologic findings.

RESULTS

Stomach cancer was shown as having a thickened wall with a rapid enhancing pattern after intravenous Gd-DTPA administration. The mucosa (and/or submucosa) affected by stomach cancer showed an early enhancement pattern (30-90 s after Gd-DTPA administration) in 43 of 46 patients (93%). The normal gastric mucosa demonstrated a delayed peak enhancement pattern (> 90 s after Gd-DTPA administration) in 29 of 46 patients (63%) and variable enhancement pattern in 17 of 46 patients (37%). An interrupted low signal intensity band or highly enhanced tumorous lesion penetrating through the gastric wall was seen in 17 of 19 pT3 patients (90%). Consistency between MR-determined staging and surgicopathologic staging occurred in three of four pT1 tumors (75%), 10 of 13 pT2 tumors (77%), 17 of 19 pT3 tumors (90%), and eight of 10 pT4 tumors (80%); overall accuracy was 83%. Overall accuracy of regional lymph node involvement, as determined by enhanced MR, was 52%; 24 of 46 node groups were positive.

CONCLUSIONS

Dynamic and delayed MR imaging can be useful for predicting depth of cancer invasion, perigastric infiltration (extraserosal invasion), and perigastric organ invasion by gastric cancer.

Significance of resistive index in color Doppler ultrasonogram: differentiation between benign and malignant breast masses

The objective of this article is to evaluate the significance of resistive index in differentiation between benign and malignant breast lesions on duplex ultrasonographic examination. Resistive indices obtained in 106 breast lesions of 104 patients were included. Sixty-four were benign (mean age: 32.4 +/- 11.1 years), and 42 were malignant lesions (mean age: 47.8 +/- 11.4 years). The resistive index was classified as follows: below 0.49, from 0.5 to 0.59, 0.6 to 0.69, 0.7 to 0.79, and above 0.8. We analyzed and defined the optimal threshold value of RI between benign and malignant lesions. The mean values of the RI of benign and malignant lesions were 0.62 +/- 0.095 (range 0.44-0.86) and 0.74 +/- 0.097 (range, 0.50-0.92), respectively. The resistive index exceeded 0.7 in 80% of malignant lesions. The difference of the RI between malignant and benign lesions was statistically significant when the threshold value was 0.7 (P < 0.001). A resistive index over 0.7 may suggest malignant lesions. Due to the considerable overlap of the range of the RI, it may not be diagnostic in any single patient; however, it may be helpful in conjunct with gray-scale image.

A high dose of ionizing radiation induces tissue-specific activation of nuclear factor-kappaB in vivo

Activation of the transcription factor nuclear factor-kappaB (NF-kappaB) is one of the important responses of cells to an external stress such as ionizing radiation. We studied radiation-induced NF-kappaB activation in vivo in male BALB/c mice. After the mice were exposed to 8.5 Gy total-body gamma irradiation, the spleen, mesenteric lymph nodes, thymus, liver, lung, colon, brain and bone marrow were harvested 1, 2.5, 5, 10 and 20 h postirradiation. NF-kappaB DNA-binding activity was analyzed in the nuclear protein extracts by a gel shift assay. When compared to the levels in untreated control mice, radiation induced activation of NF-kappaB in spleen, mesenteric lymph nodes and bone marrow but not in the other tissues examined. In contrast, an i.p. injection of a lethal dose (3 mg/kg) of lipopolysaccharide also increased activity of NF-kappaB in the liver and lung. The gel supershift assay with Nfkb1, Rela and/or Rel antibodies revealed that the specific molecular forms of NF-kappaB activated by radiation in the spleen were Nfkb1 homodimers and Nfkb1/Rela heterodimers. In mesenteric lymph nodes, the heterodimerized Rel/Rela NF-kappaB was also activated. In bone marrow, an NF-kappaB-like binding factor was induced that may be Nfkb1/Rela- and Rel/Rela-like heterodimers, but it exhibited a higher mobility than Nfkb1 homodimers. These results indicate that in vivo, ionizing radiation induces NF-kappaB activation that varies in both tissue distribution and moleoular composition.

Post-traumatic arterial priapism: colour Doppler examination and superselective arterial embolization

PURPOSE

To evaluate selective embolization for management of post-traumatic priapism and colour Doppler sonography for the diagnosis of the causative lesion and for planning embolization.

MATERIALS AND METHODS

Six male patients with post-traumatic priapism underwent selective angiography and embolization. Colour Doppler sonography with grey-scale was performed in all six patients before angiography.

RESULTS

Selective angiography showed intracavernosal arteriovenous fistulas in all patients and pseudoaneurysm of the cavernosal artery (or common penile artery) in three patients. After successful embolization, detumescence was achieved in all patients. Colour Doppler sonography enabled localization and characterization of the lesion causing priapism in four patients. Grey-scale ultrasonography showed the dilated cavernosal sinuses in all patients.

CONCLUSION

Angiography with selective embolization is safe and effective method to correct post-traumatic priapism. Colour Doppler sonography with grey scale is a useful preangiographic study, as it allows for characterization and localization of the causative lesion except lesions at the proximal cavernosal or distal penile artery near the symphysis pubis.

Observer differentiation of mechanical defects versus natural dental caries cavitations on monitor-displayed images with imaging plate readout

OBJECTIVE

The purpose of this study was to compare the ability of dentists to detect mechanically created defects vs natural dental caries cavitations on the proximal surfaces of extracted teeth by means of storage phosphor imaging plate technology.

STUDY DESIGN

Fifty-two extracted molar and premolar teeth were blocked into sets for bitewing radiographs through use of the DIGORA digital imaging system. Sixteen natural caries cavities and 28 artificial lesions were present in the 80 proximal surfaces included in the study. A group of 16 dentists assessed proximal lesions on unenhanced images on the monitor and 1 month later on contrast-enhanced images. A different group of 16 dentists assessed proximal lesions on contrast-enhanced images and 1 month later on unenhanced images. The Mann-Whitney U test was used to check for a reading-order effect. The Zelen test of odds ratio was used to test for homogeneity, and the Mantel-Haenszel analysis or stratified logistic regression was used for inference about the common odds ratio. Alpha was set at P < .05.

RESULTS AND CONCLUSIONS

With the DIGORA system, there was little difference between the detection rates of mechanical defects and natural carious cavities with unenhanced images, but the mechanical defects were more readily detected when contrast-enhanced images were used. Cavity depth positively affected the odds of diagnosis of lesions, with deeper lesions being more readily detected than more superficial ones irrespective of whether they were natural or artificial. In comparison with findings of previous studies in which film and a charge-coupled device detector were used, the overall detection rate for natural dental caries was remarkably constant across the modalities.

Contractile responses to allergen and cholinergic stimulation in bronchus and trachea of cockroach allergen-sensitized guinea pigs

Airway hyperreactivity is a hallmark of asthma. Yet, the role of allergic sensitization in the hyperreactivity remains controversial. This study examined the effects of airborne cockroach allergen (CRa) sensitization on the contractility of bronchial (BSM) and tracheal (TSM) smooth muscle rings to cholinergic stimulations, and to specific antigen, in vitro. Guinea pigs were actively immunized with CRa, 5 mg (high dose, HD), 0.5 mg (low dose, LD), or saline aerosols (2x/day, 5 days/week, for 4 weeks) and challenged by CRa inhalation 5 days after last exposure. Twenty-four hours postchallenge, the contractions of the TSM and BSM to electrical field stimulation (EFS), acetylcholine (ACh), and to CRa were measured in vitro. In addition, the contraction to these stimuli were also examined in the passively sensitized TSM with the sera of CRa-immunized guinea pigs. The contractile responses of actively immunized and passively sensitized tissues to EFS and ACh were very similar to those of control tissues. CRa induced dose-dependent contractions in both actively immunized and passively sensitized, but not in control, tissues. The CRa-induced contraction was stronger in the HD group than in the LD group (p<0.0001). Leukotriene C4/D4 receptor antagonist LY-171883 inhibited the CRa-induced contraction by 86% in actively immunized TSM, and by 9% in the passively sensitized TSM. Pyrilamine inhibited the contraction by 57% in actively immunized TSM and 70% in passively sensitized TSM. The results indicate that CRa sensitization does not cause increased airway smooth muscle contractility to cholinergic stimulations, but induces antigen-specific contractions in vitro. Leukotrienes appear to play a significant role in the CRa-specific contractions, more in the actively immunized than those in the passively sensitized tissues, while histamine exerts a moderate effect on the CRa-induced contractions.

A dose-response relationship between exposure to cockroach allergens and induction of sensitization in an experimental asthma in Hartley guinea pigs

OBJECTIVE

An indoor allergen, cockroach allergen (CRa) has been partly implicated in the rising prevalence of inner-city asthma. This study investigates a dose-response relationship of exposure to CRa with the degree of sensitization and with airway inflammation through the use of our established guinea pig asthma model.

METHODS

Four groups of Hartley guinea pigs were exposed to aerosolized saline (control) and three dose levels of CRa: low-dose, 0.5 mg (LD); medium-dose, 5 mg (MD); or high-dose, 25 mg (HD), nebulized twice a day, 5 days per week, for 4 weeks. The development of anaphylactic antibodies was measured by both allergy skin test and passive cutaneous anaphylaxis assay. Animals were challenged with CRa 5 days after the last sensitization, and specific airway resistance was measured continuously by a double-chamber plethysmograph while animals were in the conscious state. The inflammatory cells in bronchoalveolar lavage fluid (BALF) and the contractile responses of tracheal rings were analyzed in vitro at 24 hours after CRa challenge.

RESULTS

The anaphylactic antibodies to CRa were detected in the CRa-sensitized animals by allergy skin test. Passive cutaneous anaphylaxis titers of IgG1a-like antibody were zero in control, 1:2 in LD, 1:40 in MD, and 1:160 in HD. Total leukocytes in BALF were increased by CRa challenge in all three CRa-sensitized groups compared with control (p < 0.0001). The tracheal rings from CRa-sensitized guinea pigs constricted upon addition of incremental doses of CRa challenge in vitro in a dose-responsive manner (p < 0.0001). The leukocytosis in BALF and the anaphylactic contractile responses of the tracheal rings in CRa-sensitized groups were correlated to the levels of CRa to which the groups had been exposed during sensitization (p < 0.001). CRa-provoked increase in SRaw was noted in all three groups of the CRa-sensitized guinea pigs compared with control (p < 0.01). Yet, among CRa-sensitized groups, a greater increase in specific airway resistance was noted in the LD group but not in the HD CRa group.

CONCLUSIONS

The development of anaphylactic cockroach sensitivity in guinea pigs was dependent on the levels of CRa exposure during sensitization, and the CRa-sensitized animals showed antigen-specific airway inflammation along with airway smooth muscle contractions. However, the severity of bronchospasm in conscious animals was not in agreement with the degree of CRa sensitivity.

Renovascular hypertension in children with moyamoya disease

OBJECTIVES

To examine the incidence, clinical and radiologic findings, and response to treatment of renovascular hypertension (RVHT) in moyamoya disease (MMD).

METHODS

A retrospective analysis of medical records in six RVHT cases (8.3%) among 72 MMD patients observed from November 1987 to December 1995.

RESULTS

The age at onset of MMD ranged from 9 months to 7 years 1 month (mean, 3.3 years). The most common initial manifestation of MMD was transient ischemic attack. Hypertension was detected between 4 years 4 months and 12 years 3 months (mean, 7.87 years). Unstimulated plasma renin activity was elevated in all six cases. Renal ultrasonography and captopril technetium 99m-labeled dimercaptosuccinic acid scan showed abnormal findings in four of five and in three of four available studies, respectively. However, both imaging studies showed abnormal findings only in the most severely affected kidneys even with bilateral renal artery stenosis. Renal arteriography revealed bilateral lesions in three of the patients and unilateral lesions in the others. Renal angioplasty was performed in four cases but was successful in only one and partially successful in another. A renal artery specimen obtained during renal autotransplantation showed intimal fibroplasia. At the last follow-up, one patient had normal blood pressure without the use of antihypertensive agents, but the other five patients needed this medication to control blood pressure.

CONCLUSION

Because RVHT may be more commonly associated with MMD than has hitherto been appreciated, it is recommended that blood pressure be carefully followed and that diagnostic procedures for RVHT be carried out in hypertensive patients with MMD.

Bevel-down superior to bevel-up in intradermal skin testing

BACKGROUND

Intradermal skin testing is one of the most widely used procedures in the diagnosis of hypersensitivity diseases in vivo. It is critical to perform the test accurately and expediently. Yet, there are few articles describing its detailed technique or proficiency available.

OBJECTIVES

To identify the better method for intradermal testing between the bevel-up and bevel-down techniques.

METHODS

Three inexperienced testers performed intradermal injections using both methods. Four sets of paired trails each consisting of ten injections were applied randomly, alternating between the same volunteer subject's contralateral arms. Duration to complete ten injections was measured. Numbers of injection sites that bled, that squirted into the air, and failed to form a bleb were counted. The overall comfort level was determined.

RESULTS

The time to complete the injections by bevel-up and by bevel-down methods were 165.5 +/- 31.3 and 152.5 +/- 27.4 seconds, respectively (P < .015). The number of injection sites that bled was higher in the bevel-up method, particularily on trial one (P < .001). Completion rate of successful bleb formation in bevel-down was 27.3 as compared with 23.3 in bevel-up method (P = .013). The comfort level was higher with the bevel-down than the bevel-up method (P = .0001).

CONCLUSION

The bevel-down method of intradermal testing is superior to the bevel-up method.

Experimental asthma developed by room air contamination with cockroach allergen

To study the asthmatogenic effect of certain airborne elements of the home environment, we studied a group of guinea pigs exposed to aerosolized cockroach allergen (CRa) and side-stream cigarette (S-SC) smoke. Four groups of guinea pigs were exposed to aerosols, either saline or CRa, for 4 weeks, after a sham or S-SC smoke pretreatment. Anaphylactic antibodies were measured by passive cutaneous anaphylaxis (PCA) assay and by skin test. Animals were challenged with aerosol CRa on day 35, and lung function and leukotrienes (LTB4 and LTC4/D4) were measured. Skin tests were positive on days 21 and 29. The antibodies were heat-stable, IgG1a-like antibodies (PCA titers 1:2-18). The CRa challenge caused an immediate reduction in both the maximal expiratory flow rate at 50% of the lung capacity and respiratory compliance. The decreased lung function continued for up to 6 h (p < 0.0001). LTB4 and LTC4/D4 were elevated (p < 0.0001) in the sensitized animals at the corresponding times of reduced lung function. S-SC smoke did not affect the CRa sensitization; instead, a protective effect on the CRa-induced bronchospasms was noted. Thus, the study indicates that a simple airborne CRa exposure without an adjuvant sensitizes guinea pigs, and that the animals respond to antigen challenge with CRa-specific airway obstructions.

Observer differentiation of proximal enamel mechanical defects versus natural proximal dental caries with computed dental radiography

OBJECTIVES

Various models have been used to study the accuracy of imaging systems for detection of dental caries. This study compares the ability of dentists to detect mechanically created defects versus natural dental caries cavitations on the proximal surfaces of extracted teeth with Computed Dental Radiography (Schick Industries, Long Island City, N.Y.). Detection rates are investigated according to lesion depth to permit comparisons to be made between studies in the literature with other mechanical defects or natural caries models. Discrimination of natural caries versus artificial defects with Computed Dental Radiography is also compared with a previous report that used standard dental film.

STUDY DESIGN

Fifty-two extracted molar and premolar teeth were mounted into representative sets of maxillary and mandibular posterior arches for bite-wing radiography. There were 16 proximal surfaces with natural caries and 28 proximal surfaces with mechanical defects. An optical bench was used to ensure constant beam geometry. A 1.8 cm acrylic soft tissue equivalent attenuator was placed in front of the receptor. Thirty dentists acted independently as observers to differentiate between sound proximal tooth surfaces, natural dental caries, and mechanical defects. Evaluation of intra- and interobserver variability was made with use of the kappa statistic. The Zelen test of odds ratios was used to test for homogeneity, and the Mantel-Haenszel analysis plus stratified logistic regression were used for inference about the common odds ratio. Significance was set at p < 0.05.

RESULTS AND CONCLUSIONS

Ignoring stipulation of cavity type, detection was 74% for mechanical defects and 67% for natural caries. The odds of detecting a mechanical defect were 1.40 times the odds of finding natural dental caries cavitation of the same depth. Lesion depth did influence the probability of correctly identifying the presence of a lesion; the odds of identifying cavitation increased 1.41 times with every 0.1 mm increase in lesion depth. Correct designation of lesion type was 1.42 times more likely with mechanical defects than with natural caries (p = 0.003). Intraobserver (kappa = 0.65) and interobserver (kappa = 0.43) agreements were fair to good. Discrimination between natural and artificial lesions was less with the Computed Dental Radiography than that found in our previous study with standard direct emulsion x-ray film.

Development of cockroach-allergic guinea pig by simple room air contamination

Asthma is frequently associated with inhalant sensitivities, particularly allergens of indoor environment. The aim of the study is to determine whether an indoor allergen, cockroach (CRa), can induce guinea pig sensitization without adjuvant or special manipulation. Six regimens were used in sensitizing guinea pigs by CRa aerosols: low daily (C-I), low intermittent (C-II), high intermittent (C-III), maximum intermittent (C-IV), high daily (C-V) and high alternate day (C-VI) doses, and results were compared with that of intraperitoneal sensitization (C-VII). Also studied was a role of CRa in the aerosol ovalbumin (OA) sensitization in comparison with placebo and an adjuvant, Al(OH)3. Reaginic guinea pig antibodies, anti-CRa-IgGla-like (IgGla) and IgE-like (IgE), were measured by passive cutaneous anaphylaxis (PCA). Results show that IgGla was produced only in high-dose aerosol groups, C-V and C-VI, but no IgE in all aerosol groups. The antibody was detected on day 22 (C-V) and day 19 (C-VI) and sustained till day 52 (titers 1:20 to 1:200). The preliminary pulmonary function measurements revealed that the sensitized animals (C-VI) showed a decreased ventilatory function upon CRa challenge. Aerosolized OA sensitization also produced anti-OA-IgGla in high intermittent regimens. In addition, PCA titers (anti-OA-IgGla) in OA-sensitized animals were not influenced by pretreatment with CRa, Al(OH)3, or placebo. Thus, the study indicates that simple aerosolized CRa contamination in a chamber makes guinea pigs cockroach-sensitive and become asthmatic. Yet, CRa does not enhance other allergen sensitization.

Indirect latex contact causes urticaria/anaphylaxis

Recurrent urticaria/anaphylaxis is a most perplexing and critical problem, often of unknown cause. Though difficult and time consuming, identification of causes(s) can be life saving and cost saving for the patient(s). We report a complex case of urticaria/anaphylaxis induced by latex allergen in a former intensive care unit nurse, in which the allergen contact occurred remotely and indirectly by intimate contact with the spouse. Diagnosis of the latex allergy was confirmed by epicutaneous skin test in vivo as well as RAST.

Atopic profile of inner-city asthma with a comparative analysis on the cockroach-sensitive and ragweed-sensitive subgroups

BACKGROUND

Inner-city asthma is well known for its high risk of mortality. To better understand urban asthma, we examined clinical characteristics and aeroallergen sensitivities of 592 of 680 consecutive urban Chicago residents with asthma.

METHODS

A total of 227 male and 453 female subjects who met the criteria for the study were registered. A comprehensive clinical evaluation was followed by allergy skin testing (prick and intradermal testing) with 10 groupings (5 indoor and 5 outdoor) of common aeroallergens. Serum total IgE and selective antigen-specific IgE levels, including cockroach-specific IgE, were routinely measured. A total of 592 (196 male and 396 female) subjects with an average age of 35 years were skin tested. The average duration of asthma was 12.6 years, and 31% of the population was receiving corticosteroids.

RESULTS

Aeroallergen sensitivity was noted in 85%, and 94 subjects (15%) were nonallergic. House dust sensitivity (76%) was most prevalent, distantly followed by sensitivity to cockroach (48%), ragweed (45%), other weeds (42%), cat (40%), and dust mite (24%). The average number of aeroallergen sensitivities detected was 4 of 10 groupings of both indoor and outdoor allergens. Twenty percent of subjects were allergic to only indoor allergens, whereas 4% were allergic to outdoor allergens only. Serum IgE was 245 +/- 17.3 IU/ml (geometric mean+SEM), and 74% of 444 serum samples showed IgE antibody levels greater than or equal to 100 IU/ml. A cockroach-sensitive subgroup (283 subjects) had longer duration of asthma (p < 0.0001) and fewer additional aeroallergen sensitivities (p < 0.0001) than the ragweed-sensitive subgroup (264 subjects).

CONCLUSION

The results indicate that a great majority (85%) of inner-city Chicago residents with asthma have atopic asthma, as demonstrated by highly elevated IgE levels and multiple aeroallergen sensitivities. Sensitivity to indoor allergens is more prevalent than sensitivity to outdoor allergens. The subjects with cockroach-sensitive asthma appear to be a distinctive subgroup characterized by chronicity and elevated serum IgE antibody levels with fewer aeroallergen skin test sensitivities.

Characteristics and diagnoses of cockroach-sensitive bronchial asthma

Bronchial asthma with cockroach hypersensitivity is prevalent among urban asthmatic populations. To elucidate characteristics of cockroach asthma, we analyzed 592 consecutive urban Chicago asthmatic patients retrospectively. Allergy skin testing (AST) with common inhalants, serum total IgE, and cockroach-specific IgE (IgE-CR) antibodies were measured. Some cockroach asthmatics were studied further for bronchial reactivity in vivo and histamine releasability (HR) in vitro against cockroach allergen (CRa), and diagnostic accuracy for asthma was analyzed. Clinical characteristics were evaluated and compared with those of ragweed asthmatics and asthmatics in general. Two hundred eighty-three (196 women, 87 men) were reactive to CRa by AST. The average age and duration of cockroach asthma were 30.4 and 15.1 years, respectively. Steroid dependency of the cockroach asthma was higher (32%) than those of general asthmatics (P less than .05) and ragweed asthma (P less than .05). IgE level was elevated (geometric mean 413.2 IU/mL), higher than that of general asthmatics (P less than .001), and 87% showed IgE level higher than 100 IU/mL. IgE-CR and BPT-CR were positive in 61% (175 tested) and in 87% (166 tested), respectively. Sensitivity and specificity of skin test were 99% and 40%, while those of IgE-CR were 91% and 58%, respectively. IgE-CR increased probability of cockroach asthma from 87% to 91%. BPT with CRa was correlated well with the HR of leukocytes (P less than .0001). Thus, cockroach asthma is a severe allergic asthma and can be diagnosed accurately by skin test plus BPT or skin test plus HR.

Cockroach-allergen study: allergen patterns of three common cockroach species probed by allergic sera collected in two cities

Antigens/allergens of three common cockroach extracts, crude whole body extract of the American cockroach (CRa-A), crude whole body extract of the German cockroach (CRa-G), and crude whole body extract of the Oriental cockroach (CRa-O), were studied with crossed immunoelectrophoresis, crossed radioimmunoelectrophoresis, and Western blot analysis. Sera of cockroach-allergic patients with asthma, 10 from Chicago, Ill. (C group) and six patients from Lexington, Ky. (L group), were used; results were then compared with sera of control subjects with asthma. Qualitative differences in protein bands were noted among CRa-A, CRa-G, and CRa-O by crossed immunoelectrophoresis and sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Allergen bands on Western blot were analyzed for distribution by molecular weight (MW) with relative intensity scores. Results were compared by species and by geography. Two to 12 allergenic bands of variable MW (14 kd to greater than 116 kd) were identified by 13 of 16 individual sera from cockroach-allergic patients from all three extracts. CRa-A demonstrated 55 bands with an intensity score of 125; CRa-G, 58 bands with an intensity score of 100; and CRa-O, 51 bands with an intensity score of 108. Allergenic bands of CRa-A were identified by six sera of the C group and one sera of the L group, whereas bands of both CRa-G and CRa-O were noted by nine sera of the C group and four sera of the L group. All three species had an allergen band in MW range of 40 to 45 kd that reacted to most sera from cockroach-allergic patients with asthma.

Characterization and partial purification of the cockroach antigen in relation to housedust and housedust mite (D.f.) antigens

Allergens in crude cockroach antigens (CRa) have not been well defined. In order to characterize the CRa, the authors partially purified CRa by gel filtration (G-75) and analyzed it by polyacrylamide electrophoresis (PAGE) and allergy skin testing (AST). Hyperimmune serum was produced against CRa in rabbit (R anti-CRa) and used for immunoelectrophoresis (IEP), double immunodiffusion (DID), crossed immunoelectrophoresis (CIE), and crossed radio immunoelectrophoresis (CRIE) to further characterize the CRa. The crude CRa contained 9 and 15 precipitating arcs by IEP and CIE, respectively. Indirect CRIE revealed that CRa contained nine to 15 different allergens. There were no lines of identity between the CRa and housedust mite (D.f.) or between the CRa and commercial housedust by DID or IEP. Autologous housedust of cockroach asthmatic subjects showed lines of identity with the CRa. Fractionation of CRa on a Sephadex G-75 column chromatography showed two distinct peaks (B1 and B2) separated by a broad valley. The high molecular fraction B1 was most allergenic (100%) and contained three antigens of high molecular weight. These three antigens were identifiable by the techniques of IE, CIE, and DID. B2, the low molecular fraction (molecular weight less than 13,000 dalton) contained minor allergen(s). B2 elicited positive AST in 55% of cockroach-sensitive individuals, but it was not detected by IEP, CIE, nor by DID.

Multidisciplinary approach in the management of gestational trophoblastic tumor (GTT)

In summary of our 15 years experiences it is obvious that at least about 15% of GTT patients still do not get complete remission in spite of development of multiagent chemotherapy. To obtain better therapeutical result in unceasing problems should be solved and the improvement in newer methods of management as listed below is mandatory: (1) Prediction on risk factors and early diagnosis of the persistent GTT before and after molar evacuation (2) "Clinico-biochemical classification" based on more collective tumor markers (3) New chemotherapeutic agents (4) Regimen for prevention and/or modulation of drug resistance (5) Multimodality treatment including initial and adjuvant surgery, irradiation and immune response modifiers. (6) Remission consolidation

In vivo release of beta human chorionic gonadotropin by luteinizing hormone releasing hormone stimulation and its clinical application as a remission criterion in patients with gestational trophoblastic disease

In vivo responses of trophoblasts to luteinizing hormone releasing hormone (LHRH) stimulation in 48 gestational trophoblastic disease patients were observed. Serum beta human chorionic gonadotropin (beta-hCG) levels after LHRH injection were significantly increased in patients with hCG values between 5 and 20 mIU/ml (minimal resistance group) but not in patients whose hCG levels were less than 5 mIU/ml (possible remission group). The sensitivity, specificity and the predictive values of LHRH stimulation test were 75.0, 91.3 and 95.5% in the possible remission group and 87.5, 20.0 and 77.8% in the minimal resistance group.

The role of immunotherapy in cockroach asthma

To evaluate the preventive role of immunotherapy in severe perennial asthma, we investigated cockroach asthma as a model. Twenty-eight subjects with bronchial asthma due to cockroach hypersensitivity (BACR) were divided into two groups in alternating order: 15 were started with cockroach antigen immunotherapy (CRa-IT) and 13 were given control immunotherapy. Eleven in the former group and two in the latter group completed the study after 5 years. The changes in symptoms and medication scores were assessed; blocking antibody factor in the paired pre- and postimmune serum of the two groups was measured and compared. Cellular sensitivity (HR50) was measured using the basophil-rich leukocytes (BRLs) obtained from the two treated asthma groups, and the result was compared with that of the untreated cockroach asthmatic cells. The average symptom score changed from 7.2 +/- 2.7 to 1.2 +/- 0.4 in the CRa-IT group. The control-IT group showed no change. The medication score changed from 11.4 +/- 1.6 to 5.2 +/- 1.4 in the CRa-IT group only (p less than 0.01). The mean blocking antibody factor in the immune serum of the CRa-IT group showed a 2.5 x 10(2)-fold increase [1.3 +/- 0.3 x 10(-1) in postimmune serum/5.2 +/- 2.0 +/- 10(-4) in preimmune serum (p less than 0.001)]. No difference was noted in the HR50 of the BRLs in the post- and preimmune serum of the control-IT group. Antihuman IgG absorption of the post-CRa-IT serum reduced the blocking antibody to 1/1000-fold; no difference in the HR50 of the BRLs was noted between the post-control-IT and the pre-CRa-IT serum (p greater than 0.2). The BRLs of the CRa-IT asthmatics, however, showed blunted sensitivity not affected by the serum factor (5.8 +/- 1.5 x 10(-2) micrograms/ml in post-CRa-IT serum and 5.6 +/- 1.3 x 10(-2) micrograms/ml in pre-CRa-IT serum) (p greater than 0.2). The BRLs of the control-IT group retained their cell sensitivity as well as the blocking effect of the CRa-immune serum. This study thus demonstrated that CRa-IT reduces symptom and medication scores clinically in cockroach-asthmatic subjects, and the CRa-IT produces the CRa-specific blocking antibody of the IgG type. It also reduces anaphylactic leukocyte sensitivity, which is not affected by humoral factor.

Response of human chorionic gonadotrophin to luteinizing hormone-releasing hormone stimulation in the culture media of normal human placenta, choriocarcinoma cell lines, and in the serum of patients with gestational trophoblastic disease

In vitro and in vivo responses to luteinizing hormone-releasing hormone (LHRH) stimulation of human chorionic gonadotrophin (hCG) production were evaluated. We cultured placental tissues of ten weeks and term pregnancy, choriocarcinoma tissues, and monolayers of the BeWo cell line, and added serial dilutions of LHRH (1, 5 and 10 micrograms) to the media for five to seven days. In in vivo experiments, 100 micrograms LHRH was intravenously administered to 20 normally cycling women (control group), 27 women who were 'possible remission', and 21 women with 'minimal resistance' to gestational trophoblastic disease. After injection of LHRH, blood samples were collected at 0, 30, 60, 90 and 120 minutes. The concentrations of immunoreactive beta-hCG in in vitro culture media, and in sera from patients, were measured before and after LHRH stimulation by double-antibody radioimmunoassay. These in vitro and in vivo experiments revealed that normal and malignant trophoblastic cells responded to the LHRH stimulation by producing immunoreactive beta-hCG. Therefore, LHRH stimulation may be useful in detecting residual choriocarcinoma cells in gestational trophoblastic disease patients during their periremission periods.