Search

We present a severe case of progressive autoimmune pneumonitis requiring surgical intervention in a patient with the monogenic syndrome, autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED). APECED is caused by loss-of-function mutations in the autoimmune regulator (AIRE) gene, which lead to impaired central immune tolerance and autoimmune organ destruction including pneumonitis, an underrecognized, life-threatening complication. When clinicians evaluate patients with pneumonitis, recurrent mucosal candidiasis, and autoimmunity, APECED should be considered in the differential. Additionally, in patients with established APECED, a chest computed tomography is preferred to identify pneumonitis early on and to promptly initiate lymphocyte-directed immunomodulatory treatment, which can prevent irreversible lung destruction.

Glycerol dehydratase activating enzyme (GD-AE) is a radical S-adenosyl- l -methionine (SAM) enzyme that installs a catalytically essential amino acid backbone radical onto glycerol dehydratase in bacteria under anaerobic conditions. Although GD-AE is closely homologous to other radical SAM activases that have been shown to cleave the S-C(5′) bond of SAM to produce 5′-deoxyadenosine (5’-dAdoH) and methionine, GD-AE from Clostridium butyricum has been reported to instead cleave the S-C(γ) bond of SAM to yield 5′-deoxy-5′-(methylthio)adenosine (MTA). Here we re-investigate the SAM cleavage reaction catalyzed by GD-AE and show that it produces the widely observed 5’-dAdoH, and not the less conventional product MTA.

Purpose Radiology-trained nurse practitioners (NPs) may perform image-guided medical renal biopsies with computed tomography (CT). This study evaluates the procedural differences and diagnostic success between biopsies performed by NPs compared to radiologists. Data sources A retrospective study was performed on patients who underwent nontargeted, CT-guided renal biopsy between 2009 and 2014. Provider type (NP or radiologist), number of core specimens obtained, sedation medication dose, CT dose index (CTDI), and diagnostic success were recorded. Categorical and continuous variables were analyzed using χ2 and Student's two-tailed t-test, respectively, comparing NPs with radiologists. Conclusions A total of 386 patients were included; radiologists performed 215 biopsies and NPs performed 171 biopsies. There was no significant difference in diagnostic success, amount of tissue harvested (number of cores), radiation dose, or sedation dosage between NPs and radiologists performing CT-guided renal biopsies. Only 4% were nondiagnostic (n = 7, radiologists; n = 9, NPs; p = .325). Overall mean number of cores obtained was 3.7, mean CTDI was 176.5 mGy, mean fentanyl dose was 86.3 μg, and mean midazolam was dose 1.54 mg without a statistically significant difference between provider types. Implications for practice NPs perform image-guided medical renal biopsies in a similar fashion to radiologists with respect to diagnostic success, amount of tissue harvested, total radiation dose exposure, and administration of sedation.

Six discriminant functions, developed from an historic White population, were tested on a contemporary White population for determination of sex from the hyoid. One hundred and thirty four fused and unfused hyoids from a contemporary White population were used. Individuals ranged between 20 and 49 years old. Six historic White discriminant functions were applied to the fused and unfused hyoids of the pooled contemporary White population, i.e. all males and females and all age ranges combined. The overall accuracy rates were between 72.1% and 92.3%. Correct sex determination for contemporary White males ranged between 88.2% and 96.3%, while correct sex determination for contemporary White females ranged between 31.3% and 92.0%. Discriminant functions were created for the contemporary White population with overall mean accuracy rates between 67.0% and 93.0%. The multivariate discriminant function overall accuracy rates were between 89.0% and 93.0% and the univariate discriminant function overall accuracy rates were between 67.0% and 86.8%. The contemporary White population data were compared to other populations and showed significant differences between many of the variables measured. This study illustrated the need for population-specific and temporally-specific discriminant functions for determination of sex from the hyoid bone.

The purpose of this study was to identify opportunities for reducing epinephrine administration errors after a sentinel event entailing an overdose of i.v. epinephrine occurred in a radiology department.A root cause analysis was performed that included review and analysis of current system protocols, a medication audit, and access to treatment algorithms. A proctored three-question multiple-choice test was administered to radiology attending physicians, fellows, residents, and nurses to gauge baseline knowledge of epinephrine use. Chi-square analysis was performed.Twelve of 13 radiology department central pharmacy automation system locations lacked epinephrine ampules. As a result, personnel had to access i.v. epinephrine stocked on hospital code carts designed for use during cardiac arrest. This led to errors related to appropriate dosing. Test participants included 46 attending physicians, 23 fellows, 28 residents, and 25 nurses (n = 122). Almost all (99%) correctly identified epinephrine as the medication to administer in this situation. Approximately one half (52%) correctly identified the dose of intramuscular epinephrine, but only 29% knew the dose and rate of administration of i.v. epinephrine (p0.001). Attending physicians were more likely to administer i.v. epinephrine correctly than were the other groups (p0.0001).Stocking and routine auditing of medication availability are essential. The use of epinephrine intended for cardiac arrest stocked on code carts should be avoided during contrast reactions. It would be optimal if first-line responders to contrast reactions included attending physicians, but this may not always be the case at academic institutions.

than in 2002 (41%), P= 0.027. ABPM recordings showed significantly fewer undiagnosed hypertensive individuals in 2012 (14%) that in 2002 (28%), P< 0.001. Significantly more hypertensive individuals were optimally treated in 2012, (44%) versus (19%), P < 0.001. Minimum and mean systolic BP were significantly lower in the 2012 cohort, but maximum systolic BP and diastolic BP did not differ. Use of ACE inhibitor, angiotensin receptor blockers and diuretics had significantly increased over the 10-year interval. Patient reported rates of falls, dizziness and syncope had not risen significantly. Ischaemic heart disease was significantly less common in the 2012 cohort, P< 0.05. Conclusion: Hypertension in older people is better recognised and more effectively managed now than 10 years ago. This has not been associated with a significant change in rates of falls, dizziness or syncope.

History of Present Illness A 23-year-old woman presented to the allergy/immunology clinic with a previous diagnosis of allergic rhinitis and asthma. The patient reported that she had started immunotherapy (IT) 34 weeks ago, prescribed by her prior allergist, and had been receiving IT at her college health clinic. Following graduation 2 months earlier, she had been giving herself IT injections at home. She denied any reactions and had injectable epinephrine available at home. She was new to our area and was interested in restarting her IT. Her nasal symptoms included congestion, rhinorrhea, sneezing, itching, and postnasal drip. She also complained of ocular watering, itching, injection, and discharge when around cats or dogs. Chest symptoms included a daily cough and occasional wheezing that she did not notice but others had pointed out to her. She denied any nocturnal symptoms. She had an albuterol metered-dose inhaler available but had not used it in the previous 3 months.

Intravascular lymphomatosis (IVL) is a rare lymphoid neoplasm that is typically of B-cell lineage and characterized by proliferation of malignant cells within small arterioles, capillaries, and venules. We report a patient with pulmonary IVL who presented clinically with progressive dyspnea, fever, and a dry cough. Pulmonary function tests revealed a marked decrease in diffusion capacity with airflow obstruction and severe air trapping. High-resolution CT (HRCT) of the chest with inspiratory and expiratory images revealed mosaic attenuation consistent with air trapping. Transbronchial biopsies revealed the diagnosis of IVL with capillary expansion in the alveolar and peribronchiolar interstitial tissue. IVL should be considered in the differential diagnosis of a patient with an interstitial lung disease, air trapping on pulmonary function tests, and mosaic attenuation on HRCT. Transbronchial biopsies may be the initial diagnostic procedure of choice.

This study presents the frequency and correlates of traumatic injury during sexual assaults for male and female victims. Sexual assaults (6,877 total, 6,213 among females, 664 among males) were reported in South Carolina from October 1991 to September 1994 through the Federal Bureau of Investigation's National Incident Based Reporting System. Sexual assaults were defined to include vaginal rape, sodomy, and sexual assaults with objects. Among sexually assaulted females, 28.5% had traumatic physical injuries compared with 18.4% of similarly assaulted males. Risk factors for nongenital traumatic injury during sexual assault included: increasing number of assailants (females only), being sodomized (females only), weapon use by assailant, being kidnapped (females only), being assaulted by intimates or strangers (females only), African American race (males only), and use of alcohol or other drugs. Avoiding environments in which drugs and alcohol are abused may reduce one's risk of traumatic physical injury during sexual assaults.

This paper describes the dental care provided at an English hospice. Dental care is felt to be important because the ability to enjoy food is an important element in the quality of life. Over a three-year period, 67 patients were referred for dental advice of whom all but four were edentulous. The commonest complaint was of ill-fitting dentures, and the causes and possible solutions to this problem are reviewed.

Appropriate staging procedures for patients with hormone-refractory prostate cancer are poorly defined. In particular, there are no studies correlating prostate-specific antigen (PSA) with more traditional methods of staging. We have evaluated the abdominal/pelvic CT scan, bone scan, and PSA results following initial diagnosis of hormone-refractory prostate cancer in 177 consecutive patients (median age = 63.1 years, range 45-80). Thirty-four patients (19.2%) had measurable lesions (or = 2 cm) on CT scan compatible with metastatic disease. Of the patients with measurable lesions, 29/34 (85.3%) had retroperitoneal and/or pelvic adenopathy; 5 patients (14.7%) had measurable lesions in the liver. Other sites of metastatic disease were detected in less than 1% of the patients receiving scans. All patients had bone scan abnormalities compatible with metastatic disease. Results of these imaging studies were then compared to PSA serum concentration (Abbott IMx). The mean PSA concentration was not different in those patients with soft tissue disease as compared to those without soft tissue involvement and there was no correlation between PSA concentration and the presence or absence of measurable soft tissue disease. In contrast to previously published studies in hormone-naïve prostate cancer patients, these studies in hormone-refractory patients indicate that the detection of metastatic disease by standard radiological procedures cannot be predicted by measurement of serum PSA.

Previous clinical trials have suggested that hydroxyurea may possess some activity against prostate cancer. The in vitro antiproliferative activity of hydroxyurea was evaluated in three hormone-refractory prostate cancer cell lines, PC-3, DU-145 and PC-3M. Fifty-percent inhibition of growth in all three cell lines required prolonged (120 h) exposure to hydroxyurea at a concentration of approximately 100 microM. Using pharmacokinetic data obtained during the course of a clinical trial of hydroxyurea, we simulated a dosing regimen that would sustain plasma drug concentrations above 100 microM for 120 h (1 g loading dose, followed by 500 mg every 6 h for 5 days in a 70 kg man). Since this dosing regimen is likely to generate an unacceptable degree of myelosuppression, in vitro combination studies were conducted with hydroxyurea and phenylbutyrate, a new differentiating agent with no myelosuppressive effects. These studies resulted in a reduction of the hydroxyurea concentration necessary for 50% growth inhibition (50 microM of hydroxyurea plus 0.5 mM of phenylbutyrate). A regimen designed to achieve that hydroxyurea concentration (400 mg loading dose, followed by 200 mg every 6 h for 5 days) should be clinically achievable. Based on these results, this combination deserves further evaluation in patients with stage D prostate cancer.

A case is described where an abdominal fistula was temporarily closed using a plug made from dental addition curing silicone rubber impression material. An effective seal was maintained using a stoma flange and a gentle pressure dressing; this still allowed normal gastric function.

A patient presented with recurrent facial dermatitis associated with dental work. Dermatology referral identified the cause as allergic contact dermatitis to the epoxy acrylate BIS-GMA. Occupationally-induced allergic contact dermatitis to epoxy resin was also demonstrated. A structurally distinct aliphatic acrylate was successfully substituted. Contact sensitivity to BIS-GMA is reviewed and the potential for epoxy sensitive patients to cross-react to BIS-GMA is discussed.

Objective Aim of the present study was to evaluate the clinical suitability of the condensable metal-reinforced glass ionomer cement Hi-Dense in classes I and II cavities of primary molars. Methods Seventeen children received a total of fifty four Hi-Dense fillings (nineteen class I and thirty five class II). The restorations were clinically assessed at baseline, after one and after two years of clinical service according to modified USPHS codes and criteria. The restorations were replicated in each recall and representative samples were qualitatively analysed under a SEM. Results Over the observation period of two years, five restorations failed due to total retention loss, two fillings needed replacement because of persisting hypersensitivity, one filling was lost because of an unsuccessful endodontic treatment, and four restorations remained intact until natural exfoliation (Two year survival rate: 92% for Class I and 66% for Class II). The SEM analysis of surfaces and marginal areas exhibited an inferior adhesive performance primarily in proximal areas, whereas a negative step formation due to wear was frequently observed in occlusal parts. Conclusions The results clearly indicate that the condensable, metal-reinforced GIC Hi-Dense reveals no enhanced performance and lifetime expectancy for class II restorations in primary molars when compared to other non-resin-modified GICs.

Objective To compile an inventory of data from clinical studies on anterior veneer restorations, with special reference to clinical trials to produce a mean survival result using a meta-analysis. Data sources Medline search 1983 to November 1996 using key words ‘dental’ and ‘Veneer’. Study selection A two-stage selection was employed. Initially all non-clinical studies case reports and descriptive papers were excluded. Subsequently all papers which did not meet the following criteria were excluded: English language, 2-year or more follow-up, type, number and location of restoration noted, number of patients stated together with type of restoration, study outcome shown as failure or survival. A quality scoring system was applied to the selected papers and used in combination with the sample size for combining the studies. Results Initially 1056 studies were identified after the initial selection 25 clinical studies remained; this was reduced to 15 at the subsequent selection. Two further studies were excluded, as their data did not allow calculation of survival curves. The cumulative proportion of survival for porcelain and pre-formed acrylic veneer restoration after 3 years is shown in the table below. Conclusion Porcelain veneers show acceptable longevity after 3 years, which appears better than the preformed acrylic type. The evaluative and statistical analysis of clinical veneer restoration studies may be improved. Kreulen C M, Creugers N H J, Meijering A C. Meta-analysis of anterior veneer restorations in clinical studies. J Dent 1998; 26: 345–353