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Kang BC, Wu CW, Johnson J, Mt. Sinai Hospital-Rush Medical School, Chicago. Characteristics and diagnoses of cockroach-sensitive bronchial asthma. Ann Allergy. March 1992:68:237-244. *Cockroach hypersensitivity was found to be an [...]

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. (J Pediatr 1997;131:258-63)

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 k 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 (@k=0.65) and interobserver (@k=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.

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 IgG"1"a-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.(J Allergy Clin Immunol 1998;101:653-9.)