Impact of allergy on children with attention deficit hyperactivity disorder.

Summary: Background. Attention deficit hyperactivity disorder (ADHD) is commonly present worldwide, causing serious problems to those affected. ADHD was suggested to be secondary to allergic disorder or its medication. Both ADHD and allergy depend on complex environmental and genetic interaction, and they meet the hypersensitivity criteria. Objective. Detect the percentage of allergy in ADHD children, the common allergic disorders and allergens, and the effect of allergy on symptom and severity of ADHD. Material and methods. 100 children with ADHD were subjected to psychiatric assessment for ADHD type and severity, history of allergy, skin prick test to common environmental allergens, serum total IgE levels and open food challenge. Co-morbid neuropsychiatric disorders, below average intelligence quotient (IQ), and chronic illnesses were excluded. A control of 60 healthy children was chosen to compare the results of skin prick test and serum total IgE levels. Results. 35 ADHD children (35%) were allergic. Most cases had combined allergic rhinitis and bronchial asthma (25%). Common allergens were hay dust (43%) followed by different pollens (37.5%). There were statistical significant differences between coexistence of allergy, type of ADHD, early onset and severity of symptoms. Conclusion. Children with ADHD had an increased prevalence of allergic diseases. Evaluation of allergy in ADHD is mandatory, to decrease the burden of the condition.

Limited ovarian stimulation (LOS), prevents the recurrence of severe forms of ovarian hyperstimulation syndrome in polycystic ovarian disease.

OBJECTIVES: We aimed to test the possibility that LOS could be used to avoid the risk of occurrence of severe OHSS in PCOD patients with past history of severe OHSS in their previous IVF treatment. STUDY DESIGN: A prospective study, with patients stood as their own controls. Twenty patients with history of severe OHSS in their previous IVF treatment were included in the study. The patients received LOS cycles during the six months period commencing January 1998, a full dose of human chorionic gonadotropin (10,000 IU) was administered when the leading follicle reached a mean diameter of 12 mm, and oocytes retrieval 36 h later was followed by intracytoplasmic sperm injection (ICSI) and embryo transfer. Signs and symptoms of severe OHSS were recorded. RESULTS: All patients produced mature oocytes, achieved fertilisation and eight clinical pregnancies were diagnosed. None of the patients re-experienced the symptoms of severe OHSS, and none required hospitalisation. CONCLUSION: We confirm that, in the studied group of patients, LOS helped in the prevention of the severe forms of OHSS in PCOD patients with past history of severe OHSS.

Temporomandibular joint ankylosis: the Egyptian experience.

This is a review of 204 patients with temporomandibular joint (TMJ) ankylosis treated according to a definitive protocol in the Cranio-Maxillo-Facial Department of the Alexandria University Hospital during the period 1990-1996 with a follow-up varying from 1.5 to 7 years. A history of trauma was confirmed in 98% of cases. Patients were grouped into: (1) Those with ankylosis not associated with facial deformities. The management involves release of the ankylosed joint(s) and reconstruction of the condyle ramus unit(s) (CRUs) using costochondral graft(s) (CCGs). (2) Those with mandibular ankylosis complicated by facial bone deformities, either asymmetric or bird face. The treatment consists of release of the ankylosis, reconstruction of the CRUs, and correction of jaw deformities--all performed simultaneously. Respiratory embarrassment was an important presenting symptom in the second group, all of whom complained of night snoring, eight of whom had obstructive sleep apnoea (OSA). In this latter group, respiratory obstruction improved dramatically after surgical intervention. The degree of mouth opening, monitored as the interincisal distance (IID) improved from a range of 0-12 mm to over 30 mm in 62% of patients and to 20-30 mm in 29% of patients. However, reankylosis was still around 8% and was attributed to lack of patient compliance in 75% and to iatrogenic factors in 25% of patients. CCGs resorption, whether partial or complete, occurred in 27% of patients, resulting in retarded growth, relapse of deformities and night snoring.

Limited ovarian stimulation results in the recovery of mature oocytes in polycystic ovarian disease patients: a preliminary report.

This pilot study including five patients, examined the feasibility of obtaining oocytes from partially stimulated ovarian follicles in patients with polycystic ovarian disease (PCOD). We evaluated oocyte maturity, and fertilization potentials. The diagnosis of PCOD was based on ultrasound findings and endocrine criteria. The long protocol of pituitary ovarian axis down-regulation was used and follicles were stimulated with daily injections of human menopausal gonadotropin (HMG), until the mean diameter of the leading follicle reached 12 mm. A full dose of HCG (10000 I.U.) was administered and oocytes were collected 36 h later. The mean number of oocytes collected per patient was 12.6+/-4.9, the mean number of MII oocytes was 8.8+/-4.4, with fertilization rate of 70.5% following intracytoplasmic sperm injection (ICSI). To our knowledge this is the first report in the literature documenting the recovery of mature oocytes following limited stimulation of the ovaries. The potentials of this novel approach open a new dimension in the management of patients with PCOD.

Tensile bond strength of porcelain teeth to denture resin before and after aging.

PURPOSE: This in vitro study compared the effects of four surface treatments on the bond strength between porcelain denture teeth and heat-polymerized denture base acrylic with and without a ceramic primer and bonding agent and after three storage conditions. MATERIALS AND METHODS: Polished porcelain specimens (120) were divided into 24 groups of five each as follows: surface treatments (none, etched, sandblasted, and air abraded), ceramic primer and bonding agent (yes and no), and storage conditions (water storage, thermocycling, and accelerated aging). All the specimens were tested to failure in tension on a testing machine. RESULTS: Hydrofluoric acid etching, sandblasting, and air abrasion did not improve the bond strength of specimens without ceramic primer and bonding agent compared to those polished with 600-grit silicon carbide paper. Use of ceramic primer and light-activated bonding agent (Scotchbond MP) increased the bond strength. For thermocycled specimens treated with ceramic primer and bonding agent, the bond strengths ranged from 10 to 31 MPa in the following order: air abraded = etched < no treatment < sandblasted. CONCLUSIONS: Ceramic primer and bonding agent dramatically improved the bond strength of porcelain teeth to heat-polymerized denture resin. Sandblasting improved bond strength of bonded samples compared to those that were etched or polished only.

Management of unilateral temporomandibular ankylosis associated with facial asymmetry.

Longstanding unilateral temporomandibular joint ankylosis, which starts during the active growth period in early childhood, results in facial asymmetry. Three problems are encountered: the ankylosed joint; the asymmetric face and, occasionally, upper airway obstruction. Simultaneous surgery was performed on 27 patients to release the joint ankylosis and to correct the facial deformity. Bimaxillary surgery was done for adult patients with occlusal canting, and mandibular surgery alone for adult patients without occlusal canting and for young children. Very satisfactory results were obtained during a follow-up period ranging from 2 to 6 years, regarding the restoration of joint function, improvement in aesthetic appearance and relief of respiratory obstruction.

Bird face deformity secondary to bilateral temporomandibular joint ankylosis.

This paper describes our experience in the treatment of 10 patients with bilateral longstanding temporomandibular joint ankylosis occurring during the active growth period and causing severe bird face deformity. The clinical manifestations were: (1) upper airway obstruction in the form of either severe night snoring or obstructive sleep apnoea; (2) inability to open the mouth and (3) severely convex facial profile. Surgery consists of simultaneous release of the ankylosed joints, advancement of the mandible and insertion of posterior mandibular costochondral graft struts. A Le Fort I osteotomy was performed concomitantly in marked deformities to help in the restoration of the posterior facial height. Dramatic improvement in the airway, facial profile and jaw function were obtained by this programme.

Vascular malformations of the jaw bones. Report on nine patients.

Nine patients with vascular malformations of the jaw bones, 4 affecting the mandible, 2 affecting both jaws and 3 affecting the maxilla only. Four lesions were of the high flow type and 5 were of low flow type. Our experience in the management of these lesions is presented together with the possible complications.

The split rib bundle graft in mandibular reconstruction.

This article describes a modified technique for the use of free non-vascularized split ribs (bound together in the form of a tight bundle), to reconstruct different types of mandibular defects. Experience gained over the last 4 years in treating 38 patients with different pathological lesions is presented. The procedure, carried out simultaneously with bone resection proved to be highly effective in providing mesio-distal spanning of the defect, adequate mandibular height as well as bucco-lingual thickness. This technique utilizes the different theories of osteogenesis: (a) from the periosteal cells, (b) from the transplanted living osteocytes and from (c) stimulating host mesenchymal cells to form new bone by bone induction. The surgical technique, results and conclusions are presented in this report.

Genital herpes simplex virus infections: laboratory confirmation in diverse patient groups.

The laboratory diagnosis of genital herpes simplex virus (HSV) infections in various patient groups with diverse clinical manifestations including asymptomatic pregnant women with history of genital herpes and in a high prevalence group consisting of male patients with recurring genital ulcerations is described. HSV was detected by conventional cell culture and also by a CPE-enhancement technique using human embryonic lung fibroblasts (MRC-5) and Vero cells with subsequent typing of isolate by HSV type-specific monoclonal antibodies. A definite improvement in HSV diagnosis was noted by the use of the CPE-enhancement technique with the reduction of turn-around time to 24 h at which 61.1% and 50% isolation rates were detected in MRC-5 cells in comparison to 38.9% and 16.6% by conventional cell culture in the high prevalence patient population and asymptomatic pregnant women, respectively. Delayed development of CPE and reduced isolation rates were detected using Vero cells. Follow-up sampling of subsequent episodes of genital ulcerations in those with history of recurrence but an initial negative cell culture result, increased the isolation rate substantially and enabled the confirmation of diagnosis of genital HSV infection.

Enzyme immunoassay in the diagnosis of Chlamydia trachomatis infections in diverse patient groups.

An enzyme immunoassay (EIA) in parallel with cell culture was used to investigate the extent of infections due to Chlamydia trachomatis. EIA reactive confirmed in cell culture was taken as positive. C. trachomatis was found in 6 (26.0%) of 23 men with symptomatic non-gonococcal urethritis (NGU), ten (17.2%) of 58 symptom-free males and in three of 4 with postgonococcal urethritis. Among 106 asymptomatic pregnant women studied the incidence of C. trachomatis was 8.5% while a higher incidence (16.7%) was found in those with symptoms. C. trachomatis positivity in asymptomatic and symptomatic post-natal screening were 11.4% and 7.7%. Of 43 symptomatic non-pregnant females investigated, 7 (16.3%) were found to be positive for C. trachomatis. Of 3 women with PID, 2 (66.7%) harboured C. trachomatis in their cervix while in another 29 infertile women, C. trachomatis was positive in 3 (8.1%). Contraceptives appeared to have an effect on the chlamydial positivity. Comparative testing of EIA with the standard cell culture method in this study indicate EIA as a suitable alternative for the definitive diagnosis of chlamydial infection in high prevalence settings and with caution in low prevalence settings.

PIP: In Riyadh, Saudi Arabia, physicians took endocervical swab examples from 325 women and urethral swab samples from 85 men to determine the extent of Chlamydia trachomatis infections and to compare an enzyme immunoassay (EIA) for the detection of C. trachomatis with the standard cell culture. All the men had urethritis. The women included pregnant, postnatal, and nonpregnant women. EIA positive tests were used to indicate C. trachomatis infection. 22.4% of all men had chlamydia infection (17.2% of symptom free men, 26% of men experiencing pain when urinating and/or urethral discharge, and 75% of men with postgonococcal urethritis). 8.6% of all pregnant women had cervical C. trachomatis infection (8.5% of asymptomatic pregnant women and 16.7% of pregnant women with vaginal discharge). 11.4% of all postnatal and nonpregnant women tested positive for C. trachomatis. The rates among these women were 66.7% for those who had pelvic inflammatory disease (PID), 50% for those with a history of abortion. 50% for those with a herpetic lesion, 25% for those using oral contraceptives (OCs), 16.3% for nonpregnant women with pain during urination and/or vaginal discharge, 11.4% for those with no symptoms, 8.1% for those with infertility, 7.7% for postnatal women having pain during urination or vaginal discharge, and 4% for those using IUDs. The EIA's sensitivity rates ranged from 75% for women with infertility to 100% for symptomatic men and those with postgonococcal urethritis, symptomatic pregnant women, symptomatic postpartum women, women with PID, and women using OCs. Specificity rates were higher and ranged 92.9-100%. EIA's high sensitivity and specificity along with its rapid performance make it a valuable diagnostic test in clinics where incidence of C. trachomatis infection tends to be high, e.g., sexually transmitted disease clinics. Clinicians could also use it in low risk settings, but they should be careful when interpreting results.

The effect of Permixon on androgen receptors.

Permixon, the liposterolic extract of the plant Serenoa Repens is a recently introduced drug for the treatment of benign prostatic hyperplasia. The effect of Permixon on dihydrotestosterone and testosterone binding by eleven different tissue specimens was tested. The drug reduced the mean uptake of both hormones by 40.9% and 41.9% respectively in all tissue specimens. Since hirsutism and virilism are among other gynecological problems caused either by excessive androgen stimulation or excess endorgan response, we suggest that Permixon could be a useful treatment in such conditions and recommend further investigations of the possible therapeutic values of the drug in gynecological practice.

Routine screening of gynaecological and obstetric patients for Chlamydia trachomatis.

Chlamydia trachomatis infection of the cervix uteri was diagnosed in 9% of 221 gynaecological and obstetric patients. Infection occurred more commonly among obstetric (12.6%) than gynaecological patients (5.5%). In obstetric patients chlamydial infection was commoner in those complaining of excessive vaginal discharge or spontaneous premature rupture of the membranes. Chlamydial infection in gynaecological patients occurred in those with previous pelvic infection, menstrual disorders or excessive vaginal discharge. No cases of chlamydial infection were detected among intrauterine device users. The enzyme immunoassay we used is an easy and relatively quick method of diagnosis for genital chlamydial infection.

[Effects of neurectomy of the tympanic plexus on secretion of the parotid gland in man. Histopathological, histochemical and clinical study (author's transl)]. / Effets de la neurectomie du plexus tympanique sur la sécrétion de la glande parotide chez l'homme.

This study involved five patients suffering from bilateral chronic parotiditis and then with a persistent unilateral fistula of the parotid gland. Two types of parotid biopsy were examined: the first taken during surgery and the second six months later. All of the specimens underwent histopathological and histochemical investigations. Definitive degeneration and atrophic type changes were seen in all the parotid fragments removed six months after selective neurectomy of the tympanic plexus. Six months after surgery, all of the patients were cured.

Effect of tympanic neurectomy on human parotid salivary gland. Histopathologic, Histochemical, and Clinical Study.

Five patients with bilateral chronic recurrent parotiditis and ten patients with unilateral persistent paratoid gland fistulas underwent tympanic neurectomies. Two biopsy specimens from the diseased gland were examined. The first biopsy specimen was taken at the time of operation, while the second one was taken six months later. All specimens were subjected to both histopathologic and histochemical investigations. Definite degenerative and atrophic changes occured in all parotid gland specimens taken six months after selective tympanic neurectomy. All patients were completely cured at about that time. This supported the practical indication of the selective tympanic neurectomy for treating certain benign disorders or diseases of the parotid gland that require persistent arrest of the function of its secretory units.

Tympanic neurectomy for parotid fistula.

Complete excision of the trophic secretomotor parasympathetic nerve supply of the parotid gland produces abolition of its salivary secretion and ends in atrophy of the gland units. We report 20 patients treated by tympanic neurectomy to relieve the distressing problem of parotid fistulas. The tympanic nerve was identified and excised at its appearance through the hypotympanic floor. In seven of our cases, we found an early division of the main nerve that crossed the promontory anteriorly-hence, the importance of excising the tympanic nerve as proximal as possible. All patients observed for more than two years had complete dryness and cure of their fistulas. We describe the basis of tympanic neurectomy and its results compared with other forms of treatment.