California's tobacco control saga.

The California tobacco control program known as Proposition 99 was established in 1989 using a portion of a twenty-five-cent increase in the cigarette tax. With an initial availability of more than $150 million, tobacco control was the state's single most important public health activity. Health and medical care programs also were supported by the tax. Despite sustained public support, the tobacco control component was weakened by political actions of the tobacco industry and also by the competing efforts of organized medicine and the lack of support from the executive and legislative branches of government. Nevertheless, Proposition 99 succeeded in reducing exposure to environmental tobacco smoke, cigarette consumption, and smoking prevalence among adults in California.

Control of epistaxis in patients with hereditary hemorrhagic telangiectasia.

Twenty-nine patients were admitted to Pennsylvania Hospital between March 1984 and July 1990 with a diagnosis of epistaxis and hereditary hemorrhagic telangiectasia. Data were obtained through a retrospective review of the charts of these patients. Patients were treated for epistaxis with the CO2 laser, neodymium:aluminum garnet laser with a wavelength of 1064 nm (Nd-Yag), Nd-Yag laser with a wavelength of 532 nm (KTP), septodermoplasty, or any combination of these procedures. Patients underwent an average of 2.5 procedures each. Overall, 25 of 29 patients reported their symptoms had greatly improved with therapy. The average length of time without the need for further surgical intervention was 16.3 months for the Nd-Yag laser and 11.7 months for the KTP laser. Septodermoplasty using buccal mucosal grafts allowed, patients to avoid additional procedures for 24.4 months, which was twice as long as for standard septodermoplasty using split-thickness skin grafts. Although no therapy completely resolves the epistaxis, laser therapy combined with septodermoplasty enables the patients to gain excellent control of the epistaxis for several years.

Mandibular fractures in the pediatric patient.

Seventy-three patients were admitted to the Children's Hospital of Philadelphia (Pa) between January 1979 and June 1989 with a diagnosis of mandibular fracture. Data were obtained through a retrospective review of these cases. The cases were divided into three age groups that reflected the developing structure of the mandible and the maturation of the dentition. A trend toward a greater number of fractures and a predominance of males is shown with increasing age. Child abuse is a relatively frequent cause of fractures throughout all groups. Associated injuries are more common in young children, except in cases where abuse has been documented. The high osteogenic potential of the pediatric mandible allowed conservative management to be successful in 25% of younger patients and was responsible for a low complication rate overall.

Ectodermal dysplasia: the otolaryngologic manifestations and management.

Ectodermal dysplasia is a rare group of diseases presenting special problems in management for the otolaryngologist, but the full spectrum of otorhinolaryngologic manifestations has been previously unrecognized in the otolaryngologic literature. The anhidrotic form, characterized by deficient sweating, sparse hair growth and deficient teeth, with associated decreased mucous production in the aerodigestive tract leads to chronic upper respiratory tract infections, otitis, dysphagia, hoarseness, bronchitis and sometimes hemoptysis.

Further experience with division of the left renal vein.

The left renal vein (LRV) has numerous tributaries including, but not limited to, the inferior phrenic, suprarenal, and gonadal veins. The resultant potential for collateral LRV outflow through these tributaries in instances of LRV division is obvious. One of us has previously reported 10 such cases of LRV division (close to its confluence with the inferior vena cava and without reanastomosis) for the purpose of facilitating proximal abdominal aortic exposure for reconstructive procedures. One of the 10 patients had moderate renal insufficiency at follow-up. We present herein an additional 19 patients who underwent LRV division predominantly for aneurysmal disease of the abdominal aorta. Sixteen patients were available for follow-up. Three patients died in the intraoperative and early postoperative periods. Multivariate analysis of variance of preoperative, postoperative, and follow-up laboratory data--serum creatinine and BUN--showed no significant change in renal function as assessed.

Transsphenoidal hypophysectomy: a critical review.

The approach to resection of pituitary tumors has undergone radical changes over the past one hundred years and continues to change. Prolactinomas are the most common indication for hypophysectomy. While transsphenoidal hypophysectomy has now become the standard surgical procedure for gaining access to the pituitary fossa, alternative methods of approaching the sphenoid sinus are advocated. A thorough knowledge of sinonasal anatomy is essential for these transsphenoidal procedures, necessitating otolaryngologic consultation. While mortality is low with any of these procedures, the morbidity of the sublabial approach may be avoided with alternative techniques.

Involucrin, a marker of squamous and urothelial differentiation. An immunohistochemical study on its distribution in normal and neoplastic tissues.

Involucrin is a soluble protein precursor of the cross-linked envelope present in the submembranous zone of human stratum corneum, and subsequently demonstrated in stratified squamous epithelia. The immunoperoxidase technique was used to assess the distribution of involucrin in 107 normal and 318 abnormal tissues. With few exceptions, involucrin was restricted to squamous epithelia, urothelium, some skin appendages and thymic Hassall's corpuscles. In normal squamous epithelium and normal urothelium, staining was most intense in the superficial layers where it was concentrated at the cell periphery and gradually decreased toward the basal layer. This orderly staining pattern was maintained in benign squamous and urothelial lesions and in grade I papillary urothelial carcinomas. Higher grade papillary urothelial carcinomas, infiltrating urothelial and squamous carcinomas, and in situ urothelial and squamous carcinomas demonstrated abnormal staining patterns for involucrin that are described. Foci of squamous differentiation in adenocarcinomas and other epithelial malignancies stained intensely for involucrin. Brenner tumours of the ovary and Walthard rests of the fallopian tube, lesions of uncertain histogenesis but possibly urothelial-related, also stained for involucrin. Results of this study suggest that involucrin is a sensitive and specific marker for squamous and urothelial differentiation, staining patterns for involucrin may be helpful in distinguishing benign from malignant urothelial and squamous lesions, and presence of involucrin may be helpful in determining the histogenesis of selected lesions.

Choline uptake into renal phospholipids following renal ischemia in rats.

Renal phospholipid metabolism was studied after ischemia was induced by occlusion of the left renal artery in the rat. There was no change in the rate of cellular [14C]choline uptake after 25 or 60 minutes of ischemia. However, [14C]choline incorporation into phospholipid was two to three times greater in slices from the ischemic kidney than in slices from the contralateral control kidney. The increase occurred after 25 minutes of ischemia plus 15 minutes of reflow, and after 60 minutes of ischemia with or without reflow. When [14C]choline was injected into rats after a 60-minute period of renal ischemia, the rate of incorporation into phospholipid in the ischemic kidney was almost twice that of the control kidney. These results were similar to those of the in vitro experiments. Since virtually all of the cellular phospholipids of the kidney are present in cellular membranes, renal ischemia affects membrane metabolism. The mean distribution ratio of alpha-aminoisobutyric acid in slices of kidneys ischemic for 60 minutes was similar to that of control slices: 4.11 +/- 0.2 (SEM) vs. 4.30 +/- 0.30. The normal uptake of alpha-aminoisobutyric acid indicates that the increased incorporation of choline is associated with functional integrity of the membrane.

Collateral circulation after renal artery occlusion in the rat.

We used angiographic and microsphere methods to evaluate the anatomic and functional features of renal collateral circulation in the rat. By the microsphere method, renal parenchymal blood flow was less than 1% of control 1 hour after occlusion of the main renal artery; 2.8% of control 1-2 weeks after arterial occlusion; and 1% of control 4-9 weeks after occlusion. Radiographic observations during chronic occlusion revealed numerous collateral vessels to the kidney. These vessels readily filled with angiographic contrast medium but the intrarenal circulation did not visualize. We conclude that collateral circulation to renal parenchyma is negligible after acute or chronic occlusion of the main renal artery in the rat. The rich anatomic plexus of collateral vessels has no functional significance and is unable to preserve viability of the parenchyma.

Renal failure in Burkitt's lymphoma.

A case of Burkitt's lymphoma with renal failure due to massive infiltration of the kidney is reported. There was a striking initial response to chemotherapy with a parallel improvement in renal function and decrease in renal size. The rare occurrence of renal failure due to lymphomatous infiltration of the kidney parenchyma in the absence of urinary tract obstruction is reviewed.