Scabies associated with radiation therapy for cutaneous T-cell lymphoma.

Scabies, infection with Sarcoptes scabiei, is known to be predisposed to by poor body hygiene, environmental exposure, and systemic immunodeficiency. We report the case of an 83-year-old man with Sezary's syndrome who developed scabies limited to the skin of the upper chest, the same location where he had previously received electron beam radiation treatments for cutaneous T-cell lymphoma. Histologic and immunohistochemical studies demonstrated that sections of the previously irradiated right and left chest skin, compared to non-irradiated chest, abdominal, and leg skin, had infestation by scabies, diminished involvement by T-cell lymphoma, and notably reduced numbers of Langerhans cells. These findings suggest that the development of scabies may be predisposed to by local cutaneous radiation therapy, and that it may be mediated by local cutaneous immunodeficiency secondary to reduced numbers of Langerhans cells.

Broad support evident for the emerging specialty of orofacial pain.

The emerging field of Orofacial Pain is being considered by the American Dental Association for full status as a new dental specialty. Many recent advances in the neuroscience of orofacial pain have lead to treatments by orofacial pain dentists that provide significant relief for patients with chronic orofacial pain disorders. However, access to this care has been limited leaving many patients to continue to suffer. Subsequently, recent efforts to improve this by developing the field into a specialty have shown broad support among dentists and increased awareness of the benefits this field can provide for dentists and their patients. A recent survey of 805 individuals in the general population who reported having a persistent pain disorder revealed that more than four out of 10 people have yet to find adequate relief, saying their pain is out of control-despite having the pain for more than 5 years and switching doctors at least once. "This survey suggests that there are millions of people living with severe uncontrolled pain," says Russell Portenoy, MD, President of the American Pain Society. "This is a great tragedy. Although not everyone can be helped, it is very likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed." (1). Development of the field of Orofacial Pain into a dental specialty has been motivated primarily by this issue; patients with complex chronic orofacial pain disorders have not been historically treated well by any discipline of health care. Recent studies of chronic orofacial pain patients have found that these patients have a high number of previous clinicians and have endured many years with pain prior to seeing an orofacial pain dentist (2) (Fig. 1). Complex pain patients and the clinicians who see them are often confused about whom they should consult for relief of the painful disorder. Treatment for these patients within the existing structure of dental or medical specialties has been inadequate and millions of patients are left suffering. Insurers are also confused with regard to reimbursement and make decisions to exclude treatment for orofacial pain disorders under both dental and medical policies. However, Dentistry has taken a leading role in health care to address this national problem by developing the field of Orofacial Pain into a dental specialty. A study of dentists and dental specialists have shown that there is a recognized need and broad support for further development of this field into a new dental specialty(3).

Assessment of temporomandibular injury and orofacial pain.

Every individual has physical faults which makes him less than a perfect biological specimen. This is the foundation for the legal "eggshell principal." Most of us do not have perfect skeletal formation, muscular adaptation, neurological or vascular systems. Additionally, we may not have complete symmetry and ideal form to our cranium or mandible. Our dentitions are imperfect. All of these imperfections play a role in every injury. The variances of normal that are seen in any medical or dental population, must be accepted; therefore, a given injury can have tremendously varied sequelae, depending on the person receiving it. The patho-physiology resultant from an accident may not parallel the severity of the motor vehicle accident, fall or blow. Prompt and proper evaluation of the individual-turned-patient is imperative. Referral to a dentist, competent in providing the necessary evaluation of the injury, is the responsibility of those individuals attending to the injured person's physical, emotional, and financial trauma. Their physician, dentist, attorney or counselor should take the responsibility of providing proper referral. The four most dangerous words in medicine and dentistry today are: "It Will Go Away." People often develop serious sequelae by assuming that their problem will "go away" by just leaving it alone long enough or by simply ignoring it. With proper evaluation and management, most trauma related temporomandibular injuries can be corrected or at least be properly managed.

T M J screening for orthodontics.

A crisis seems to be developing in the ongoing dilemma of the relationship of orthodontics to temporomandibular disorders. Articles in the lay and dental press bear out this increasing concern. This paper provides a six step TMJ screening process for all dental practitioners providing orthodontic services. Specialty licensed orthodontists as well as dentists providing orthodontics as a part of family practice will find these guidelines simple to incorporate into their clinical evaluations.

Bordetella bronchiseptica bronchitis.

The clinical course of a patient with bronchitis caused by Bordetella bronchiseptica is described. The organism was recovered on one occasion from a protected catheter brush specimen obtained at bronchoscopy and on two occasions from expectorated sputum specimens. The infection was eradicated with antimicrobial therapy.

Spurious elevation of automated leukocyte counts induced by Fluosol DA 20%.

During studies with Fluosol DA 20% (FDA) in rats, an artifactual leukocytosis was observed when an impedance type electronic cell counter was used. The effect was found to be directly related to the duration of the interval between addition of an erythrocyte lysing fluid and counting, observed up to 11 d after transfusion with FDA, blood cell associated, reproducible in vitro, FDA concentration dependent, temperature dependent, and present when human blood was used instead of rat blood. Microscopically, the effect appears to be the result of agglutination of lysed erythrocyte membranes due to the interaction of erythrocytes, the emulsion component of FDA, and the quaternary ammonium salt component of the lysing fluid. These data suggest that FDA causes subtle changes in erythrocytes and raises the possibility that other cells may be similarly affected.

Human myocardial morphologic and functional changes in the first 24 hours after doxorubicin administration.

The purpose of this study was to document early structural changes in the human heart after the initial administration of doxorubicin. Endomyocardial biopsies were performed at baseline and at 4 and 24 hours after doxorubicin administration to 13 patients. Morphometric analysis of electron micrographs (x 31,200) quantitated mitochondrial and tubular sizes (sarcoplasmic reticulum and T tubules). The mitochondrial size increased from 0.25 +/- 0.01 mu 2 (mean +/- SE) at baseline to 0.27 +/- 0.03 mu 2 (not significant [NS]) at 4 hours and 0.30 +/- 0.03 mu 2 (NS) at 24 hours. The tubular size increased from 2.24 +/- 0.13 x 10(4) nm2 at baseline to 2.60 +/- 0.26 x 10(4) nm2 (P less than 0.05) at 4 hours and 2.46 +/- 0.29 x 10(4) nm2 (NS) at 24 hours. Micrographs analyzed for nuclear changes showed nucleolar contraction and segregation of granular and fibrillar components. These changes were noted in five of ten patients at 4 hours and in eight of 13 patients at 24 hours. Serial echocardiographic and systolic time interval determinations of left ventricular function demonstrated a significant improvement at both 4 and 24 hours. In conclusion, doxorubicin has its most significant effect on tubular structures. Left ventricular function improved during this time despite these findings.

Clinical evaluation of automated antibiotic susceptibility testing with the MS-2 system.

The MS-2 (Abbott Laboratories) system for automated antimicrobial susceptibility testing was evaluated for both accuracy and general utility in our clinical laboratory. A total of 984 fresh clinical bacterial isolates (745 gram-negative, 239 gram-positive) were tested with the MS-2 system, and results were compared directly with those from a conventional agar disk diffusion method. Discrepancies between the two methods were categorized as very major, major, and minor. For gram-positive isolates, full accord (all discrepancies considered) was 91.6%, and essential accord (minor discrepancies not included) was 96.2%. With gram-negative isolates, full accord was found to be 93.9%, with essential accord of 97.9%. Aggrement as a function both of organism group and of antimicrobial agent was determined. Full accord of 90% or more was found for all major organism groups tested, with the exception of enterococci, where discrepant results between the two methods were observed. Mean test time for all isolates tested was 4.3 h. The MS-2 was found to be an accurate and highly automated instrument which required minimal technician time and was readily adaptable to work flow in our clinical laboratory.