Mechanism of airway inflammation in asthma.

Airway inflammation has emerged as an important contributor to mechanisms of asthma. Furthermore, the presence of airway inflammation is present even in the absence of severe symptoms. To study the mechanisms by which bronchial inflammation can occur in asthma, a number of models have been developed including the airway response to antigen in allergic subjects. The pattern that has emerged from such studies indicates prompt pulmonary mast-cell activation and the apparent initiation of an inflammatory response. This inflammatory response develops over hours and is important in the later and more persistent development of bronchial obstruction. The eosinophil is an important cell in this process as are proinflammatory cytokines generated from activated lung mononuclear cells. The consequence of this multiple cell, multiple proinflammatory product interaction is the establishment of a self-perpetuating, redundant process by which asthma severity increases.

The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients.

The natural history of gallstone disease in 691 patients, followed for a mean +/- SD duration of 78 +/- 61.6 months (median 62.9 months), is presented. These patients are all subscribers of a large health maintenance organization and are believed to represent a cross-section of middle income Americans. Symptoms attributed to biliary tract disease were present in 556 (80.5%), and the other 135 (19.5%) patients were asymptomatic. In the symptomatic group, the mean +/- SD duration of observation was 82.9 +/- 63.2 months (median 68.5 months); 242 (44%) eventually underwent biliary tract operations most often because of persistent symptoms. Only 10% of asymptomatic patients followed for 58 +/- 50.2 months (median 46.3 months) developed symptoms of biliary calculi, and seven per cent required operations. There were 50 deaths in this series of 691 patients, 25 in the symptomatic group, and 25 in the asymptomatic. Only two of these deaths were biliary tract related, and both were in the symptomatic group. This study suggests that patients with silent stones do not need to be operated on prior to the development of symptoms. In addition, many patients with symptoms of biliary calculi can tolerate their symptoms for long periods of time and prefer this course of action to cholecystectomy.

A comprehensive quality assurance system for practicing dentists.

A comprehensive outcome-oriented quality assurance methodology manual has been developed for use by practicing dentists. The audit consists of four parts. Provision for immediate feedback to providers in order to monitor behavior change is a critical part of the review process as is the emphasis on the appropriateness of care dimension, a relatively unexplored area of quality assurance activity.

Message disruptions during syntactic processing in schizophrenia.

Twenty-four schizophrenics and 24 nonschizophrenic psychiatric patients were given the Hunt test, which requires the subject to use syntactic strategies to synthesize an extended multisentence text on the basis of a controlled set of input propositions. This syntactic processing task induced many more meaning misrepresentations of input propositions in the schizophrenic group compared to the control group. These group differences could not be accounted for by confounding variables such as level of psychopathology, medication, and verbal skills. An error analysis indicated that schizophrenics were highly likely to produce meaning errors when the rewritten proposition assumed a passive syntactic form. Conceptually complex sequences of propositions also resulted in a high frequency of message errors among schizophrenics; this second factor did not account, however, for the high association of errors and passive rewrites. These data are interpreted as indicating that schizophrenics suffer from a multilevel language-production disturbance that includes higher-level message errors that are reflexively induced by lower-level syntactic processing disturbances.

Stroke rehabilitation: correlation and prognostic value of computerized tomography and sequential functional assessments.

In a 13-month period, 41 selected patients with cerebrovascular accidents were studied utilizing computerized tomography of the brain and the Barthel index in an attempt to correlate findings with final rehabilitation outcome. Parameters that were studied included age, sex, lesion size and location, and functional status on admission, during hospitalization, and at discharge. Multiple regression analysis assessed impact of the five independent variables on functional outcome as measured by predischarge Barthel scores. Initial Barthel scores emerged as the most reliable predictor factor, explaining 64% of the variability. The study suggested that computerized tomography scans of the brain are presently not as reliable predictors as sequential functional assessments and should be considered as an adjunct measure.

Contribution of endoscopy to diagnosis and treatment of gastric cancer.

The contribution of fiberoptic endoscopy to the diagnosis and treatment of gastric cancer was evaluated in 174 patients. For the purpose of staging, they were compared with 99 patients admitted to the same institution in the pre-endoscopy era. The frequency of minimal gastric cancer (stages I and II) was 16.5 percent in the patients who had esophagogastroduodenoscopy in contrast with only 4 percent in the patients without endoscopy. Fiberoptic endoscopy was superior to barium gastrography in the diagnosis of minimal gastric cancer. The effect of early diagnosis on survival was such that at 3 year follow-up, the cumulative proportion of stage I and II patients still alive was 85 percent compared with only 17.5 percent of stage III patients and none of the stage IV patients.

Surgical therapy of chronic mastoiditis with cholesteatoma.

One hundred fifty-seven ears treated surgically for chronic mastoiditis with cholesteatoma are reviewed. The selection of an operative procedure ("canal wall up" or "canal wall down") was dictated by the extent of pathologic indications in relation to the size of the patient's mastoid. The incidence of recurrent or residual cholesteatoma, the hearing results, and the frequency of visits required for mastoid cavity care are reported.

Leucocyte responsiveness to corticosteroids in diabetic retinopathy.

The in vitro response of white blood cells of maturity onset diabetics to corticosteroids was the subject of these experiments; the response was assessed with the leucocyte migration inhibition assay. Leucocytes from patients with nonproliferative retinopathy demonstrated increased responsiveness to corticosteroids in comparison with the white cell response of both controls and patients with proliferative retinopathy. Similarly leucocyte migration inhibition was greater in the insulin independent than in insulin dependent diabetics. Furthermore leucocyte migration responsiveness may be related to duration of the diabetic state. This preliminary study points to the possible importance of corticosteroids and their receptors in retinopathy and angiopathy.