The SomnuSeal Oral Mask Is Reasonably Tolerated by Otherwise CPAP Noncompliant Patients with OSA.

Compliance with CPAP is the major limiting factor in treating patients with OSA. The novel SomnuSeal mask is an oral self-adaptable mask located between the teeth and the lips ensuring that there are no air leaks or skin abrasions. Fifty patients with AHI > 20, who failed previous CPAP trials, were asked to sleep with the mask for one month. In all patients, the mask was connected to an AutoPAP machine with a heated humidifier. Efficacy, convenience, and compliance (average usage for 4 or more hours per night) were monitored. Fifty patients (41 m and 9 f, mean age 57 ± 12 years, BMI 33.6 ± 4.9 kg/m(2), and AHI 47 ± 23/h) participated. Eleven were classified as compliant (average mask usage of 26 nights, 4.7 hours per night), five were only partially compliant (average usage of 13 nights, 2.9 hours per night), and 34 could not comply with it. In all patients who slept with it, the efficacy (assessed by residual AHI derived from the CPAP device) was good with an AHI of less than 8/hour. Interestingly, the required optimal pressure decreased from an average of 9.3 cmH2O to 4.6 cmH2O. The SomnuSeal oral interface is effective and may result in converting noncompliant untreated patients with OSA into well-treated ones.

Immunophysiology of Atlantic sturgeon, Acipenser oxyrinchus oxyrinchus (Mitchill), and the relationship to parasitic copepod, Dichelesthium oblongum (Abilgaard) infection.

The copepod parasite, Dichelesthium oblongum, is known to infect the Atlantic sturgeon, Acipenser oxyrinchus oxyrinchus, within the area near New York city, USA, known as the NY Bight. The gross pathology associated with the juvenile and adult copepod stages along with the parasite's link in causing changes in sturgeon osmoregulatory capabilities has led us to investigate the host immunophysiology in relation to this host-parasite system. All the host variables, which included gill Na(+) -K(+) -ATPase activity, serum alkaline phosphatase (AP) and white blood cell differential counts, were affected in a non-linear manner by the copepod parasite. The parasites increased the host gill Na(+) -K(+) -ATPase activity and serum AP along with the percentage granulocytes while decreasing the percentage lymphocytes. A new method, developed to sample and preserve white blood cells in the field for future flow cytometry analysis, proved adequate. The effects of fish size, location and time of sampling were accounted for by the use of generalized linear models, and their effects on the host variables are discussed.

Incidence and factors related to flare-ups in a graduate endodontic programme.

AIM: To investigate the incidence and factors related to endodontic flare-ups in nonsurgical root canal treatment (NSRCT) cases completed by graduate endodontic residents at University of Pennsylvania, USA. METHODOLOGY: Residents at University of Pennsylvania enter all clinical patient records into an electronic database called PennEndo database. Analysis of records of 6580 patients treated from September 2000 to July 2005 revealed a total of 26 patients with flare-ups (0.39%). Patients were categorized to have undergone flare-up when they attended for an unscheduled visit and active treatment, and when they suffered from severe pain and or swelling after initiation or continuation of NSRCT. SAS software was used to develop a logistic regression model with flare-up as a dependent variable. Independent variables included in the model were: history of previous pain, one vs. two visit NSRCT, periapical diagnosis, tooth type, rotary versus hand instrumentation, and lateral versus vertical compaction of gutta-percha. RESULTS: The odds for developing a flare-up in teeth with a periapical radiolucency were 9.64 times greater than teeth without a periapical radiolucency (P = 0.0090). There was no statistically significant difference in flare-ups between one and two visits NSRCT. The odds of developing a flare-up increased 40 fold when NSRCT was completed in three or more visits. However, this result may have been confounded by addition of an unscheduled visit in patients suffering from flare-ups. Other independent variables did not have any statistically significant correlations. CONCLUSIONS: A low percentage of patients experienced flare-ups during NSRCT procedures. The presence of a periapical lesion was the single most important predictor of flare-ups during NSRCT.

The emergency department approach to violently injured patient care: a regional survey.

OBJECTIVE: Since the early 1990s public health workers have challenged healthcare practitioners to take an active role in violence prevention with patients aged 10-24 years. Emergency department (ED) clinicians are uniquely positioned to identify, assess, and refer youth involved in violent events. The objective of this study was to describe ED directors' estimate of the number of violently injured youth seen, the presence of established protocols or guidelines for handling youth violence, and the type of training programs offered to ED physicians regarding this issue. METHODS: The authors conducted a survey of EDs (n = 64) in the Philadelphia metropolitan region to determine the standard of ED care for violently injured youths. Half of the EDs were in urban areas and half in suburban. RESULTS: A total of 41 out of 64 (64.1%) ED directors completed and returned the written questionnaire. In addition to treating the specific injuries sustained, ED responses to youth violence primarily involved talking with patients about the events surrounding the injury. The estimated number of violently injured youth seen per month varied considerably. Twenty four directors (58.5%) estimated that their institution treated fewer than 10 per month; 10 (24.4%) reported 11-30, and seven (17.1%) mostly large urban hospitals, saw more than 30 per month. Although most hospitals reported that the staff counsels patients about safety concerns, only 17% offered their staff formal training programs on youth violence. CONCLUSIONS: To address the prevention of youth violence, EDs need specific training programs for ED staff, as well as systematic risk assessment and referral resources for structured intervention and follow up.

[Interest in intestinal resection for treatment of advanced ovarian cancer]. / Intérêt des exérèses digestives dans le traitement des cancers évolués de l'ovaire.

AIM OF THE STUDY: Digestive surgery is often necessary for surgical management of advanced ovarian carcinoma. PATIENTS AND METHODS: In a series of 62 patients with stage III ovarian carcinoma, postoperative morbidity and mortality, overall survival after 5 years and disease-free survival after 2 years were studied and corelated with several patients criteria (age, stage of the disease, residual disease, type of surgery, CA125 normalisation delay, postoperative complications and hospital stay). Patients were divided into two groups according to the surgical treatment. The first group (n = 17) included patients treated by gynecologic and digestive surgery, the second group (n = 45) included patients treated by gynecologic surgery only. All patients were proposed for chemotherapy included platyn salt. Mean age was 60 years (range: 20-83). The stage of the cancer was stage IIIa in 7 cases, stage IIIb in ten and stage IIIc in 45. RESULTS: Postoperative mortality was 3.5% (2/62). Postoperative morbidity was 26% (13/62). No statistical differences were noted for hospital stay, general morbidity, surgical morbidity when a gastric resection or a colon resections or a splenectomy were performed. Overall survival at 5 years was 56%. Residual disease less than 2 cm3 is the only prognostic factor for overall survival (56% vs 23% [P = 0.03]) and disease-free survival (86% vs 46% [P = 0.02]). CONCLUSION: This study including 62 patients confirmed the prognostic significance of extensive cytoreductive surgery for treatment in advanced ovarian epithelial cancer without increasing the postoperative morbidy and mortality.

Autocorrelation spectroscopy on single ultrathin layers of CdSe/ZnSe: hints for a non-thermal distribution of excitons in quantum islands.

Autocorrelation spectroscopy on the basis of thousands of individual near-field photoluminescence spectra of single ultrathin CdSe layers at low temperatures exhibits a strong positive correlation peak around 18 meV energy with a width of 5 meV. Using simulations and experiments as a function of temperature and laser intensity, we can exclude interpretations along the lines of biexcitons or phonon sidebands. We attribute this feature to the splitting of ground state and an excited state in individual quantum islands. This interpretation implies that the potential minima are rather uniform in size and that the distribution of excitons is nonthermal.

Short-term outcome of chronic immunosuppression on the development of breast lesions in premenopausal heart and lung transplant patients.

The risk of development of breast lesions in patients on chronic immunosuppression is unknown. In order to assess this risk, a retrospective review was performed of the records of 87 women between the ages of 12 and 47 years who received thoracic organ transplant from 1987 to 1996 at our institution. Inclusion criteria consisted of patients who were premenopausal, had no previous history of breast disease, and survived for at least 1 year posttransplantation. All patients were on a triple immunosuppressive regimen consisting of cyclosporine, steroids, and azathioprine. Mean follow-up was 4 +/- 1.2 years with a range of 1-6 years. During this period, 21 patients (24%) with a mean age of 38 +/- 10 years had screening or diagnostic mammography. The remainder of patients with a mean age of 24 +/- 9 years were followed clinically. Overall, 10 patients (11%) developed a total of 17 palpable, solid lesions at 33 to 72 months posttransplantation. Fifteen of these lesions were surgically excised. Five of the patients had multiple lesions. Pathological examination of the specimens revealed fibroadenoma in nine, fibrocystic disease in four, low grade phylloides tumor in one, and T-cell lymphoma in one case. None of the patients have developed primary breast cancer during follow-up. In conclusion, short-term immunosuppression does not increase the risk of the development of benign breast lesions in young women after thoracic organ transplantation, but rather the distribution of benign lesions is similar in an age-matched population. There were several cases of multiple fibroadenomas in the transplant population, but mammography revealed no malignant disease in this age group and does not need to be utilized in this population beyond what is considered standard for immunocompetent patients. The long-term effect ofimmunosuppressive therapy on the developmentof breast cancer in this group remains to be defined.

Dibenzoxepinone hydroxylamines and hydroxamic acids: dual inhibitors of cyclooxygenase and 5-lipoxygenase with potent topical antiinflammatory activity.

Hydroxylamine and hydroxamic acid derivatives of a known nonsteroidal antiinflammatory dibenzoxepine series display both cyclooxygenase (CO) and 5-lipoxygenase (5-LO) inhibitory properties. Many of these new dual CO/5-LO inhibitors also exhibit potent topical antiinflammatory activity in the arachidonic acid-induced murine ear edema model. On the basis of their promising profile of in vitro and in vivo activities, hydroxamic acids 24h, 3-(6,11-dihydro-11-oxodibenz[b,e]oxepin-2-yl)-N-hydroxy-N-++ +methylpropanamide (HP 977), and 25, 3-(6,11-dihydrodibenz[b,e]oxepin-2-yl)-N-hydroxy-N- methylpropanamide (P10294), were selected as developmental candidates for the topical treatment of inflammatory skin disorders.

Models of alcoholism used in treatment: contrasting AA and other perspectives with which it is often confused.

Current popular and professional conceptions of alcoholism in the United States blend four models that differ in their emphases and implications and contain mutually contradictory beliefs. Elements of moral-volitional, personality and dispositional disease models have been confused with, and mistakenly attributed to, the essentially spiritual views of Alcoholics Anonymous (AA). An original AA model can be distinguished from prior and subsequent beliefs with which it has been added. Clarity regarding the essential elements of an AA understanding of alcoholism is important both for clinicians and for those who would undertake research on AA.

[Therapy of seborrheic eczema with an antifungal agent with an antiphlogistic effect]. / Therapie des seborrhoischen Ekzems mit einem antiphlogistisch wirksamen Antimykotikum.

Numerous AIDS patients show the typical seborrheic eczema in a very prominent way. For this is an inflammatory disease, combination preparations were taken frequently which contain antimycotics and corticosteroids. We investigated 7 antimycotic compounds in 3 inflammatory models: amorolfin, ciclopiroxolamine (cic), fluconazole, ketoconazole, miconazole, naftifine, and rilopirox. In an in vitro model the inflammatory activity towards the 5-lipoxygenase was investigated. 1,000 mumol naftifine, 100 mumol ketoconazole, 50 mumol cic, and 10 mumol rilopirox inhibited 5-HETE by 90%. In a cell culture model only cic had a significant activity towards cyclo-oxygenase. In this model the inhibition of the prostaglandin E2 liberation by 1 mumol cic was 40%. In an in vivo model the anti-inflammatory activity on a mouse ear was investigated (arachidonic acid induced). In this model only cic showed a significant inhibition of inflammation (50%) at 1 mg/ear. These investigations show, that cic has a strong antiphlogistic activity. In an open clinical trial with 20 patients suffering from seborrheic eczema after 4 weeks on cic cream a strong inhibition of infiltration and flakiness had been observed. The antimycotic compound cic offers a possibility to treat inflammatory mycoses without using corticosteroid combinations. In a double blind clinical trial (tinea) where cic was compared with a cic/hydrocortisone combination no statistical differences were found.

Laboratory identification of erythroblastosis fetalis.

The clinical laboratory assumes the paramount role of supplying accurate data to the attending physician for the diagnosis, treatment and prevention of HDN. Maternal prenatal testing identifies patients at risk for Rh-HDN. The antibody titer is of primary value in assessing patients as candidates for amniocentesis. Amniotic fluid analyses provide an assessment of fetal prognosis in HDN and also an assessment of gestational age, lung maturity, and placental function. In severe HDN, amniotic fluid analysis can indicate the need for intrauterine transfusion. Postnatal laboratory studies can confirm the suspected diagnosis of HDN, identify those neonates at risk of developing kernicturus, and provide the physician with information pertaining to the treatment of HDN. Finally, prenatal and postnatal laboratory testing identifies those females eligible for Rh-immune globulin therapy to prevent HDN in subsequent pregnancies.

Ultrastructural assessment by colloidal iron of the distribution and localization of anionic sites in human glomerulonephritides.

The distribution of anionic sites within glomerular basement membranes from patients with different glomerulonephritides was examined by the dialyzed colloidal iron (DI) staining technique. The correlation of ultrastructural findings with glomerular disease, renal function, and degree of proteinuria revealed three alterations: 1) speckled DI staining in the lamina densa of patients with decreasing renal function and a proteinuria of greater than 1 g/24 hours; 2) an apparent staining disparity and diminution of DI at the lateral borders of swollen and retracted foot processes with inclination of the foot processes in the direction of the more weakly staining lateral border; and 3) heavy DI reaction on the apical of free surfaces of fused foot processes. Human subjects with a proteinuria of more than 1 g/24 hours display optimal labeling of the endothelial fenestrae, endothelial cell coat, lamina rara interna, and lamina rara externa. The staining observed may be explained either on the basis of direct DI interaction with diffusing plasma proteins secondary to a decrease in the transglomerular charge barrier consequential to a loss of intrinsic anionic sites or on the basis of "unmasking" of anionic moieties within the glomerular basement membrane. Regardless of the mechanism involved, the present study indicates that a threshold proteinuria of 1 g/24 hours is needed to effect staining in the lamina densa.