Historical case: "Portrait of a one-eyed man" by Vincent Van Gogh.

The post-impressionist Dutch painter Vincent Willem Van Gogh (1853-1890) painted the "Portrait of a one-eyed man" (1889) when he was admitted to the mental hospital of Saint Paul-de-Mausole. The portrait probably depicts one of Van Gogh's fellow patients who was suffering from a left-sided upper eyelid ptosis. Neurofibromatosis type I with orbitotemporal involvement has been suggested as the underlying disease process. However, from an otorhinolaryngological point of view, alternative diagnoses are possible. In this paper, the entities of giant frontal sinus osteoma and giant frontal sinus mucocoele are discussed, as well as the operative procedures available at the end of the nineteenth century to treat these lesions.

Effect of adenotonsillectomy on the use of respiratory medication.

OBJECTIVE: Recurrent tonsillitis and upper respiratory tract obstruction due to adenotonsillar hypertrophy are the most common indications for (adeno)tonsillectomy ((A)TE). Symptoms of upper respiratory tract infection and obstruction can, however, be attributed to lower airway pathology and thus treated with respiratory medication - this is non-antimicrobial medication used for lower respiratory diseases like bronchitis, bronchiolitis, asthma and episodic wheezing. The aim of this study is to investigate the effect of the current (A)TE practice in Belgium on the use of respiratory medication in subjects aged 0-15. METHODS: Retrospective data on 11.114 subjects aged 0-15 years old who underwent (A)TE from January 1st 2002 until Sept 30th 2003 were retrieved from the database of the Christelijke Mutualiteit, the largest mutual health insurance society in Belgium. We compared the use of respiratory medication 12 months before and 12 months after (A)TE. RESULTS: Out of 11.114 subjects, 4.654 received at least one prescription for respiratory medication in the year before and/or after (A)TE. In this subgroup, the median respiratory medication use reduced with 32% in the year after surgery. CONCLUSION: Compared with the year before surgery, the median use of respiratory medication in subjects aged 0-15 drastically reduces in the year after (A)TE. A possible reason for this reduction is that children with upper airway obstruction and infections are often wrongly diagnosed as having lower airway problems.

Alice in Wonderland syndrome and upper airway obstruction in infectious mononucleosis.

The Alice in Wonderland syndrome is a rare clinical feature characterised by perceptual disturbances including visual disturbances and distortion of the body image. This uncommon--but often easy to recognise--syndrome, to which children seem particularly susceptible, can be defined in patients with Epstein Barr Virus (EBV) infection. This report describes a 10-year-old child with a mild upper airway obstruction and manifestations of the Alice in Wonderland syndrome resulting from an acute EBV infection. Because meningo-encephalitis was considered in the differential diagnosis, an MRI examination was performed under midazolam sedation, leading to a severe life-threatening upper airway obstruction.

Community learning: the Reach for Health Nursing Program-Middle School Collaboration.

Nursing faculty and students have a vital role to play in promoting adolescent health at the community level. However, few nursing education programs have developed programs which provide nursing students with the skills and hands-on experiences they need to work with adolescents in community settings. A successful model for integrating community-based adolescent health promotion into nursing education is described in this article. Developed by nursing faculty from Medgar Evers College Department of Nursing, teachers and staff from a large middle school in Brooklyn, New York serving economically disadvantaged Black and Hispanic youth, and Education Development Center, Inc., the Reach for Health (RFH) Nursing Program-Middle School Collaboration has two mutually reinforcing components: (a) classroom-based health instruction taught by teachers with assistance from nursing students and faculty, and (b) community youth service in which middle school students spend approximately 3 hours per week providing assistance in health-related facilities under the guidance of nursing faculty and student nurse mentors. As part of an evaluation study, the authors conducted focus groups with nursing students involved in this program and administered an identical survey before and after intervention to assess potential benefits of participation. Compared to a control group of nursing students, those who participated in the RFH program reported increased skills and comfort working in school and community settings and with young adolescents, their teachers, and their parents. An example of other benefits was a greater understanding of the health and developmental needs of adolescents. At the same time they provided a service to the community, nursing students gained the skills and experience needed to be effective in community health promotion efforts.

The effectiveness of the Reach for Health Community Youth Service learning program in reducing early and unprotected sex among urban middle school students.

OBJECTIVES: This study evaluated the effectiveness of a community youth service (CYS) program in reducing sexual risk behaviors among African American and Latino urban young adolescents. METHODS: A total of 1061 students at 2 urban middle schools were surveyed at baseline and 6-month follow-up. Students at one school were randomly assigned by classroom to receive either the Reach for Health CYS program or the Reach for Health classroom curriculum only. Students at the other school served as controls. RESULTS: At follow-up. CYS participants reported significantly less recent sexual activity (P < .05) and scored lower on a sexual activity index than those in the control condition (P < .03). The greatest effect was among eighth graders, who received the most intensive service program (P < .03). The benefit of the curriculum-only intervention appeared greatest among students in special education classes. CONCLUSIONS: Well-organized CYS that couples community involvement with classroom health instruction can have a positive impact on the sexual behaviors of young adolescents at risk for HIV, sexually transmitted diseases, and unintended pregnancy. This study also suggests the importance of including students in special education classes in health education programs.

Violence prevention and young adolescents' participation in community youth service.

PURPOSE: To examine whether participation in a school-sponsored community youth service program reduces self-reported violent behaviors among young urban adolescents. METHODS: A total of 972 seventh- and eighth-grade students at two large, urban, public middle schools were surveyed at baseline and at 6-month follow-up. One school was assigned to interventions and the other served as a control. All students at the intervention school received the Reach for Health classroom curriculum that included a 10-lesson unit focusing on violence prevention. In addition, approximately half the students were randomly assigned by classroom to participate in the Reach for Health Community Youth Service program (CYS). Under the guidance of teachers and community nurses, these students spent several hours each week providing service in local health care agencies. Regression analyses were used to assess the influence of treatment condition on violent behavior outcomes. RESULTS: Comparing students in the curriculum-only and curriculum-plus-CYS interventions to the control group, there is a statistically significant interaction (p < .03) among grade, CYS participation, and violence at follow-up. Eighth-grade CYS students reported significantly less violence at follow-up than students in the control school, taking into account baseline level of risk behavior, gender, ethnicity, and social desirability (p < .04). There was no significant difference between controls and students in the curriculum-only condition. Comparing students in the CYS intervention to the curriculum-only condition within the intervention school, the grade by intervention interaction again is significant (p < .05). Eighth-grade CYS students-who received the broadest CYS experience-reported less violence at follow-up than their curriculum-only counterparts. CONCLUSION: When delivered with sufficient intensity, school programs which couple community service with classroom health instruction can have a measurable impact on violent behaviors of a population of young adolescents at high risk for being both the perpetrators and victims of peer violence. Community service programs may be an effective supplement to curricular interventions and a valuable part of multicomponent violence prevention programs.

A statewide institute to deliver professional development programs to school health personnel in Massachusetts.

Schoolchildren suffer from health problems ranging from chronic medical and developmental problems to new morbidities related to drugs, violence, and sexual behavior. To help administrators, teachers, and health personnel meet the new challenges in schools, nursing educators from the University of Massachusetts and Simmons College developed the UMass-Simmons School Health Institute. The Institute delivers a series of professional development programs in all regions of the commonwealth to: 1) devise innovative strategies to remove health barriers to learning and to promote the health of children and adolescents, and 2) enhance the design, implementation, integration, and management of comprehensive school health programs, including those mandated and regulated by the Commonwealth of Massachusetts. This article describes a statewide model to prepare school health personnel for delivery of comprehensive school health services.

Antibody-mediated killing of suppressor T lymphocytes as a possible cause of macroglobulinemia in the tropical splenomegaly syndrome.

To investigate the pathogenesis of macroglobulinemia in the tropical splenomegaly syndrome (TSS), we assessed the functional activity of B lymphocytes and T cell subsets in a pokeweed mitogen-driven assay of immunoglobulin synthesis. Mononuclear cells from patients with TSS produced more IgM than cells from village or from distant controls. This appeared to result from a decrease in the number and/or activity of suppressor T cells of the T8+ phenotype. The lack of functional suppressor T lymphocytes was associated with the presence in sera from patients with TSS of IgM antibodies that specifically killed T8+, 9.3-, 60.1+ T cells from normal donors. These results support the hypothesis that macroglobulinemia in TSS results from defective immunoregulatory control of B cell function, and that this may be caused by lysis of suppressor T cells by specific lymphocytotoxic antibodies produced by patients with this syndrome.

Reduction of suppressor T lymphocytes in the tropical splenomegaly syndrome.

To study the pathogenesis of tropical splenomegaly syndrome, we compared immunologic findings in patients from Flores, Indonesia, with those obtained in local residents without splenomegaly and in controls. Villagers with tropical splenomegaly syndrome had markedly elevated levels of total IgM, higher titers of IgM antibodies to Plasmodium vivax, and reduced levels of circulating T lymphocytes. The latter were caused by a decrease in the total number of T cells with the suppressor/cytotoxic phenotype (T8+). Levels of B lymphocytes were similar in all groups. All immunologic abnormalities reverted toward normal in patients treated weekly for 9 to 26 months with chloroquine phosphate. These findings suggest that overproduction of immunoglobulins in patients with tropical splenomegaly syndrome is caused by an imbalance in the normal ratio of helper: suppressor T cells that regulate B-lymphocyte function, and that this imbalance is due to a decrease in suppressor T lymphocytes.

Opposing effects of filariasis and chronic malaria on immunoregulatory T lymphocytes.

The effect of parasitic infections on immunoregulatory T lymphocytes was evaluated by means of quantitative determinations of total T cell and T-cell subset populations present in peripheral blood of patients with lymphatic filariasis, with the malaria-induced tropical splenomegaly syndrome (TSS), and with both infections. Total T-cell numbers were similar to control values in patients without TSS, and reduced in donors with TSS. OKT4+/OKT8+ T-cell ratios were decreased in microfilaremic donors without TSS (0.76 +/- 0.08) and elevated in patients with TSS without microfilaremia (1.97 +/- 0.16). Patients with dual infections tended to yield results similar to uninfected control donors. Thus, filariasis and chronic malaria (TSS) have opposing effects on the normal balance of immunoregulatory T lymphocytes. In patients with TSS, the imbalance appears to result from a decrease in the absolute number of circulating T cells with suppressor/cytotoxic phenotype.

Antigen-specific suppressor T lymphocytes in human lymphatic filariasis.

Immune responses to parasite antigens are much lower in patients with microfilaremia than in persons with other manifestations of brugian filariasis. To determine whether hyporeactivity is associated with changes in populations of lymphocytes that regulate immune responses, we quantitated helper and suppressor T cells in the blood of patients infected with Brugia malayi. Increased numbers of suppressor T cells were present in 15 of 17 patients with microfilaremia and in six of 11 patients with elephantiasis. This increase correlated with hyporeactivity to filarial antigens but not to nonparasite antigens. Removal of suppressor T cells activated in vivo or in vitro improved reactivity to filarial antigens. These results suggest that immunosuppression induced by filarial parasites is a possible mechanism of survival of these organisms in an immunocompetent host.

Effect of treatment with diethylcarbamazine on immune responses to filarial antigens in patients infected with Brugia malayi.

We studied the effect of treatment with diethylcarbamazine (DEC) on immune responses to parasite antigens in humans infected with Brugia malayi. In vitro lymphocyte proliferative responses to microfilarial antigens increased in patients who became amicrofilaremic after treatment with DEC. No changes in reactivity were observed in amicrofilaremic individuals who were given DEC or in a small number of patients who remained microfilaremic after treatment. Reactions to other antigens (PPD and SKSD) were not affected by drug treatment. Serum titers of antibodies to the sheath of B. malayi microfilariae did not significantly change during the period of observation. These findings indicate that DEC partially reverses the state of cellular unresponsiveness to parasite antigens associated with patient filarial infections.

Antigen-specific suppressor cells and suppressor factors in human filariasis with Brugia malayi.

We investigated the mechanisms of specific immune unresponsiveness to microfilarial antigens. The blood of patients with obvious Brugia malayi infections contains an adherent cell type that specifically suppresses reactions to microfilarial antigens but not to other antigens. In the absence of continued stimulation by parasite antigens, this suppressor cell loses its functional activity after overnight culture in vitro. Furthermore, serums from patients with and without microfilaremia contain factors that also suppress reactions to filarial antigens in vitro. These results suggest that immune unresponsiveness in human beings with patent filarial infections is due to active suppression of immune responses directed against the parasite and not to an intrinsic inability of infected patients to react to parasite antigens.

Immune responses in human infections with Brugia malayi: specific cellular unresponsiveness to filarial antigens.

We evaluated the cellular immune competence of 101 subjects living in an area of South Kalimantan (Borneo) where Malayan filariasis is endemic. All patients with elephantiasis but none with other clinical stages of filariasis reacted with adult worm antigens. The majority of subjects without clinical or parasitological evidence of filariasis and approximately one-half of those with amicrofilaremic filariasis reacted with microfilarial antigens. In contrast, most patients with patent microfilaremia did not respond to microfilarial antigens. The in vitro reactivity of all patient categories to nonparasite antigens was similar to that of the distant control group. These results indicate that patent microfilaremia is associated with a state of specific cellular immune unresponsiveness and are consistent with the current hypothesis that the various clinical manifestations of filariasis result from different types of immune responses to distinct antigens associated with different developmental stages of filarial worms.