Endobronchial ultrasound-guided transbronchial needle aspiration: performance of biomedical scientists on rapid on-site evaluation and preliminary diagnosis.

OBJECTIVES: Rapid on-site evaluation (ROSE) of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) followed by a subsequent preliminary adequacy assessment and a preliminary diagnosis, was performed at Aarhus University Hospital by biomedical scientists (BMS). The aim of this study was to evaluate the BMS accuracy of ROSE adequacy assessment, the preliminary adequacy assessment and the preliminary diagnosis as compared with the cytopathologist-rendered final adequacy assessment and final diagnosis. METHODS: The BMS-rendered assessments for 717 sites from 319 consecutive patients over a 4-month period were compared with the cytopathologist-rendered assessments. Comparisons of adequacy and preliminary diagnoses were based on inter-observer Cohen's Kappa coefficient with a 95% confidence interval (CI). RESULTS: Strong correlations between ROSE and final adequacy assessments [Kappa coefficient of 0.90 (CI: 0.85-0.96)] and between the preliminary and final adequacy assessments [Kappa coefficient of 0.93 (CI: 0.87-0.99)] were found. As for the correlation between the preliminary and final diagnoses, the Kappa coefficient was 0.99 (CI: 0.98-1). CONCLUSION: Both ROSE and preliminary adequacy assessments as well as preliminary diagnoses, all performed by BMS, were highly accurate when compared with the final assessment by the cytopathologist.

Periodontal pathogens affect the level of protease inhibitors in gingival crevicular fluid.

In periodontitis, an effective host-response is primarily related to neutrophils loaded with serine proteases, including elastase (NE) and protease 3 (PR3), the extracellular activity of which is tightly controlled by endogenous inhibitors. In vitro these inhibitors are degraded by gingipains, cysteine proteases produced by Porphyromonas gingivalis. The purpose of this study was to determine the level of selected protease inhibitors in gingival crevicular fluid (GCF) in relation to periodontal infection. The GCF collected from 31 subjects (nine healthy controls, seven with gingivitis, five with aggressive periodontitis and 10 with chronic periodontitis) was analyzed for the levels of elafin and secretory leukocyte protease inhibitor (SLPI), two main tissue-derived inhibitors of neutrophil serine proteases. In parallel, activity of NE, PR3 and arginine-specific gingipains (Rgps) in GCF was measured. Finally loads of P. gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia and Treponema denticola were determined. The highest values of elafin were found in aggressive periodontitis and the lowest in controls. The quantity of elafin correlated positively with the load of P. gingivalis, Ta. forsythia and Tr. denticola, as well as with Rgps activity. In addition, NE activity was positively associated with the counts of those bacterial species, but not with the amount of elafin. In contrast, the highest concentrations of SLPI were found in periodontally healthy subjects whereas amounts of this inhibitor were significantly decreased in patients infected with P. gingivalis. Periodontopathogenic bacteria stimulate the release of NE and PR3, which activities escape the control through degradation of locally produced inhibitors (SLPI and elafin) by host-derived and bacteria-derived proteases.

Remission of severely impaired subjective wellbeing in 727 patients with schizophrenia treated with amisulpride.

UNLABELLED: Studies of subjective wellbeing (SW) in schizophrenia have missed to define and to assess rate and predictors of SW response (SW-res) and SW remission (SW-rem). METHOD: A total of 727 patients with schizophrenia and severely impaired SW at entry (Subjective Wellbeing under Neuroleptics Scale, short version, SWN-K, total score < or =60) were treated with amisulpride over 12 weeks. SW-res was defined as SWN total score increase of at least 20% and by at least 10 points and SW-rem as total score of > or =80 points. RESULTS: Seventy percent fulfilled the SW-res criterion at week 4. At week 4 and week 12 (endpoint), the SW response criterion distinguished between patients with or without later SW remission and overall symptomatic and functional response. While 39% fulfilled the SW-rem criterion at endpoint, only 9.1% without early SW-res were in SW-rem at follow-up. Regression analyses indicated that SW-res was mainly predicted by greater severity of positive symptoms at baseline and SW-rem by lower severity of negative symptoms and better social functioning, and particularly by early SW-res. CONCLUSION: Patients with a risk of SW non-remission need to be identified early with subsequent treatment adaptation according to recommendations for incomplete remission and treatment resistance in schizophrenia.

Comparison of olanzapine and risperidone in 367 first-episode patients with non-affective or affective psychosis: results of an open retrospective medical record study.

INTRODUCTION: Previous studies comparing olanzapine (OLZ) and risperidone (RIS) have tended to focus on multiple-episode patients, with no studies examining their comparative efficacy in a non-selective sample of first-episode psychosis. METHODS: The Early Psychosis Prevention and Intervention Centre in Australia had admitted 786 first-episode psychosis (FEP) patients between 1998-2000. Data were collected from the medical records (MR) of 367 patients, which met inclusion criteria. The primary objective was to evaluate the efficacy of OLZ vs. RIS as measured by CGI-S, CGI-BP (symptomatic level), GAF and SOFAS (functioning level). RESULTS: 367 FEP patients were entered into the study, 278 in the RIS- (2.7 mg/day) and 89 in the OLZ group (10.2 mg/day). No between-group differences were found in non-affective FEP (n = 273). In affective FEP patients (n = 94), mainly treated for acute mania (86.7 %), OLZ treatment was related to better response on the symptomatic (CGI-S; p = .002), but not on the functioning level (GAF and SOFAS; ns). There were trends in the OLZ group towards a higher rate of remission of positive symptoms ( p = .054) and a shorter treatment duration to reach this remission in affective FEP patients ( p = .077). More extrapyramidal side effects ( p <.001) were related to RIS and more weight gain to OLZ-treatment ( p <.001). DISCUSSION: Despite the limitations of a retrospective MR design, study results suggest equal therapeutic efficacy of OLZ and RIS in non-affective FEP and some therapeutic advantages of OLZ compared to RIS in affective FEP patients, especially in those with acute mania. Results may serve as hypotheses for future randomised controlled trials.

The hypergraph regularity method and its applications.

Szemeredi's regularity lemma asserts that every graph can be decomposed into relatively few random-like subgraphs. This random-like behavior enables one to find and enumerate subgraphs of a given isomorphism type, yielding the so-called counting lemma for graphs. The combined application of these two lemmas is known as the regularity method for graphs and has proved useful in graph theory, combinatorial geometry, combinatorial number theory, and theoretical computer science. Here, we report on recent advances in the regularity method for k-uniform hypergraphs, for arbitrary k > or = 2. This method, purely combinatorial in nature, gives alternative proofs of density theorems originally due to E. Szemeredi, H. Furstenberg, and Y. Katznelson. Further results in extremal combinatorics also have been obtained with this approach. The two main components of the regularity method for k-uniform hypergraphs, the regularity lemma and the counting lemma, have been obtained recently: Rodl and Skokan (based on earlier work of Frankl and Rodl) generalized Szemeredi's regularity lemma to k-uniform hypergraphs, and Nagle, Rodl, and Schacht succeeded in proving a counting lemma accompanying the Rodl-Skokan hypergraph regularity lemma. The counting lemma is proved by reducing the counting problem to a simpler one previously investigated by Kohayakawa, Rodl, and Skokan. Similar results were obtained independently by W. T. Gowers, following a different approach.

[The initial dysphoric reaction (IDR) to the first dose of neuroleptics]. / Die initial dysphorische Reaktion (IDR) auf die Ersteinnahme von Neuroleptika.

Initial dysphoric response (IDR) is characterized by a negative affective reaction within 48 h after a neuroleptic test dose. Currently, there are three scales for measuring the IDR (Neuroleptic Dysphoria Scale, Dysphoric Response Index, Drug Attitude Inventory). The debate continues about the definition, measurement, and underlying aetiology of IDR. Nevertheless, with a prevalence of 30%, the response is a clinically relevant phenomenon. Empirical data give some evidence of an association between IDR and short-term outcome. No correlation of IDR with pretreatment variables has been found yet (e.g. age, gender, and psychopathology at baseline, especially depression and hostility). With respect to aetiology, a negative subjective reaction to concurrent extrapyramidal side effects and direct dysaffective effects of some neuroleptics have been discussed. Other studies found that IDR might not be a specifically antipsychotic effect. Our first results give some evidence that patients treated with atypical antipsychotics experience IDR less often and less severely than those treated with conventional antipsychotics described in the literature. Further research should include placebo-controlled studies and the evaluation of specific pretreatment variables. To assess the aetiology of IDR, further basic research is needed.

rf Spectroscopy with a single Ba+ ion.

We have employed the method of shelving to measure Zeeman resonances of a single trapped Ba+ ion. We use optical pumping to place the ion in a selected magnetic sublevel of either the 6S(1/2) ground state or the 5D(3/2) metastable state. The ion is exposed to an rf field, and a probing/shelving mechanism detects whether spin-flip transitions have taken place. We have observed rf transitions with linewidths of 15 Hz, limited by magnetic-field noise. We have also observed the shift in the Zeeman frequency when the ion is illuminated by off-resonant light. A simultaneous measurement of such light shifts in two atomic states of Ba+ will permit a precise determination of the ratio of transition matrix elements.

Vasovasostomy in rabbits using fibrin adhesive prepared from a single human source.

We were interested in determining whether fibrin glue derived from a single human source could be used effectively to produce a sutureless vasovasostomy in the rabbit model. Fifteen rabbits were divided into two groups (7 control, 8 experimental) and underwent vasal transection and reanastomosis by conventional microsurgical suture techniques (control group) and sutureless anastomosis using single source fibrin glue (experimental group). The patency and tensile strength of the anastomoses were compared at four weeks and the anastomotic sites underwent histologic examination. This study demonstrated that a vasovasal anastomosis in the rabbit could be achieved using human single source fibrin glue with patency equivalent to a standard sutured anastomosis. The tensile strength of the glued anastomosis at four weeks was greater than the tensile strength of the sutured anastomosis.

A local direct effect of pituitary graft on growth of the lateral prostate in rats.

Prolactin and testosterone are synergistic in stimulating growth of the rat prostate. The lateral lobe is more sensitive to this synergism than the ventral and dorsal lobes. To investigate whether prolactin acts directly in the rat prostate or indirectly through another systemic mediator, anterior pituitary grafts (1 mm3) were implanted in the lateral prostate of castrated Sprague-Dawley rats in whom a 0.5 cm or 1.0 cm testosterone-filled silastic tubing was implanted subcutaneously at the same time. Rats were randomly assigned to receive either the pituitary or a muscle chip of similar size grafted beneath the fascia lateral to the lateral prostate. Twenty-one days later, serum prolactin levels were not elevated in pituitary-grafted animals and were not significantly different from those in muscle-grafted rats. The mean lateral prostate weight on the grafted side in pituitary-implanted rats with 1.0 cm testosterone tubing was 43% heavier than either that of the contralateral side or the corresponding weights in muscle-implanted rats. In pituitary-implanted rats with 0.5 cm testosterone tubing, the mean lateral prostate weight on the grafted side was 60% heavier than either that of the contralateral side or that of the corresponding weights in muscle-implanted rats. The weight of the ventral and dorsal lobes of the prostate was not significantly affected by the presence of pituitary grafts in one of the lateral lobes. The local effect of prolactin on the lateral prostate was further demonstrated by an overall decline in tissue concentrations of dihydrotestosterone in the grafted side. These results provided evidence to indicate that there was a direct effect of prolactin on growth of the lateral prostate in rats.

Ureterocutaneous fistula: a case report of treatment by subtrigonal injection of polytetrafluoroethylene (Sting procedure).

A ureterocutaneous fistula developed in a patient after nephrectomy for pyohydronephrosis in a kidney with vesicoureteral reflux. Endoscopic injection of polytetrafluoroethylene (Teflon) paste at the ureteral orifice prevented further reflux and cured the ureterocutaneous fistula.

Diagnosis and management of testicular sarcoidosis.

We report testicular sarcoidosis in a patient who had known systemic involvement with this disease. The literature is reviewed and a protocol is presented to delineate specific indications for biopsy rather than orchiectomy to preserve testicular function.

Biochemical markers in prostatic cancer.

The status of the biochemical markers explored for use in patients with carcinoma of the prostate is reviewed. No unique marker has been identified. However, a variety of substances, primarily enzymes and specific proteins, found in the serum, urine, and prostatic fluid, have been evaluated. Their main value remains in the staging of disease and the monitoring of response to therapy.

Ureteroceles in children. A simplified and successful approach to management.

This review documents the success that we have experienced in treating most ureteroceles that present in children by heminephroureterectomy. If excision of the ureterocele is required, or reimplantation of a ureter other than the ureter obstructed by the ureterocele, this is deferred until the degree of hydronephrosis is reduced or bladder thickening and trabeculation have returned toward normal. In instances where there is function in the upper pole segment obstructed by the ureterocele, ureteropyelostomy has enabled us to preserve renal function by removing the obstructed ureter to permit the ureterocele to collapse.