Massive pericardial effusion as the first manifestation of childhood non‐Hodgkin's lymphoma: A case report

Although one of the serious manifestations of advanced malignancies is pericardial involvement, pericardial involvement of lymphoma is extremely rare. We present a case of a 6‐year‐old girl arriving at the hospital with dyspnea and pleuritic chest pain, which is eventually diagnosed with massive pericardial effusion due to mediastinal non‐Hodgkin lymphoma.     

Selective mutism and abnormal electroencephalography (EEG) tracings

Epileptic discharges are not considered a part of the clinical picture of selective mutism, and electroencephalography is generally not recommended in its work-up. This report describes 6 children with selective mutism who were found to have a history of epilepsy and abnormal interictal or subclinical electroencephalography recordings. Two of them had benign epilepsy of childhood with centro-temporal spikes. The mutism was not related in time to the presence of active seizures. While seizures could be controlled in all children by medications, the mutism resolved only in 1. Although the discharges could be coincidental, they might represent a co-morbidity of selective mutism or even play a role in its pathogenesis. Selective mutism should be listed among the psychiatric disorders that may be associated with electroencephalographic abnormalities. It can probably be regarded as a symptom of a more complicated organic brain disorder.     

Force degradation of orthodontic elastomeric chains--a product comparison study

In the last 20 years, synthetic elastic modules have been introduced to the orthodontist. However, force decay of these materials has been a clinical problem and the purpose of this project was to evaluate the force decay patterns of three commercially available elastomeric products--Ormco Power Chain II, Rocky Mountain Energy Chain, and TP Elast-O Chain--in a simulated oral environment. Thermal-cycled samples experienced less force decay over a 21-day period than samples stored at 37 degrees C. Furthermore, statistical analysis confirmed that there was a highly significant difference (p less than 0.01) between the mean force exerted by short modules and long modules for each material. Overall, modules producing higher initial forces (short modules) underwent less force decay after 21 days than did modules producing lower initial force values (long modules). All materials exerted 216 to 459 grams of force initially. After 21 days of simulated tooth movement, the force exerted by the elastic modules was 70 to 230 grams--a significant reduction (p less than 0.001).     

Pharmacologic management of neuropsychiatric lupus

Neuropsychiatric lupus affects above 50% of patients with systemic lupus erythematosus and may span from mild symptoms to acute devastating life-threatening ones. Owing to the clinical variability, most pharmacological data rely on small, uncontrolled trials and case reports. The mainstay of therapy relies on immune-suppression by glucocorticoids, in adjunction with cyclophosphamide or anti-B-cell therapy, in moderate to severe cases. In selected scenarios (e.g., chorea) intravenous immunoglobulin or plasmapheresis may be effective. Anticoagulation is warranted if anti-phospholipid antibodies are present. In parallel there may be a need for symptomatic treatment such as anti-epileptic or anti-depressive treatments, etc. In the future, more studies addressed to assess pathogenesis and preferred treatments of specific manifestations are needed in order to personalize treatments.     

Placental and trophoblastic in vitro models to study preventive and therapeutic agents for preeclampsia

In the field of preeclampsia, enormous efforts are ongoing to identify biomarkers predicting the syndrome already in the first trimester of pregnancy. At the same time, there is the need for in vitro models to test such biomarkers prior to their use in clinical trials. In addition, in vitro models may accelerate the development and evaluation of the benefit of any putative therapeutics. Therefore, in vitro systems have been established to evaluate the release of biomarkers and measure the effect of putative therapeutics using placental villous explants as well as the choriocarcinoma cell line BeWo. For explants, a cryogenic method to freeze, transport and thaw villous explants was developed to use such tissues for a multi-site tissue culture evaluation.Here we focus on three out of many in vitro models that have been established for human placental trophoblast. (1) Choriocarcinoma cell lines such as BeWo, Jeg-3 and Jar cells (2) isolated primary trophoblast cells, and (2) villous explants from normal placentas delivered at term. Cell lines were used to assess the effect of differentiation and fusion on the expression and release of a preeclampsia marker (placental protein 13; PP13) and beta-hCG. Moreover, cell lines were used to study the effect of putative preeclampsia therapeutics such as vitamins C and E, heparin and aspirin on marker release and viability. Cryopreservation of villous explants enabled shipment to a remote laboratory and testing of parameters in different countries using explants from one and the same placenta.Recently published data make it tempting to speculate that the choriocarcinoma cell line BeWo as well as fresh and cryogenically stored placental villous explants may well serve as in vitro models to study preventive and therapeutic agents in the field of preeclampsia.     

Cryogenic and low temperature preservation of human placental villous explants – A new way to explore drugs in pregnancy disorders

BackgroundA major handicap in cell culture studies using human tissues is the insufficient availability of fresh material on site. A method was developed for cryogenic storage and low temperature preservation of human placental villous explants, facilitating multi-site distribution for functional studies.MethodsExplants from term placentas were incubated with cryoprotectant agents (dimethyl-sulfoxide (DMSO), ethylene glycol, propanediol or Aedesta), frozen in liquid nitrogen, thawed and then cultured in-vitro. Viability was assessed by comparing frozen and thawed explants with non-frozen controls for morphological changes, lactate dehydrogenase (LDH) release, placenta protein 13 (PP13) secretion, and PCNA Western blotting. Functional studies determined the effect of oxygen and magnesium on explant viability.ResultsCryoprotection by 3 M DMSO best maintained explants’ viability, morphological integrity and PP13 release after freezing and thawing from liquid nitrogen. The effect of oxygen and magnesium was used to test the functional viability of cultured explants, after freezing in liquid nitrogen and transfer to dry ice for 1–5 days on site or for shipment to a remote lab. The tested parameters were similar between controls and cryogenically treated explants in the remote lab and the lab of origin, demonstrating the possibility of cryostoring explants for functional studies.ConclusionCryogenically stored placental villous explants shipped frozen can serve as a useful tool for comparative functional studies of placental villous tissues. The results of this pilot study also open the way for multi-site studies associated with drug tailoring for pregnancy disorders.     

Management of unexpected cerebrospinal fluid fistulae during endoscopic sinus surgery

BACKGROUND: The aim of this study was to determine the incidence and perioperative management of patients with cerebrospinal fluid (CSF) fistulas during endoscopic sinus surgery (ESS) in New York State. METHODS: A questionnaire was mailed to otolaryngologists in New York State who were registered with the American Academy of Otolaryngology, Head and Neck Surgery in November 2005. Questions addressed the incidence and perioperative care of patients with successful closure of unexpected CSF fistula during ESS. RESULTS: Twenty-five percent of respondents have experienced at least one episode of unexpected CSF fistula during ESS over the prior 5 years, with a calculated incidence of 0.16%. Surgeons most often (46%) observed patients for 1-2 days. Antibiotics were used in 93% of patients. A lumbar drain was most commonly not used. Repair techniques most often used an intranasal flap or graft (92%). CONCLUSION: The incidence of unexpected CSF fistula during ESS may be lower than previously reported. A majority of surgeons use an intranasal flap or graft in repair with antibiotic use, with no consensus regarding use of lumbar drain or inpatient observation. More study is needed to determine consensus algorithms for management of CSF leaks during ESS.     

Effects of maternal caffeine intake on the growth of rat tooth germs in protein-energy malnourished neonates

Fourteen rat dams with 8 pups each were fed either a 6, 12 or 20 per cent protein diet upon birth. Another group of 12 dams with the same number of pups was pair-fed either a 6, 12 or 20 per cent protein diet supplemented with caffeine (2 mg/100 g body weight). At day 15, randomly-selected pups were injected with [14C]-proline to determine collagen synthesis of the incisor and molar tooth germs. Another group of pups was used to determine calcium content of these tooth germs. Body weight, incisor weight and total calcium contents of tooth germs of pups from dams fed with 6 per cent protein diet were greater in the caffeine-supplemented group, whereas in the 20 per cent protein diet with caffeine group, these parameters were lower. The molar weights of the 12 per cent protein diet with caffeine animals were greater than the 12 per cent group without caffeine. The total hydroxyproline content of the incisor tooth germs from animals in the 12 per cent protein diet with caffeine was greater than is the non-caffeine group. However, total hydroxyproline of the molar tooth germs in the 20 per cent protein groups with caffeine was less than in the non-caffeine group. The rate of collagen synthesis of the incisor and molar tooth germs showed no difference in the presence or absence of caffeine in the 6, 12 and 20 per cent protein groups. Incisor and molar tooth germs are thus affected differently by the interaction of protein and caffeine, possibly due to differences in the pattern of tooth development.     

Knowledge and expectations of patients receiving aeroallergen immunotherapy.

BACKGROUND: Patients receiving aeroallergen immunotherapy frequently have poor knowledge and unfounded expectations of various important aspects of their treatment. OBJECTIVE: To evaluate patients' knowledge about the content, benefit, and risk related to the aeroallergen immunotherapy that they were receiving. METHODS: A self-administered questionnaire was distributed to all patients older than 16 years who had undergone aeroallergen immunotherapy for allergic rhinitis at 3 university-affiliated allergy clinics. RESULTS: A total of 132 patients (77 males and 57 females; mean +/- SD age, 30 +/- 13 years) participated in the study. The mean +/- SD duration of treatment was 30 +/- 60 months. Complete recovery of their allergies was expected by 39% of the patients. One fifth of the study group did not know when improvement should be expected, and 18% anticipated improvement to occur within days or weeks from the initiation of treatment. Only 32% were aware that immunotherapy might have some potential risk or adverse effects, and 24.2% failed to identify at least one of the allergens they were receiving. Patients who were interviewed during their first 6 months of aeroallergen immunotherapy had more knowledge about it than those who had been undergoing long-term treatment. CONCLUSIONS: There is a grave lack of knowledge and numerous misconceptions among substantial numbers of patients receiving aeroallergen immunotherapy. More educational effort is needed to increase patients' knowledge about immunotherapy before and during aeroallergen immunotherapy to improve their compliance and the success and safety of this therapeutic modality.