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Background: Atlanto-axial rotatory fixation is a persistent deformity of the C1-2 vertebral relationship caused by subluxation of the articular surfaces, and can occur after positioning for ENT procedures where the head is rotated - for example to access the ear or posterior triangle of the neck. If promptly recognised, it can usually be managed successfully with conservative methods, without long-lasting sequelae, but delayed or inappropriate management may lead to permanent neck deformity, neurological problems and pain. Method: Case review. Case report: Two children with atlanto-axial rotatory fixation following ENT surgery; one child was referred early and managed successfully, and one had delayed referral resulting in permanent severe positional deformity. Conclusion: Atlanto-axial rotatory fixation is easily missed; there are significant clinical and medicolegal implications if it is not promptly recognised. A suggested management algorithm is presented. [ABSTRACT FROM AUTHOR]

In majority of individuals blood pressure rises in the early morning hours, which lead to serious cardiovascular complications. Formulation of pulsatile system makes it possible to deliver drug at definite period of time when symptoms of the disease condition are most critical. The purpose of the present work was to develop pulsatile release tablet of losartan potassium for chronotherapy in hypertension. The prepared system consisted of a core tablet coated with versatile and safe hydrophilic cellulosic ethers such as, hydroxypropyl methylcellulose, hydroxypropyl cellulose and sodium carboxy methylcellulose to produce burst release after predetermined lag time. Various formulation factors were studied through series of test and in vitro dissolution study. It was found that core tablets containing superdisintegrant failed to produce burst drug release pattern while effervescent agent was able to do so. Results also reveal that coating composition and coating level affects lag time. Formulation containing effervescent agent in core and coated with 200 mg hydroxypropyl cellulose provide lag time of 4.5 h with 73% drug release in 6 h that followed a sigmoidal release pattern. These values were close to the desired objective of producing lag time of 5-6 h followed by fast drug release. This approach can thus provide a useful means for timed release of losartan and is helpful for patients with morning surge. [ABSTRACT FROM AUTHOR]

Most cluster headache patients respond to oxygen therapy, but approximately 20% do not. The aim of the present study was to assess which factors differ between cluster headache patients who respond to oxygen therapy and those who do not. We included patients from the headache clinic of Atrium Medical Centre Heerlen ( n = 53) and patients who responded to a cluster headache web-site ( n = 62). Participants completed a questionnaire with questions on cluster headache and factors that might be of significance with respect to the response to oxygen. Non-responders had less often smoked in the past ( p = 0.014), had longer cluster headache attacks ( p = 0.049), and more often reported interictal headache ( p = 0.02) than responders. Logistic regression analysis showed these variables to be independent risk factors for not responding to oxygen and a clinical prediction model is provided. The area under the receiver operating characteristic curve was 0.75. We conclude that cluster headache patients who smoked in the past, had shorter attacks and were pain-free interictally respond best to oxygen inhalation. The results did not provide clues for the mechanism of action of oxygen therapy. [ABSTRACT FROM AUTHOR]

Corneal transplantation has been performed successfully for over 100 years. Normally, HLA typing and systemic immunosuppressive drugs are not utilized, yet 90% of corneal allografts survive. In rodents, corneal allografts representing maximal histoincompatibility enjoy >50% survival even without immunosuppressive drugs. By contrast, other categories of transplants are invariably rejected in such donor/host combinations. The acceptance of corneal allografts compared to other categories of allografts is called immune privilege. The cornea expresses factors that contribute to immune privilege by preventing the induction and expression of immune responses to histocompatibility antigens on the corneal allograft. Among these are soluble and cell membrane molecules that block immune effector elements and also apoptosis of T lymphocytes. However, some conditions rob the corneal allograft of its immune privilege and promote rejection, which remains the leading cause of corneal allograft failure. Recent studies have examined new strategies for restoring immune privilege to such high-risk hosts. [ABSTRACT FROM AUTHOR]

The quiescent cell population of tumours poses a barrier to the success of many cancer therapies. Most chemotherapeutic drugs target proliferating cells, but the growth fraction of many tumours is low. Based on the multicellular tumour spheroid model, a system was developed using human colon adenocarcinoma (DLD-1) cells to mimic the microenvironment of quiescent microregions of solid tumours. The quiescent tumour spheroids (TS(Q)) showed decreased expression of the proliferation marker Ki-67 and increased expression of the quiescence marker p27(kip1) compared to proliferating spheroids (TS(P)). The quiescent status of the TS(Q) was confirmed by long-term growth assessment. The quiescence was completely reversible demonstrating that the TS(Q) retained the ability to proliferate and morphological assessment by light microscopy confirmed the absence of significant apoptosis. When the efficacy of widely used chemotherapeutic drugs was determined, vinblastine, doxorubicin, cisplatin and 5-fluorouracil (5-FU) all produced significant cell death in the TS(P). However, while still effective, the potencies of doxorubicin and cisplatin were significantly reduced in TS(Q). In contrast, 5-FU and vinblastine did not produce cell death in the TS(Q). In summary, TS(Q) show considerable resistance to a panel of established chemotherapeutic agents and represent a useful model for evaluating the efficacy of drugs and other cancer therapies in quiescent tumours. [ABSTRACT FROM AUTHOR]

The ability of Staphylococcus aureus to develop multidrug resistance is well documented, and the antibiotic resistance showed by an increasing number of bacteria has shown the need for alternative therapies to treat infections, photodynamic therapy (PDT) being a potential candidate. The aim of this study was to determine the effect of photodynamic therapy as a light-based bactericidal modality to eliminate Staphylococcus aureus. The study investigated a technique based on a combination of light and a photosensitizer that is capable of producing oxidative species to induce a cytotoxic effect. A Staphylococcus aureus suspension was exposed to a light emitting diode (LED) emitting at 628 nm, 14.6 mW/cm(2), and energy density of 20 J/cm(2), 40 J/cm(2), or 60 J/cm(2) in the presence of different porphyrin concentrations (Photogem). Three drug concentrations were employed: 12 microl/ml, 25 microl/ml, and 50 microl/ml. The treatment response was evaluated by the number of bacterial colony forming units (CFU) after light exposure. The results indicated that exposure to 60 J/cm(2) eliminated 100% (10 log(10) scales) of bacteria, on average. The best PDT response rate to eliminate Staphylococcus aureus was achieved with exposure to LED light in combination with the photosensitizer at concentrations ranging from 25 microl/ml to 50 microl/ml. These data suggest that PDT has the potential to eliminate Staphylococcus aureus in suspension and indicates the necessary drug concentration and light fluency. [ABSTRACT FROM AUTHOR]

The article discusses some developments with vasopressin. Topics covered include the comparison between the use of vasopressin and noradrenaline in septic shock, the beneficial effects of vasopressin on renal perfusion especially when combined with corticosteriods, and the immune-modulating effects of vasopressin. Also discussed are the serious adverse events (SAEs) and pharmacogenetics of vasopressors, and the suggestion that selective V1a agonist selepressin may be preferable to vasopressin. [ABSTRACT FROM AUTHOR]

The article discusses on the large-scale control programs initiated to minimize the occurrence of soil-transmitted hilminth infection. Considerable improvement have been made in the use of geographical information systems and remote sensing to comprehend helminth ecology and epidemiology and to formulate low-cost ways to identify target populations for treatment. Satellite-derived environmental data provide insight into the ecology of the infection at a geographical scale.

Purpose: To study the efficacy of photodynamic therapy (PDT) with verteporfin in the treatment of juxtafoveal choroidal neovascularization (CNV) secondary to pathologic myopia.Methods: Prospective, open label, two-centre, noncomparative, interventional case series. Consecutive patients with juxtafoveal CNV associated with pathologic myopia were recruited and treated with a standard regimen of PDT with verteporfin. Patients were being followed up every 3-monthly and retreatment was considered when there was evidence of angiographic leakage. Outcome measures included changes in the mean best-corrected visual acuity (BCVA) at the 1-year follow-up when compared with the baseline, the proportion of patients who had stable (within 1 line) and improved visions.Results: A total of 11 eyes from 11 patients with juxtafoveal CNV secondary to pathologic myopia were recruited and all completed the 1-year follow-up. The mean age at presentation was 44.8 years. The refractive error ranged from -6.0 to -15.0 D (+/-SD was -9.55+/-3.04 D). The logMAR BCVA improved from 0.57 to 0.39 at the 1-year follow-up (Wilcoxon signed-ranks test, P=0.027). The mean improvement was 1.8 lines. Five eyes (45.4%) had BCVA improved by >or=3 lines. None of the treated patients had visual loss of >or=1 line. The mean number of treatments over the 12-month study period was 2.3 sessions.Conclusions: The results are encouraging, especially on considering the low retreatment rate, stable or improved BCVA in all treated eyes, and consistently good safety profile. Juxtafoveal myopic CNV may be an expanded indication for PDT with verteporfin. [ABSTRACT FROM AUTHOR]

The article presents information on cytokine gene polymorphism and immunologist in periodontal disease. Understanding what triggers inappropriate tissue destructive host responses is central to providing rational diagnostic and therapeutic strategies for this condition. It is clear that there is significant individual variation in the development and progression of periodontitis. The genetic element for periodontal disease, a central pathogenic role for cytokines, as well as the principle of individual variation in disease experience are tenets of periodontal research. However, a role for cytokine gene polymorphism in immunoregulation in periodontal disease remains suggestive rather than being firmly established.

Aims: To evaluate the visual and fluorescein angiographic outcomes of photodynamic therapy (PDT) with verteporfin in patients with subfoveal choroidal neovascularisation (CNV) caused by pathologic myopia in the Chinese. Methods: Prospective, non-comparative, two centre interventional study. Patients with CNV secondary to pathologic myopia of Chinese ethnicity were recruited and treated with a standard regimen of PDT with verteporfin. Results of this study in Chinese eyes with pigmented retinal pigment epithelium were compared with those from the Verteporfin in Photodynamic Therapy (VIP) Study of predominantly white eyes. Results: Thirty one and 22 eyes that completed the 12 month and 24 month follow up studies respectively were analysed. The mean and median best corrected visual acuities (BCVA) could be maintained at the baseline level at the 12 month and 24 month visits. Fourteen (63.6%) eyes had stable or improved BCVA at 24 months and six (27.3%) of them had a moderate gain in vision (improved by three or more lines). Visual results were comparable with that of the VIP study, but the average accumulative PDT treatments required in one and two years were 1.7 and 2.3 respectively, which were significantly less than 3.4 and 5.1 treatments in VIP study. Mean logMAR BCVA of the younger age group (<55 years) at 24 months was 0.41 (SD 0.29), which was significantly better than the older age group (&ges;=55 years) of 0.82 (SD 0.40) (Mann-Whitney U test, p = 0.029). Conclusions: PDT using the predetermined treatment protocol has achieved similar visual outcomes in the Chinese population as in white people with subfoveal myopic CNV over a 2 year study period. The complete cessation of CNV leakage can be accomplished, on average, with fewer PDT retreatments than reported in the VIP study. The disparity may be due to ethnic differences in these two populations. [ABSTRACT FROM AUTHOR]

: ObjectiveThis study describes the clinical features, management, and outcome of 19 patients who had severe Acanthamoeba sclerokeratitis (ASK) unresponsive to conventional management, requiring systemic immunosuppression to control disease.: DesignRetrospective, noncomparative, interventional case series.: ParticipantsRecords of all patients with Acanthamoeba keratitis treated at Moorfields Eye Hospital between 1989 and 2000 were reviewed. From more than 200 patients, 19 who developed ASK treated with systemic immunosuppression were identified.: Main outcome measuresVisual acuity, level of pain, and degree of inflammation were recorded after immunosuppressive treatment.: ResultsASK requiring immunosuppression occurred in 20 eyes of 19 patients (11 males and 8 females). The mean age (mean ± standard deviation) at onset was 38.6 ± 13.2 years. On presentation, best-corrected visual acuity was counting fingers or worse in 11 eyes (55%), 6/18 to 6/60 in 5 eyes (25%), and 6/12 or better in 4 eyes (20%). The mean time between onset of initial symptoms of Acanthamoeba keratitis and commencement of systemic immunosuppression was 4.8 ± 3.5 months. The mean duration of immunosuppression required to control inflammation was 7.2 ± 3.9 months. Severe scleritic pain remained uncontrolled in two patients and resulted in enucleation. Best-corrected visual acuity at final follow-up was counting fingers or worse in eight eyes (40%), 6/18 to 6/60 in six eyes (30%), and 20/40 or better in six eyes (30%). The mean follow-up period after resolution of inflammation was 24.3 ± 20.9 months (range, 0.2–59.7 months).: ConclusionsASK is an uncommon complication of Acanthamoeba keratitis. The scleritis associated with this infection seems to be an immune-mediated response. After topical amebicidal treatment, systemic immunosuppression may be required to control the pain and tissue destruction associated with ASK. [Copyright &y& Elsevier]

Purpose: To identify the optimal technique for closed reduction for shoulder instability, based on success rates, reduction time, complication risks, and pain level.Methods: A PubMed and EMBASE query was performed, screening all relevant literature of closed reduction techniques mentioning the success rate written in English, Dutch, German, and Arabic. Studies with a fracture dislocation or lacking information on success rates for closed reduction techniques were excluded. We used the modified Coleman Methodology Score (CMS) to assess the quality of included studies and excluded studies with a poor methodological quality (CMS < 50). Finally, a meta-analysis was performed on the data from all studies combined.Results: 2099 studies were screened for their title and abstract, of which 217 studies were screened full-text and finally 13 studies were included. These studies included 9 randomized controlled trials, 2 retrospective comparative studies, and 2 prospective non-randomized comparative studies. A combined analysis revealed that the scapular manipulation is the most successful (97%), fastest (1.75 min), and least painful reduction technique (VAS 1,47); the "Fast, Reliable, and Safe" (FARES) method also scores high in terms of successful reduction (92%), reduction time (2.24 min), and intra-reduction pain (VAS 1.59); the traction-countertraction technique is highly successful (95%), but slower (6.05 min) and more painful (VAS 4.75).Conclusion: For closed reduction of anterior shoulder dislocations, the combined data from the selected studies indicate that scapular manipulation is the most successful and fastest technique, with the shortest mean hospital stay and least pain during reduction. The FARES method seems the best alternative. [ABSTRACT FROM AUTHOR]

Presents the results of a study on the treatment of women with advanced mucinous epithelial ovarian cancer with platinum-based chemotherapy. Response rate of patients who received the treatment; Percentage of patients that progressed on chemotherapy; Survival rate of patients with the disease.