Patient reported outcome measures (PROMs) in children with sleep-disordered breathing undergoing adenotonsillectomy.

OBJECTIVES: Patient reported outcome measures (PROMs) asses the health status or health related quality of life from the patient's perspective. The aims of this study were to assess the effect of adenotonsillectomy on symptoms and daily functioning in children with sleep-disordered breathing (SDB) using an electronic questionnaire, and to determine if this is a feasible method to evaluate treatment outcome in this patient population. METHODS: The electronic questionnaire was administered to the parents of children undergoing adenotonsillectomy for SDB on the day of surgery (T0), and two weeks (T1) and six months (T2) after surgery. The questionnaire scored symptoms in 5 different fields (snoring, sleepiness, behaviour, appetite, and apnoea). Higher scores indicated more pronounced symptoms. The score on T0 measured the preoperative symptoms. The main outcome measure (the change in scores between the postoperative measurements and the preoperative measurement) was analysed using the Wilcoxon signed-rank test. RESULTS: Eighty-eight percent of invited patients participated in the study. Six percent had no access to internet, and another 6% did not wish to participate. Language problems were not reported. Response rates for T1 and T2 were 82.6% and 79.7% respectively. The T1 and T2 scores were significantly lower than the scores on T0 for snoring, behaviour, apnoea, and sleepiness. The T2 appetite score was significantly higher than on T0, which indicates an improvement of appetite. CONCLUSION: A comparison of pre- and postoperative results from an electronic disease-specific questionnaire indicated significantly improved symptoms and daily functioning in children undergoing adenotonsillectomy for SDB. High participation and response rates indicated it was feasible to assess treatment outcome by means of an electronic questionnaire.

Physiology of the mouth and pharynx, Waldeyer's ring, taste and smell.

This paper reviews the contribution of the different parts of the oral cavity and the pharynx to the basic physiology of breathing, phonation, speech, swallowing, and of Waldeyer's ring to the functioning of the immune system. We discuss the development of taste and smell, as well as possibilities for chemosensory testing in children.

The effect of RBC transfusions on cytokine gene expression after cardiac surgery in patients developing post-operative multiple organ failure.

AIM: To determine the effect of red blood cell (RBC) transfusions during cardiac surgery on cytokine gene expression (GE) in relation to multiple organ failure (MOF) development after systemic inflammatory response syndrome (SIRS). BACKGROUND: RBC transfusion in cardiac surgery patients is dose-dependently associated with post-operative MOF, possibly acting as a second hit after cardiopulmonary bypass. METHODS: For this observational study, 29 patients divided into four groups of cardiac surgery patients were selected from a randomised controlled trial (RCT). Group 1: no-RBC, no-MOF (N = 8); group 2: MOF, no-RBC (N = 7); group 3: RBC, no-MOF (N = 6); group 4: RBC and MOF (N = 8). Selection was based on age, gender, number of (leukocyte-depleted) RBC transfusions, type and duration of surgery. A 114 cytokine GE array was applied to blood samples withdrawn before and 24 h after surgery. Expression of selected genes was confirmed with reverse transcriptase real time-polymerase chain reaction (RT-PCR). RESULTS: Nineteen of the 39 detectable genes showed a significant change in GE after surgery. Confirmed by RT-PCR, transfused MOF patients exhibit significantly less downregulation of CD40 ligand than control patients. Patients who would develop MOF show significantly larger increases in GE of transforming growth factor-α (TGF-α), tumour necrosis factor (TNF)-superfamily members 10 and 13B (TNFsf10/13B). CONCLUSIONS: When tested at 24 h after surgery, cytokine GE in peripheral blood leucocytes showed no significant differences between those transfused and those not transfused. Some alterations were seen in those developing MOF compared to those who did not, but the findings offer no role of leukocyte depleted (LD) RBC transfusion in the development of MOF.

Time trends in primary-care morbidity, hospitalization and mortality due to pneumonia.

Most studies reporting pneumonia morbidity are restricted to hospitalized patients, although only a minority of pneumonia patients are admitted to hospital. To get a better understanding of the burden of disease in the general population, we conducted a population-based retrospective study to examine trends in pneumonia incidence in general practice, hospitalization, and mortality due to pneumonia in The Netherlands between 1997 and 2007. Between 2001/2002 and 2006/2007 there was an adjusted yearly increase of 12% in the clinical diagnosis of pneumonia in patients consulting general practitioners. Hospitalizations increased 5% per year between 1999/2000 and 2006/2007, while mortality annually decreased by 2% between 1997/1998 and 2006/2007. Our study suggests that the morbidity of pneumonia in the Dutch population increased considerably over this period, especially in primary-care settings, and that focusing only on hospitalization might underestimate the increasing public health burden of pneumonia.

Element partitioning: the role of melt structure and composition.

We segregated coexisting gabbroic and granitic melts by centrifuging them at high pressures and temperatures and measured the trace element compositions of the melts by laser ablation inductively coupled plasma mass spectrometry. Our results demonstrate that the effect of melt structure contributes about one order of magnitude to crystal/melt partition coefficients. Partitioning of alkali and alkaline earth elements strongly depends on field strength: Amphoteric and lone pair electron elements partition into the polymerized granitic melt; and rare earth, transition, and high field strength elements coordinated by nonbridging oxygens partition remarkably similar into the gabbroic melt. A regular solution model predicts these effects.

Efficacy of topical corticosteroids in nickel-induced contact allergy.

In this study we used the nickel contact allergy patch (CAP) test to investigate the effect of topical corticosteroids on allergic contact dermatitis (ACD). On day 1, three CAP tests were applied for 48 h on the forearms of 20 female volunteers with a known nickel ACD. CAP of the right forearm contained 5% nickel, and of the left forearm physiological saline. Clinical scoring, transepidermal water loss and skin hydration were measured on day 1 before CAP application, on day 4 (0, 2 and 6 h) after ACD and from days 5 to 8 (0 h). A topical corticosteroid and its vehicle were applied twice daily starting from day 4 on two ACD sites. Transepidermal water loss values were significantly decreased on the topical-corticosteroid-treated sites in the early phase of ACD (day 4, 6 h after the first application) while clinical efficacy showed significant improvement on days 7 and 8. The vehicle was found to improve skin hydration only on day 8. In conclusion the topical corticosteroid improved the skin barrier function in the early inflammatory phase of ACD (day 4, 6 h). The lack of improvement in transepidermal water loss in the later phase of ACD might be accounted for by the secondary effects of the corticosteroid on proliferation and differentiation of keratinocytes.

Infectious crystalline keratopathy: a case report.

We report a case of crystalline keratopathy. Corneal smears showed yeasts. Cultures showed growth of Pityrosporon ovale. We summarise some causes of crystalline keratopathy and mention some hints for the treatment of infectious crystalline keratopathy.

High-dose melphalan allows durable engraftment of allogeneic bone marrow.

Conditioning regimens for allogeneic bone marrow transplantation are designed to eradicate malignant cells and to provide sufficient immunosuppression for engraftment of donor marrow. Total body irradiation and high-dose cyclophosphamide are the most established immunosuppressive agents used for this purpose. It is uncertain whether other alkylating agent-based conditioning regimens are sufficiently immunosuppressive to allow engraftment of allogeneic marrow. We report four patients who had prompt engraftment after conditioning with melphalan-based chemotherapy regimens (BEAM or busulfan/melphalan). Two patients survived without disease for a prolonged period, indicating that these melphalan regimens are sufficiently immunosuppressive to allow sustained engraftment and donor hematopoiesis.

Autotransfusion during aorto-iliac surgery.

Red blood cell (RBC) quality and function during autotransfusion with the Solcotrans system were studied. Up to 64% (mean 999.5 +/- 310 ml) of the total volume of blood lost (mean 1895 +/- 707 ml) during operation in 10 patients undergoing elective abdominal aortic surgery was salvaged. No patient received homologous blood during surgery. Haemoglobin (Hb) and Haematocrit (PCV) values decreased but within acceptable limits. No evidence of DIC was found and renal function was unaffected. Mechanical and functional damage to the RBC was minimal and erythrocyte oxygen-carrying capacity was excellent. 2,3-DPGRBC concentration and RBC reduced glutathion were normal. The device was easy to handle and technical problems were not encountered. It was accurate in salvaging blood although the need for homologous blood was not entirely eliminated since four patients received homologous blood products in the postoperative period. No adverse clinical events occurred.

Double-blind clinical study comparing alprazolam and doxepin in primary unipolar depression.

The therapeutic effect and safety of alprazolam and doxepin were studied in 126 outpatients suffering from primary unipolar depression. The 6-week study was double-blind with a random allocation of treatment. Patients were treated with a flexible dose of 1.0-4.5 mg of alprazolam and 50-225 mg of doxepin per day. The mean final doses were 2.7 mg for alprazolam and 137.5 mg for doxepin. The results indicate that alprazolam and doxepin were equally efficacious. The incidence of side-effects was lower in the alprazolam treatment group.