The role of the transversal ligament on the atlantoaxial complex - Bending forces at C1/2 flexion limits in the elderly.

INTRODUCTION: Biomechanical functionality as well as trauma mechanisms of the atlantoaxial complex are still an issue of controversy. The transverse atlantal ligament is the strongest stabilizator. The present study aimed to analyze the bending forces of the transverse atlantal ligament and of the base of the odontoid in elderly specimens. METHODS: In this biomechanical study five cadaveric specimen with a mean age of 72 at death and bone mineral density measuring for 555.3 Hounsfield units on average were used. To analyze the strain of the transverse atlantal ligament and the dense base, strain gauges were used. A custom biomechanical setup was used to test each specimen at C1/2 flexion and the strain of the transverse atlantal ligament and the dens base (µm/m) were measured. FINDINGS: In four out of five, a rupture of the transverse atlantal ligament was observed, the mean force required for the ligament to fall was 175 N (min. 99.8 N; 249.2 N; SD 64.7) by a mean strain of 2102.9 µm/m (min. 1953.5 µm/m; max. 2272.3 µm/m; SD 189.7). In one specimen with the lowest Hounsfield units (155), the dens base fractured before the transverse atlantal ligament ruptured and no strain could be measured at the transversal ligament during movement afterwards. INTERPRETATION: The transverse atlantal ligament fails at an average of 175 N in the elderly, which is less than the value reported previously. In osteoporotic specimen the generated force to rupture the transverse atlantal ligament can fracture the dens itself.

[Radial head fractures : Epidemiology, diagnosis, treatment and outcome]. / Radiuskopffrakturen : Epidemiologie, Diagnose, Behandlung und Outcome.

Radial head fractures account for the majority of bony injuries to the elbow. The usual clinical signs include hemarthrosis, pain and limitations in movement. The standard diagnostic tool is radiological imaging using X­rays and for more complex fractures, computed tomography (CT). Concomitant ligamentous injuries occur more frequently than expected and must be reliably excluded. The classification is based on the modified Mason classification. Mason type I fractures are usually treated conservatively with immobilization and early functional aftercare. Mason type II fractures can be well-addressed by screw osteosynthesis but higher grade fractures (Mason types III-IV) can necessitate a prosthetic radial head replacement. In this case, prosthesis implantation is to be preferred to a radial head resection. The outcome after treatment of radial head fractures can be described as good to very good if all accompanying injuries are adequately addressed.

Inducing pilon fractures in human cadaveric specimens depending on the injury mechanism: a fracture simulation.

BACKGROUND: Operative management of pilon fractures, especially high-energy compression injuries, is a challenge. Operative education is of vital importance to handle these entities. Not rarely, it is cut by economics and staff shortage. As public awareness toward operative competence rises, surgical cadaver courses that provide pre-fractured specimens can improve realism of teaching scenarios. The aim of this study is to introduce a realistic pilon fracture simulation setup regarding the injury mechanism. MATERIALS AND METHODS: 8 cadaveric specimens (two left, six right) were fixed onto a custom drop-test bench in dorsiflexion (20°) and light supination (10°). The proximal part of the lower leg was potted, and the specimen was exposed to a high energetic impulse via an axial impactor. CT imaging was performed after fracture simulation to detect the exact fracture patterns and to classify the achieved fractures by two independent trauma surgeons. (AO/OTA recommendations and the Rüedi/Allgöwer). RESULTS: All cadaveric specimens could be successfully fractured: 6 (75%) were identified as a 43-C fracture and 2 (25%) as 43-B fracture type. Regardless of the identical mechanism two different kinds of fracture types were reported. In five cases (62.5%), the fibula was also fractured and in three specimens, a talus fracture was described. There was no statistically significant correlation found regarding Hounsfield Units (HU) and age as well as HU and required kinetic energy. CONCLUSION: A high energetic axial impulse on a fixed ankle specimen in light dorsiflexion (20°) and supination (10°) induced by a custom-made drop-test bench can successfully simulate realistic pilon fractures in cadaveric specimens with intact soft tissue envelope. Although six out of eight fractures (75%) were classified as a 43-C fracture and despite putting a lot of effort into the mechanical setup, we could not achieve an absolute level of precision. Therefore, we suggest that the injury mechanism is most likely a combination of axial loading, shear and rotation. LEVEL OF EVIDENCE: III.

[External fixator of the elbow]. / Fixateur externe am Ellenbogen.

AIM OF SURGERY: The placement of an external elbow fixator can be statically carried out as temporary stabilization or as a hinged movement fixator. As a hinged movement fixator a functional follow-up treatment is possible due to control of the joint guidance and reduction of the compromising forces on the osteoligamentous structures. INDICATIONS: As a temporary stabilization of the elbow, the external fixator is used as a damage control method. As a movement fixator it is used as an additional protection and movement control after complex osteoligamentous interventions and persisting tendency to dislocation of the joint and also as a standalone procedure. In some cases, the procedure is also used in distraction arthrolysis of stiff elbows and as a salvage procedure in patients with relevant comorbidities as part of fracture treatment. CONTRAINDICATIONS: Inexperience in relation to the procedure as well as a local acute infection at the level of the intended pin locations should specifically be mentioned as contraindications. In addition, compliance and patient understanding of the procedure are essential for the success of treatment. SURGICAL TECHNIQUE: Soft tissue preparation for pin placement should be preferred over percutaneous incisions to enable a safe bone exposure. Knowledge of the course of neurovascular structures (particularly the radial nerve) is essential. When placing a hinge, knowledge of the position and detection of the idealized center of rotation is of fundamental importance. POSTOPERATIVE MANAGEMENT: The type of postoperative management required essentially depends on the underlying injury. When placing a hinged fixator, the aim is to enable movement as early as possible. Nevertheless, blocking of the hinged fixator may be useful for a short period of time. Adequate pin care over the duration of the treatment is essential in order to prevent complications. RESULTS: Good functional results have been reported for the treatment of unstable elbows after primary and secondary placement of a hinged external fixator. Good functional scores and improvement in the range of motion were also recorded in the context of an arthrolysis (additive for open arthrolysis or distraction arthrolysis); however, in contrast a significant number of complications associated with this surgery are likely to emerge. As a definitive salvage procedure, satisfactory results were obtained in a small case series of a selected older patient group with relevant comorbidities.

Efficacy of Anaerobic Soil Disinfestation for Control of Prunus Replant Disease.

Prunus replant disease (PRD) is an important soilborne complex that suppresses growth and productivity of replanted stone fruit and nut orchards. It is effectively managed with preplant soil fumigation but, due to regulatory challenges, nonfumigant-based control strategies for PRD and other soilborne disease problems may become increasingly important, especially in California. We examined the potential of preplant anaerobic soil disinfestation (ASD) for control of PRD in four repeated orchard replant trials on sandy loam soil near Parlier, CA. After removal of the old orchard trees, alternative ASD treatments, all using rice bran as the main carbon source, were implemented, starting in late September. The alternative treatments incorporated rice bran at (i) 20 t ha-1, alone, in 3.0-m-wide row strips; (ii) 20 t ha-1, preceded by incorporation of a sudangrass cover crop and followed by drip application of molasses (10 t ha-1), in 3.0-m-wide row strips; (iii) 20 t ha-1, alone, in 1.8-m-wide strips; or (iv) 12 t ha-1, alone, in 1.8-m-wide strips. All ASD-treated areas were covered with clear tarp and drip irrigated with 25 cm of water. Tarps remained for 6 weeks, during which the soil moisture level was kept at or above field capacity by drip irrigation. All trials included nontreated control and fumigated standard treatments. ASD raised temperature and reduced redox potential in soil at 15- and 46-cm depths for 6 weeks. Fumigation and ASD treatments both nearly eradicated bioassay inoculum of Pythium ultimum in the soil before almond trees were replanted and significantly affected almond tree root communities of fungi and oomycetes after planting. Fumigation treatments and ASD treatments with rice bran at 20 t ha-1 in 3.0-m strips increased tree growth significantly and by similar magnitudes. Among repeated experiments, mean increases in trunk cross-sectional area growth due to fumigation ranged from 137 to 264%, while the increases due to ASD at 20 t ha-1 in 3.0-m strips ranged from 148 to 214%, compared with controls. ASD offers effective control of PRD and is worthy of further optimization and testing for management of PRD and additional orchard replant problems.

Flow microcapillary plasma mass spectrometry-based investigation of new Al-Cr-Fe complex metallic alloy passivation.

Al-Cr-Fe complex metallic alloys are new intermetallic phases with low surface energy, low friction, and high corrosion resistance down to very low pH values (0-2). Flow microcapillary plasma mass spectrometry under potentiostatic control was used to characterize the dynamic aspect of passivation of an Al-Cr-Fe gamma phase in acidic electrolytes, allowing a better insight on the parameters inducing chemical stability at the oxyhydroxide-solution interface. In sulfuric acid pH 0, low element dissolution rates (in the µg cm(-2) range after 60 min) evidenced the passive state of the Al-Cr-Fe gamma phase with a preferential over-stoichiometric dissolution of Al and Fe cations. Longer air-aging was found to be beneficial for stabilizing the passive film. In chloride-containing electrolytes, ten times higher Al dissolution rates were detected at open-circuit potential (OCP), indicating that the spontaneously formed passive film becomes unstable. However, electrochemical polarization at low passive potentials induces electrical field generated oxide film modification, increasing chemical stability at the oxyhydroxide-solution interface. In the high potential passive region, localized attack is initiated with subsequent active metal dissolution.

Polymorphisms in methionine synthase (A2756G) and cystathionine beta-synthase (844ins68) and susceptibility to carcinomas of the upper gastrointestinal tract.

PURPOSE: Folate deficiency is considered to increase the risk for the development of malignant tumors such as prostate and colorectal cancer. Methionine synthase (MTR) and cystathionine ss-synthase (CBS) are enzymes that play a central role in folate metabolism, thereby affecting DNA methylation and synthesis. A single A-->G substitution at nucleotide 2756 of the MTR and a 68 bp CBS insertion polymorphism in exon 8 have been associated with decreased enzyme activity. The purpose of this study is to compare the association of the MTR A2756G polymorphism and CBS insertion polymorphism with susceptibility to carcinomas of the upper gastrointestinal tract. METHODS: Using the restriction fragment length polymorphism (RFLP)-PCR, the prevalence of MTR A2756G and CBS insertion polymorphism was determined in healthy controls (n = 257) and in patients with esophageal squamous cell carcinoma (ESCC) (n = 263), Barrett's esophagus-associated esophageal adenocarcinoma (BC) (n = 89), cardiac carcinoma (CC) (n = 144), or gastric carcinoma (GC) (n = 221) from German Caucasian subjects. RESULTS: No significant difference in MTR A2756G genotype distribution was observed between controls (A/A 66.9%, A/G 29.8%, G/G 3.3%) and patients with ESCC (A/A 61.7%, A/G 36.3%, G/G 2.1%), BC (A/A 69.2%, A/G 26.9%, G/G 3.9%), CC (A/A 51.8%, A/G 44.6%, G/G 3.6%), or GC (A/A 73.4%, A/G 20.9%, G/G 5.7%). Similarly, the CBS genotype (I: allele with 68 bp insertion; N: allele without insertion) distribution among German patients with ESCC (N/N 86.8%, I/N 13.2%), BC (N/N 90.2%, I/N 9.8%), CC (N/N 90.1%, I/N 9.9%) or GC (N/N 91.3%, I/N 8.7%) was not different from healthy controls (N/N 90.4%, I/N 9.6%). The gene allele constellation I/I was not present. CONCLUSIONS: The current study suggests that there is no association between MTR A2756G polymorphism and the CBS (844ins68) insertion polymorphism and cancer of the upper gastrointestinal tract.

The predictive value of molecular markers (p53, EGFR, ATM, CHK2) in multimodally treated squamous cell carcinoma of the oesophagus.

Pretherapeutic identification of oesophageal squamous cell carcinomas that will respond to neoadjuvant chemoradiotherapy is an important attempt for improvement of patient's prognosis. In the current study, pretherapeutic biopsies from 94 oesophageal squamous cell carcinomas (cT3, cN0/+, cM0) in patients who underwent neoadjuvant chemoradiotherapy (RCTx: 45 Gy plus cisplatin and 5-fluorouracil) and subsequent oesophagectomy in the setting of a single-centre prospective treatment trial were investigated by means of immunohistochemistry. Expression of proteins involved in DNA repair and/or cell-cycle regulation, that is p53, p53 (phosphorylated at Ser15), EGFR, ATM protein kinase (phosphorylated at Ser1981) and checkpoint kinase 2 (CHK2) (phosphorylated at Thr68) was correlated with the response to RCTx and with overall survival. Tumours that were positive for CHK2 expression more frequently showed clinically determined regression after RCTx (69.4%) than tumours that were negative for CHK2 expression (32.1%; P=0.0011), whereas other parameters did not correlate with tumour regression. Expression of ATM correlated with expression of CHK2 (P=0.0061) and p53-phospho (P=0.0064). Expression of p53 correlated with expression of p53-phospho (P<0.0001). In contrast to clinical and histopathological response evaluation, none of the molecular parameters under investigation correlated with overall survival. In conclusion, expression analysis of p53, EGFR CHK2 and ATM has no predictive value in multimodally treated oesophageal squamous cell carcinoma.

Ozone increases root respiration but decreases leaf CO2 assimilation in cotton and melon.

It is well established that exposure of plant foliage to tropospheric ozone (O3) inhibits photosynthetic gas exchange in leaves and the translocation of current photosynthate to sink tissues. It is less clear what impact O3-reduced source strength has on the physiological responses of sink tissue such as fine roots. The responses were investigated of carbon acquisition in leaves and carbon utilization in the respiration of fine roots, following chronic (weeks) and acute (hours) exposures to O3 in open top chambers. Previous reports indicate increased, decreased, and unchanged rates of root respiration following exposure to O3. A decline in source activity is confirmed, but an increase in sink respiration is reported in fine roots of Pima cotton (cv. S-6) and muskmelon (cv. Ambrosia hybrid). Leaf source strength and root sink activity changed in opposing directions, thus there was no positive correlation that might indicate direct substrate control of root function. Additional linkages between shoot and root following exposure to O3 may be involved.

Effects of C1 inhibitor and r-SP-C surfactant on oxygenation and histology in rats with lavage-induced acute lung injury.

OBJECTIVE: To assess the effects of C1 inhibitor (INH) administration and r-SP-C surfactant application on oxygenation and lung histology in an acute respiratory distress syndrome model. DESIGN AND SETTING: Randomized, controlled experimental study in an animal research laboratory. MATERIAL: 36 adult male Sprague-Dawley rats. INTERVENTIONS: Animals were subjected to repetitive lung lavage. Four experimental groups and two control groups were studied: groups 1 and 2 served as controls. Animals of groups 3-6 received 200 U/kg body weight C1-INH (group 3), 25 mg/kg r-SP-C surfactant (group 4) or both (group 5) at 60 min postlavage (pl). Animals of group 6 were treated with 200 U/kg C1-INH1 at 10 min pl. Animals of group 1 were killed 60 min (min) pl, animals of groups 2-6 were killed at 210 min pl. Thereafter the lungs were excised for histological examination. MEASUREMENTS AND RESULTS: Hyaline membrane formation, intra-alveolar neutrophil (PMN) accumulation and intra-alveolar/perivascular haemorrhage were graded semiquantitatively (0-4). Blood gases were determined 120, 150, 180 and 210 min pl. At 210 min pl pO(2) in group 4 (456+/-74 mmHg) and group 5 (387+/-155 mmHg) was significantly higher than in controls (72+/-29 mmHg) or after C1-INH monotherapy (group 3: 120+/-103, group 6: 63+/-12 mmHg). PMN infiltration after C1-INH monotherapy was significantly less severe than in controls. The combination of r-SP-C surfactant and C1-INH led to significantly lower PMN infiltration than surfactant monotherapy. CONCLUSION: In this lavage-induced acute respiratory distress syndrome model the administration of C1-INH might be followed by a higher clinical efficacy of exogenously supplied recombinant SP-C surfactant.

Increased thyroid epithelial cell proliferation in toxic thyroid nodules.

Most toxic thyroid nodules (TTN) result from clonal expansion of a single cell caused by a somatic mutation in the thyrotropin (TSH) receptor, the Gsalpha protein, or yet unknown proteins. Expanding a single cell into a TTN with thousands of cells suggests a prolonged increase in proliferation compared to nonaffected surrounding cells. To test this hypothesis, we evaluated cell proliferation in TTN. Tissue from 20 TTN and their surrounding normal thyroid tissue was studied for the occurrence of the proliferating cell nuclear antigen (PCNA) and Ki-67 epitope as markers for cell proliferation. The labeling index (number of labeled cells versus total cell number) for nodular and surrounding tissue was calculated. Nineteen samples were evaluated for PCNA immunohistochemistry. In 16 TTN, a significant (p< or =0.05%) up to 3-fold increase in the labeling index for PCNA was detectable. In only 3 toxic nodules (2 without a detectable TSH receptor or Gsalpha protein mutation), we found no significant difference in the labeling index compared to the surrounding tissue. Because labeling for KI-67 was much lower, only 16 toxic thyroid nodules were quantified. Twelve of these showed significantly (p< or =0.05%) increased labeling indices. The increase of the labeling index for both markers was similar for histologically defined adenoma versus adenomatous nodule or nodules with or without TSH receptor mutation or clonal versus polyclonal origin of toxic nodules studied. These findings are evidence that an increased thyroid epithelial cell proliferation is a uniform feature common to most TTNs, independent of their histopathological or molecular characteristics. Although increased proliferation in many TTNs is very likely the result of TSH receptor mutations, the cause of increased proliferation in TTN without a mutation is unknown.

Dermal eosinophils in atopic dermatitis undergo cytolytic degeneration.

BACKGROUND: Immunofluorescent staining for eosinophil granule proteins in lesional skin of patients with atopic dermatitis shows extensive extracellular deposition throughout the upper dermis with relatively few intact eosinophils. OBJECTIVE: This study was carried out to determine whether eosinophil granule protein deposition in atopic dermatitis occurs by classical exocytosis, by piecemeal degranulation, or as a result of cytolysis. METHODS: Skin biopsy specimens from 10 patients with atopic dermatitis were examined by electron microscopy. RESULTS: The biopsy specimens showed varying degrees of dermal eosinophil granule major basic protein deposition by indirect immunofluorescence. Specimens from seven patients showed striking alterations of eosinophils by electron microscopy including intact eosinophils with granule alterations (reversal of core staining and/or core lucency) and with uropod processes. Biopsy specimens from six patients showed evidence of eosinophil degeneration with disruption of nuclear and/or plasma membranes. In four patients' specimens, membrane-bound eosinophil granules were present near degenerating eosinophils or were present in the absence of recognizable eosinophils. Evidence of classical exocytotic degranulation was not observed. Two of the specimens were also examined by immunoelectron microscopy for major basic protein localization. In these, major basic protein appeared to be lost from the granule core and distributed in the eosinophil cytoplasm as granules disintegrated and the cell disrupted. CONCLUSION: These findings support the hypothesis that eosinophils undergo cytolysis with release of granule contents and membrane-bound granules; this is likely the usual mechanism of eosinophil granule protein release in atopic dermatitis.

Ultrastructural and molecular analyses of the persistence of Chlamydia trachomatis (serovar K) in human monocytes.

Previous studies have suggested that monocytes may play a role in the dissemination of Chlamydia trachomatis, and in establishment of persistent infection with this bacterium. Infection of cultured human peripheral blood monocytes with C. trachomatis serovar K produced persistent, nonproductive infection. Transmission electron microscopy of such infected cultures revealed single or multiple Chlamydia in monocyte inclusions over a culture period of 10 days. Those inclusions were aberrant, and normal reticulate bodies within the inclusions were not observed. Immunoelectron microscopy showed the chlamydial major outer membrane protein and lipopolysaccharide to be associated with the bacterial plasma membrane. Lipopolysaccharide was also identified in the monocyte cytoplasm. Molecular analyses of primary chlamydial rRNA transcripts demonstrated that the organism is viable and metabolically active within monocyte inclusions. However, attempts to overcome chlamydial growth arrest by incubation of Chlamydia-infected monocytes with tryptophan, and antibodies against alpha interferon, gamma interferon, or tumor necrosis factor, were all ineffective, suggesting that known mechanisms of growth inhibition do not hold in human monocytes. These observations indicate that infection of human peripheral blood monocytes with C. trachomatis may be involved in the genesis/maintenance of extra-urogenital inflammation, since non-culturable, metabolically active bacteria persist in those cells.

Dentin adhesive superior to copal varnish in preventing microleakage in primary teeth.

Microleakage presents a major challenge to the success of all restorations placed in the oral cavity, resulting in postoperative sensitivity, pulpal irritation, and secondary caries formation. The objective of this study was to evaluate the effects of an adhesive cavity liner under amalgam restorations in primary teeth. Sixty class V amalgam restorations were placed on the buccal and/or lingual surfaces of 38 primary molars and canine teeth. A dentin adhesive cavity liner was placed under 20 of the amalgam restorations. Another 20 restorations were lined with copal cavity varnish prior to amalgam condensation. The remaining 20 had no liner. All teeth were thermocycled in 0.5% basic fuschin dye, sectioned, and examined under a stereomicroscope to evaluate microleakage. While all specimens demonstrated leakage around the margins of the restorations, only the teeth with adhesive resin liners prevented leakage into the dentinal walls of the restoration. The copal cavity varnish group displayed microleakage approaching the pulpal chamber, whereas the unlined specimens consistently displayed dye penetration into the pulp chamber. At P < 0.01, the use of an adhesive cavity liner under amalgam restorations in primary teeth resulted in significantly less microleakage.

Modifications of the palatal crib habit-breaker appliance to prevent palatal soft tissue embedment.

The authors recommended the use of an acrylic palatal button and .040 to .045 inch palatal wires as modifications to the palatal crib appliance. By enhancing the strength of the wire, and providing anterior support, these modifications can reduce the likelihood of the crib becoming embedded in the palatal soft tissues.

Resin bonding to primary teeth using three adhesive systems.

In vitro bond strengths of three resin adhesive systems were tested using 111 primary teeth. Ninety-six flat dentin surface specimens were divided into six groups consisting of 16 primed or 16 unprimed samples for each adhesive system. The remaining 15 tooth samples were divided into three groups of five to determine each adhesive system's bond strength to primary etched enamel. Resin buttons were polymerized to all specimens with visible light, thermocycled for 2000 cycles between 5 and 55 degrees C, and shear bond strength was measured with a Instron Testing Machine (Instron Engineering Corp, Canton, MA). ANOVA and multiple comparison tests showed that Optibond Multiuse Bonding Agent had a statistically greater mean shear bond strength to primary dentin (20.5 +/- 3.5 MPa) than Prisma Universal Bond 3 Multi-purpose Bonding System (9.1 +/- 4.4 MPa), Scotchbond Multi-purpose Dental Adhesive System (7.3 +/- 3.7 MPa), and primary etched enamel (9.8 +/- 4.4 MPa) at P < 0.05. This study demonstrated that resin adhesive systems may achieve bond strengths to primary dentin comparable to those of primary enamel, and that these bonds may be as strong as bonds to permanent enamel and dentin. These adhesive systems may allow more confident esthetic restoration of primary anterior teeth.

[The total efficiency of stunning traps for the capture of stone martens and red foxes in hunting situations]. / Die Tötungseffizienz von Schlageisen beim Fang von Steinmarder und Rotfuchs in der jagdlichen Praxis.

The actual paper represents the pathomorphologic changes on martens and foxes hunted in instant killing traps under huntsmanlike conditions. The results are critically discussed concerning the manner of death, the moment of death of the killed animals regarding the relevant legislation.

Assessment of eosinophil and neutrophil participation in atopic dermatitis: comparison with the IgE-mediated late-phase reaction.

We hypothesized that repeated IgE-mediated late-phase reactions are critical in the pathogenesis of atopic dermatitis (AD). Prior studies have shown that extracellular deposition of eosinophil granule major basic protein (MBP) occurs in lesional AD skin, despite a paucity of infiltrating eosinophils, and that deposition of both neutrophil and eosinophil granule proteins occurs in the IgE-mediated late-phase reaction. We evaluated the participation of both eosinophil and neutrophil granule proteins in AD. Cutaneous biopsy specimens and serum and urine samples were obtained from 22 patients with AD. Lesional tissue was examined by means of immunofluorescence for neutrophil elastase and lactoferrin and for eosinophil granule MBP, eosinophil-derived neurotoxin (EDN), and eosinophil cationic protein (ECP). Serum levels of elastase, MBP, EDN, and ECP and urine levels of MBP, EDN, and ECP were measured. Marked extracellular deposition of at least one of the eosinophil granule proteins was present in the dermis of 15 of the 22 AD skin specimens, but minimal or no extracellular neutrophil elastase or lactoferrin deposition was observed in any specimens. Serum and urine levels of MBP, EDN, and ECP in the patients were elevated when compared with those of normal controls, whereas serum levels of neutrophil elastase were not elevated. Serum MPB levels correlated with extent of body surface involvement. These results suggest that eosinophil degranulation occurs in AD but that neutrophil degranulation does not. Although eosinophil degranulation is prominent in both the late-phase reaction and in AD, the lack of neutrophil degranulation in AD demonstrates differences in the inflammatory reactions.

Childhood sinusitis.

Childhood sinusitis is difficult to diagnose. It is classified on the basis of duration of inflammation--acute or chronic--and cause of inflammation--infectious or noninfectious. Infectious sinusitis is often a result of obstruction of the osteomeatal complex. Inflammation in noninfectious sinusitis is similar to the inflammatory changes detected in respiratory mucosa of patients with asthma. Acute sinusitis is primarily an infectious process similar to a prolonged infection of the upper respiratory tract. Plain radiography has limited value for the diagnosis of acute sinusitis in children. The most effective treatment of acute sinusitis is administration of a beta-lactamase-resistant antibiotic. Chronic sinusitis may be infectious, noninfectious, or both. Coronal computed tomography of the sinuses and nasal endoscopy are the preferred methods for determining the presence of chronic sinusitis. When physicians prescribe therapy for chronic sinusitis, they need to consider whether the underlying cause is infectious, noninfectious, or both. Treatment of chronic infectious sinusitis is most effective when a beta-lactamase-resistant antibiotic is administered. Chronic noninfectious sinusitis may respond to topically intranasally applied corticosteroids. If medical treatment fails to resolve the disease within 3 months, surgical intervention may be necessary. Finally, although an association between asthma and sinusitis exists, a cause-and-effect relationship has not been established.