Idiopathic epistaxis and meteorological factors: case-control study.

OBJECTIVE: The aim of this study was to determine the relationship between the occurrence of idiopathic epistaxis and daily values of air pressure, temperature, and humidity. We also investigated whether biometeorological forecasts should be addressed to persons with a history of nosebleed diathesis. METHODS: We analyzed consecutive idiopathic epistaxis events over a 3-year period. Patients were included if they had been in the municipality of Mostar, Bosnia and Herzegovina at least 24 hours before the epistaxis occurrence. The monthly variation in epistaxis events was determined. Epistaxis days (Days "0", 0 = day with epistaxis occurrence) and selected nonepistaxis days (Days "-1", -1 = each first single day without epistaxis prior to Day 0) were compared according to daily values of mean, minimum, and maximum temperature; diurnal temperature range; minimum and maximum atmospheric pressure; diurnal pressure range; and mean relative humidity. RESULTS: The greatest and smallest percentage of epistaxis events occurred in the months of March and August, respectively. There were no significant differences between Days 0 and Days -1 with respect to the examined meteorological factors. CONCLUSION: In this region with a Mediterranean climate, we found a seasonal variation with an incidence peak during the spring transition months, but we did not identify any meteorological trigger factors for epistaxis. Thus, there is no need for biometeorological forecasts to be addressed to persons with a history of nosebleed diathesis.

Silencing of the cell cycle checkpoint gene 14-3-3σ in basal cell carcinomas correlates with reduced expression of IKK-α.

BACKGROUND: 14-3-3σ is down-regulated in a large proportion of basal cell carcinomas (BCC). IkappaB kinase α (IKK-α), one of the two catalytic subunits of the IKK complex involved in NF-kappaB-activation, also functions as a modulator of epidermal development and differentiation. Down-regulation of IKK-α causes hyperplasia and promotes skin cancer. IKK-α has been found to regulate the expression of 14-3-3σ by shielding its promoter from hypermethylation and thereby preventing its silencing in mouse keratinocytes. OBJECTIVES: To evaluate the potential role of IKK-α in the silencing of 14-3-3σ in basal cell carcinoma. MATERIALS AND METHODS: Expression of 14-3-3σ and IKK-α was studied by immunohistochemistry in 33 sporadic BCCs and 26 BCCs from patients with basal cell nevus syndrome (BCNS). RESULTS: Marked reduction or absence of 14-3-3σ was found in 24 (92%) BCCs from BCNS patients, and in 29 (88%) sporadic BCCs. Marked reduction or absence of IKK-α was found in 22 (85%) BCCs from patients with BCNS, and in 27 (82%) sporadic BCCs. Expression levels for 14-3-3σ and IKK-α correlated positively in 92% of BCCs from BCNS patients, and in 85% of sporadic BCCs. CONCLUSIONS: Our findings suggest that down-regulation of IKK-α is required for 14-3-3σ promoter methylation and silencing in the pathogenesis of BCC. Besides, our observation that 14-3-3σ silencing is also frequently found in BCC from patients with BCNS suggests a possible link between the sonic hedgehog/patched and 14-3-3σ/IKK-α pathways.

Algorithm for navigated ESS.

ENT navigation has given new opportunities in performing Endoscopic Sinus Surgery (ESS) and improving surgical outcome of the patients` treatment. ESS assisted by a navigation system could be called Navigated Endoscopic Sinus Surgery (NESS). As it is generally accepted that the NESS should be performed only in cases of complex anatomy and pathology, it has not yet been established as a state-of-the-art procedure and thus not used on a daily basis. This paper presents an algorithm for use of a navigation system for basic ESS in the treatment of chronic rhinosinusitis (CRS). The algorithm includes five units that should be highlighted using a navigation system. They are as follows: 1) nasal vestibule unit, 2) OMC unit, 3) anterior ethmoid unit, 4) posterior ethmoid unit, and 5) sphenoid unit. Each unit has a shape of a triangular pyramid and consists of at least four reference points or landmarks. As many landmarks as possible should be marked when determining one of the five units. Navigated orientation in each unit should always precede any surgical intervention. The algorithm should improve the learning curve of trainees and enable surgeons to use the navigation system routinely and systematically.

Executive dysfunction in late-onset depression.

OBJECTIVE: Depression in the elderly is frequently accompanied by cognitive impairment. Executive dysfunction, including disturbances in planning, sequencing, organizing and abstracting has been reported in late-onset depression. They were found to be associated with relapse and recurrence of geriatric major depression and with residual depressive symptoms. SUBJECTS AND METHODS: A group of patients with late-onset depression, compared with age matched healthy volunteers, were assessed for deficits in executive functioning. We used the computer version of Stroop Color-Word test enabling more detailed reaction time analysis. Severity of depression was evaluated with Hamilton depression rating scale and Geriatric depression scale. RESULTS: The preliminary results of a study show that patients with late-onset depression have increased absolute reaction times in Stroop colour-word test. Significant differences in the magnitude of individual interference effects pointing towards a characteristic change in attentional processes in depressed patients. CONCLUSION: The preliminary results of a study comparing a group of elderly depressed patients with a control group of older healthy volunteers confirm changes in executive functions.

Trastuzumab in the treatment of advanced breast cancer: single-center experience.

A significant number of women with advanced breast cancer fail to respond to standard-dose chemotherapy. From the beginning of 1999, 17 women with HER2 positive advanced breast cancer received Herceptin as monotherapy or in combination with paclitaxel or other non-anthracyclines. Eight (47%) women previously received high-dose chemotherapy followed by haematopoiesis stem cell rescue. Three women received Herceptin alone, eleven Herceptin plus paclitaxel and three Herceptin and some of the other non-anthracyclines (CCNU, cisplatin and gemcitabine). In the group of patients who received Herceptin monotherapy, one has partial response (PR), one stable disease (SD) and in the third patient the disease progressed. Out of three patients who received Herceptin in combination with other non-anthracyclines, two have SD and one progressed. In the group of 11 women who received Herceptin + Taxol, 7 (64%) patients achieved PR, 2 (18%) SD, and 2 (18%) had disease progression. Grade 3-4 neutropenia has been observed in four (23%) women. Febrile neutropenia was observed in two cases and resolved completely when antibiotics were introduced. Other grade 3 toxicity that has been noted is peripheral neuropathy in three (18%) patients, diarrhoea in four (23%) and onycholysis in one (6%). Serial heart ultrasound showed no significant decline in left ventricular ejection fraction. According to our preliminary experience, Herceptin therapy showed promising results in women with metastatic breast cancer.

[Gene therapy of tumors of the head and neck: clinical use of the p53 tumor suppressor gene]. / Genska terapija tumora glave i vrata: klinicka primjena p53 tumor-supresorskog gena.

Gene therapy involves the introduction of genetic material (DNA) in patient cells, in order to produce therapeutic effect after expression of the new gene. New insights in head and neck tumor etiology and the development of genetic engineering techniques made the gene transfer a reality. This article gives a brief overview of investigations leading to clinical application of gene therapy in head and neck tumors. A good therapeutic response in more than 50% patients has been reported in literature. These results and future potential of gene therapy are discussed.

A feasibility study of realtime telemedicine in Croatia using Internet videoconferencing.

We explored the feasibility of realtime telemedicine in Croatia using Internet videoconferencing. A 33 kbit/s link was established between a team of specialists in the General Hospital 'Sveti Duh' in Zagreb and a general practitioner's clinic in Selca, on the island of Brac. During a two-week study, 16 patients (median age 51 years) were studied. Twenty-one teleconsultations (seven initial and 14 follow-up visits) were conducted, 13 with a specialist in internal medicine, six with a surgeon and two with a neurologist. In 18 cases (86%) telemedicine successfully replaced hands-on examination. The mean duration of the teleconsultations was 7.2 min (initial visits 7.4 min, follow-up visits 7.1 min). Each computer system cost about US$700. The total connection cost for the study was US$4.95. The teleconsultations saved the patients US$272 in travel costs. We suggest forming a permanent on-line specialist service connected to networked clinics via the Internet to improve access to health-care in Croatia.

Regeneration of articular cartilage defects in rabbits by osteogenic protein-1 (bone morphogenetic protein-7).

Osteogenic protein-1 (OP-1, BMP-7), a member of the transforming growth factor-beta family, induces cartilage and bone formation when implanted at intra and extraskeletal sites in vivo. The human OP-1 gene has been cloned and biologically active recombinant OP-1 homodimers have been produced. In the present study, the authors investigated the influence of OP-1 on healing of full-thickness articular cartilage defects, made by drilling two adjacent (phi 3mm) holes through articular cartilage of NZW rabbit knee joint were dissected and examined histomorphometrically. Results indicated that OP-1 induced articular cartilage healing and regeneration of the joint surface which contained cells resembling mature joint chondrocytes. These data imply a new strategy for biological repair of damaged joint surfaces in humans.

[The effect of osteogenic protein 1 (bone morphogenetic protein 7) on growth in long bones in rats]. / Utjecaj osteogenog proteina 1 (kostanog morfogenetskog proteina 7) na rast dugih kosti u stakora.

Osteogenic protein-1 (OP-1; BMP-7) is a member of the bone morphogenetic protein subfamily. Since members of the TGF-beta superfamily have a role in tissue development, the influence of OP-1 on the growth of long bones in rats was examined. OP-1 was administered intraperitoneally during the fourteen days of experiment. Animals were double labeled with fluorescent bone markers seven and two days before the sacrifice. Femora were extracted and examined under UV light microscope to determine bone volume, trabecular appositional growth, growth rate and growth plate thickness. OP-1 was found to decrease trabecular appositional growth and the growth plate thickness without influencing the total bone volume.

TGF-beta and basement membrane matrigel stimulate the chondrogenic phenotype in osteoblastic cells derived from fetal rat calvaria.

Primary cultures of fetal rat calvarial cells contain a spectrum of osteogenic phenotypes including undifferentiated mesenchymal cells, osteoprogenitor cells, and osteoblasts. We recently demonstrated that rat calvarial osteoblast-like cells grown on basement membrane undergo profound morphological changes resembling a canalicular network in bone. In the present study, we examined the effect of reconstituted basement membrane Matrigel on chondroblastic versus osteoblastic differentiation of different cell subpopulations obtained by five consecutive enzymatic digestions of rat calvarial cell populations. We found that the appearance of canalicular cell processes decreased with the later digests. When cells from the fourth and fifth digest were grown on top of Matrigel for 7 days, the majority of the cell aggregates displayed chondrocytic characteristics but none of the cells became hypertrophic. When individual chondroblastic cell aggregates were subsequently transferred from Matrigel to plastic, they started expressing types I and X collagens, alkaline phosphatase, and osteocalcin. Within the next 7 days (days 8-14 of the experiment), the majority of cells increased in size, and at day 17 on plastic (day 24 of the experiment) mineralized bone nodules formed. The chondroblastic differentiation of calvarial cells grown on Matrigel could be inhibited by a specific transforming growth factor-beta 1 (TGF-beta 1) but not by a TGF-beta 2 antibody. Addition of recombinant TGF-beta 1 to similar cultures promoted the appearance of chondroblastic cell aggregates. The cartilage phenotype could not, on the contrary, be promoted by growing the cells on other extracellular matrices such as a collagen I gel. We suggest that TGF-beta 1 in concert with the basement membrane extracellular matrix induces chondroblastic differentiation of rat calvarial osteoprogenitor cells.

[Angiogenesis of gynecologic tumors studied with color Doppler]. / Angiogeneza ginekoloskih tumora ispitana obojenim doplerom.

Angiogenesis is obligatory event in solid tumors growth. Weak muscular layer in the newly formed tumoral vessels results in decreased resistance to blood flow and characteristic Doppler signal. The number and arrangement of the blood vessels differ between benign and malignant lesions as well. Parameters mentioned above enable a precise ultrasound differential diagnosis between benign and malignant tumors. Malignant uterine tumors are better perfused and have lower resistance to blood flow than benign ones. Benign lesions with secondary changes (necrosis) may have lowered resistance indices. The finding of pathological perfusion makes the diagnosis of endometrial carcinoma also very accurate. High sensitivity of the transvaginal color Doppler in detecting newly formed blood vessels in an early stages of ovarian cancer may establish this technique as a screening method for this still very high lethality disease.

Reconstructions of phase contrast, phased array multicoil data.

We present a reconstruction method for phased array multicoil data that is compatible with phase contrast MR angiography. The proposed algorithm can produce either complex difference or phase difference angiograms. Directional flow and quantitative information are preserved with the phase difference reconstruction. The proposed method is computationally efficient and avoids intercoil cancellation errors near the velocity aliasing boundary. Feasibility of the method is demonstrated on human scans.

A study of rheumatoid factors in juvenile rheumatoid arthritis (chronic polyarthritis) by the photometric latex test.

The photometric latex test (PLT) for the detection of rheumatoid factors (RF), developed and clinically evaluated in adult rheumatoid arthritis, was applied in a study of juvenile rheumatoid arthritis (JRA). A total of 40 individuals with JRA, 27 with other collagen diseases and 24 in a control group were examined. The incidence of seropositives by PLT was 50% in JRA, 33% in collagen diseases and 17% in controls. The percentage of JRA was significantly higher than in the controls, and also higher than values in the literature claiming that only about 20% of JRA patients are seropositive. These findings were discussed concerning the diagnostic capability of PLT as compared with other serologic tests for RF. The increase in PLT titer values was found to indicate an aggravation of the inflammatory process and could help estimate the clinical stage of the disease. A follow-up of patient titer values could be of great diagnostic value. The data on serum immunoglobulins and complement fractions levels could not confirm the findings on a significant increase in JRA patients, but following of "level profiles" of each patient could add to the estimation of patient's clinical status. In cases of seropositives when other laboratory parameters did not indicate a clear transition from the chronic active to acute stage of disease, the only parameter which often showed such a transition is the RF titer determined by PLT testing, which could be of importance for a timely change of the therapy.