Effect of early versus conventional epidural analgesia during labor on cytokine production.

OBJECTIVE: To compare the effect of early epidural analgesia (EEA) vs. conventional epidural analgesia (CEA) on cytokine production in mother and neonate. METHODS: Healthy parturients with uncomplicated term pregnancies were randomized into two groups: EEA - parturients who would receive epidural analgesia before onset of pain and the control group, CEA - parturients who would receive epidural analgesia after onset of pain. Cytokines were measured in maternal blood at randomization Visual Analog Scale (VAS) < 30], 24 h postpartum, and in cord blood. RESULTS: Forty-one women were studied. Epidural was performed in EEA when VAS was 23 ± 10 and in CEA when VAS was77 ± 10 (p < 0.0001). Background data were similar except for ruptured membranes at admission (EEA 15%, CEA 46.6%; p = 0.03), transient hypotension (EEA 20%, CEA 0%; p = 0.03), and meconium (EEA 25%, CEA 0%; p = 0.01). No significant differences were found in cytokine levels between groups at any time. Interleukin (IL)-6 levels changed significantly only in the control group (p = 0.046). There was significant correlation between baseline maternal IL-6 level and cord blood level in CEA (r = 0.59, p = 0.005), while no significant correlation existed in EEA (r = 0.33, p = 0.16). CONCLUSION: Although there was no significant difference in cytokine levels between the groups, EEA prevented the significant increase in IL-6 during labor and interrupted IL-6 fetal-maternal dependency.

Gastric cancer: biology and clinical manifestations in Israel.

BACKGROUND: Gastric cancer (GC) in Israel remains incompletely characterized. The aim of this study was to define the clinical and pathological characteristics of GC in Israel and to compare them to the general Western population. PATIENTS AND METHODS: This is a retrospective analysis of 461 consecutive GC patients treated at a single institution between 1995 and 2007. Epidemiological and clinical-pathological data were retrieved from the patients' medical files and the institutional electronic database and analyzed using standard statistical methods. RESULTS: Epidemiology, clinical manifestations, histopathological findings, clinical course, and prognostic factors for disease outcome were all similar to those reported in the Western literature. Findings unique to the Israeli population included: (1) rarity of GC-associated risk factors; (2) increased GC incidence in Ashkenazi Jews; (3) high incidence of second primary malignancy and family history of cancer; and (4) no dominancy of proximal GCs. CONCLUSION: There do not appear to be any major differences in the biology or clinical manifestations of GC in Israel. Western recommendations for diagnosis and treatment of GC may therefore be applied to the Israeli patient population.

Metabolic syndrome in liver transplant recipients: prevalence, risk factors, and association with cardiovascular events.

Features of metabolic syndrome are not uncommon in patients after liver transplantation. To examine the prevalence and risk factors of posttransplantation metabolic syndrome (PTMS), the files of 252 transplant recipients (mean age, 54.5 ± 2.8 years, 57.9% male) were reviewed for pretransplant and posttransplant clinical and laboratory parameters (mean follow-up, 6.2 ± 4.4 years). Rates of obesity (body mass index >30 kg/m(2) ), hypertriglyceridemia (>150 mg/dL), high-density lipoprotein cholesterol <40 mg/dL (men) or <50 mg/dL (women), hypertension, and diabetes were significantly higher after transplantation than before. Metabolic syndrome was diagnosed in 5.4% of patients before transplantation and 51.9% after. Besides significantly higher rates of the typical metabolic derangements (P < 0.0001), the patients with PTMS were older and heavier than those without PTMS, and they had a higher rate of pretransplant hepatitis C virus infection (P < 0.03) and more posttransplant major vascular and cardiac events (20 events in 15.2% of patients with PTMS versus 6 events in 4.9% of patients without PTMS; P < 0.007). There was no between-group difference in mortality or causes of death (mainly related to recurrent disease, graft failure, and sepsis). Significant independent predictors of PTMS on logistic regression analysis were age (odds ratio [OR] = 1.04), pretransplant nonalcoholic fatty liver disease (OR = 3.4), body mass index (OR = 1.13), diabetes (OR = 5.95), and triglycerides (OR = 1.01). The rate of metabolic syndrome in liver transplant recipients is more than twice that reported for the general population. PTMS is associated with cardiovascular morbidity but not mortality, and it may be predicted by pretransplantation conditions. Prospective studies are required to determine the significance and management of PTMS.

Birth month and longevity - monthly birth distribution in acute coronary events provoked by atherothrombosis in patients treated with percutaneous coronary intervention (PCI).

BACKGROUND: Human homeostasis is time related. Environmental physical factors also play a role. Recent studies published by the National Academy of Sciences (USA) describe human longevity links with the month of birth. The aim of this study was to check monthly birth distribution in patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) related to atherothrombosis - one of the main causes of morbidity and mortality in the industrial world. METHODS: A total of 4732 (3594 men) subjects were included in the study. Patients treated with PCI for AMI in the years 2000 to March 2010 were studied. The population registry specific to 1950 excluded 1024 patients, i.e., those registered as born on January 1 and they were replaced with patients with an average of births from January 2 to 31. A total of 3675 patients were finally studied (2839 men, 836 women). RESULTS: The average monthly birth number was 306±60.38. Significant monthly differences in birth number (q2=21.077, p<0.03) were observed. A higher birth rate in the first four months of the year was revealed, with the exception of February. The number of births in these months exceeded the following two four-month data (q2=20.57, p<0.024). March births exceeded the monthly average by more than two standard deviations (SD) - 462, with an analogical increase for both genders. In May-December births were below average. CONCLUSIONS: Patients with AMI treated with PCI show differences in the month of birth with the majority being born in the first four months of the year and of those most were born in March. Possible implications on pathogenetic clues of atherothrombosis can be assumed.

Different patterns of expression of the erbB family of receptor tyrosine kinases in common nevi, dysplastic nevi, and primary malignant melanomas: an immunohistochemical study.

erbB receptors contribute to tumor formation and progression. Variable expression of erbB1, erbB2, and erbB3 has been reported in nevi and melanomas; erbB4 has hardly been investigated. We examined the expression of all 4 erbB receptors in common and dysplastic nevi and melanomas. Formalin-fixed, paraffin-embedded tissues of 100 melanomas, 27 common nevi, and 23 dysplastic nevi were immunostained with antibodies against the 4 erbB receptors. erbB3 and erbB4 showed stronger positivity in nevi than in melanomas, and in common than in dysplastic nevi. Staining pattern was more orderly in nevi than in melanomas. Common nevi showed more prominent membranous staining for erbB3 than dysplastic nevi followed by melanomas. In melanomas, greater thickness was associated with more widespread erbB2 and erbB3 staining in the vertical than in the radial growth phase, and in the dermal than in the epidermal component. Higher mitotic counts were associated with more widespread and intense erbB2 expression in the vertical growth phase than in the radial growth phase and in the dermal than in the epidermal component. Melanomas with more widespread erbB2 staining had heavier lymphocytic infiltrates. erbB1 expression was negligible in all groups. erbB2, erbB3, and erbB4 are expressed in all subtypes of melanocytic lesions, but with quantitative and qualitative differences. Receptor expression seems to decrease and to become less mature and orderly with tumor progression. The complex patterns of erbB receptor expression in melanocytic lesions warrant further investigation.

Women gynecologists' attitude toward their own health.

BACKGROUND: Following the publication of the results of Women's Health Initiative in 2002 there have been gross changes in the attitude of women and physicians towards the risks and benefits of hormone replacement therapy (HRT). We evaluated the attitude of women gynecologist towards their own health, including adherence to recommended screening tests and self usage and prescription of hormone replacement therapy. MATERIAL/METHODS: Questionnaires regarding performance of screening tests, self usage and recommendation of HRT were posted by mail to all Israel's women gynecologists. RESULTS: Ninety questionnaires were eligible for analysis (43.2% response rate). Average age was 48+/-7.7 years. Only 7/90 (7.8%) gynecologists smoke regularly and average body mass index was 25+/-3.8 kg/m2. Most participants performed at least one screening tests in the past 2 years. The median interval from the last self breast exam, mammography, gynecologisy exam, Papanicolaou test, colonoscopy and bone density test was 0.2, 1.82, 1.79, 1.95, 3.27 and 1.41 years, respectively. Most of them (68.3%) did not routinely recommend HRT to their patients. The duration of self HRT usage ranged between 1-20 years (average 5.1+/-3.4 years). Most gynecologists (87.7%) recommended continuous estrogen and progesterone for women with their uterus in place. CONCLUSIONS: The health profile of Israeli women gynecologists is chracterized by a high performance of screening tests for cancer and low rate of smoking. Our study also demonstrates that the impact of the results of the WHI trial is still well manifested and most Israeli women gynecologists do not routinely recommend HRT to postmenopausal women.

Myocardial perfusion profile in a young population with and without known coronary artery disease: comparison by gender.

BACKGROUND: More and more young people are being referred for evaluation or screening for coronary artery disease (CAD). However, the value of myocardial perfusion imaging (MPI) in this population is unclear, especially in the absence of symptoms. METHODS: The study sample included 1765 consecutive patients less than 51 years old who were referred to a major medical center for stress/rest MPI study. Clinical and MPI variables were compared between patients with and without known CAD, by gender. RESULTS: There were 1346 (76%) men and 419 (24%) women of mean age 44 +/- 6 years; 461 (26%) had known CAD. Stress-induced ischemia was detected in 321 patients (18.2%) and significant ischemia in 131 (7.4%); there was no difference in the rate or severity of ischemia by presence of symptoms. Among those without known CAD, the rate of stress-induced ischemia by MPI was significantly lower in women than men. On logistic regression analysis, the independent predictors of ischemia in men were high cholesterol, diabetes, angina during stress testing, ST depression, and smoking (P<.0001); and in women, the independent predictors were diabetes and high cholesterol. CONCLUSION: Known CAD and stress-induced ischemia are significantly more prevalent in young men than in young women, irrespective of risk factors. The independent predictors of ischemia differ between men and women.

Well-differentiated thyroid carcinoma: comparison of microscopic and macroscopic disease.

BACKGROUND: The rapid increase in the incidence of well-differentiated thyroid cancer in recent years is the result of smaller thyroid tumors (1 cm or less) being diagnosed more frequently. Few studies are available regarding the appropriate approach to this previously known postmortem incidental finding, and their results remain controversial. METHODS: In 2005, our center started a registry of all patients with nonmedullary thyroid carcinoma who were followed at our institute. In the present study, data on the background, clinical, and outcome characteristics were collected from the registry for 225 patients with microscopic disease and 543 patients with macroscopic disease. RESULTS: Patients with microscopic disease were slightly older (51 vs. 47.5 years, p = 0.003), had a higher female to male ratio (189:37 vs. 419:123; p = 0.06), and were affected more by papillary carcinoma (98.2% vs. 85.5%; p < 0.001). Multifocal disease was documented in 50.2% of the patients with microscopic disease and 46.8% of the patients with macroscopic disease (NS), and bilateral disease, in 42.6% and 36.8%, respectively (NS). Corresponding rates for the two groups for other tumor-related factors were as follows: lymph node involvement at initial treatment, 25.7% and 30% (NS); distant metastases, 2.4% and 5.1% (p = 0.16); persistent/recurrent disease, 11% and 32% (p < 0.001); and new distant metastases, 2.65% and 6.5% (p = 0.07). At a median follow-up of 5 years, 96% of the microscopic carcinoma group were disease free compared to 77% of the macroscopic group (p < 0.001). CONCLUSION: The differences between patients with microscopic and macroscopic well-differentiated thyroid carcinoma may not justify a different therapeutic approach.

Serum protein N-glycans profiling for the discovery of potential biomarkers for nonalcoholic steatohepatitis.

The hepatic histology in nonalcoholic fatty liver disease can vary from isolated hepatic steatosis to steatohepatitis can progress to cirrhosis and liver-related death. The aim was to evaluate the use of blood serum N-glycan fingerprinting as a tool for differential diagnosis of nonalcoholic steatohepatitis from steatosis. A group of 47 patients with NAFLD was diagnosed by clinical laboratory analysis and ultrasonography, and was studied histologically using the Brunt's scoring system. The control group included 13 healthy individuals. N-glycan profiles of serum proteins were determined by DNA sequencer-based carbohydrate analytical profiling. We have found that the concentrations of two glycans (NGA2F and NA2) and their logarithm ratio of NGA2F versus NA2 (named GlycoNashTest) were associated with the degree of NASH-related fibrosis, but had no correlation with the grade of inflammation nor steatosis severity. When used to screen NAFLD patients, GlycoNashTest could identify advanced NASH-related fibrosis (F3-F4) with the diagnosis sensitivity of 89.5% and specificity of 71.4%. The serum N-glycan profile is a promising noninvasive method for detecting NASH or NASH-related fibrosis in NAFLD patients, which could be a valuable supplement to other markers currently used in diagnosis of NASH.

Congenital heart disease: correlation with fluctuations in cosmophysical activity, 1995-2005.

BACKGROUND: Environmental physical activity is known to be associated with many factors of human homeostasis, such as fetal development, birth number, and some genetic abnormalities. This study sought to investigate possible temporal links between the occurrence of congenital heart disease and solar, geomagnetic, and cosmic ray activities. PATIENTS AND METHODS: The study sample include 79,085 infants born live at a tertiary medical center in central Israel from 1995 to 2005, of whom 1739 were diagnosed with congenital heart disease, including 309 with patent ductus arteriosus (PDA). The number of infants with congenital heart disease (total and excluding PDA) was analyzed against the values of the physical parameters, as derived from international indices, by year of birth and 1 year before and by month of birth and 9 months before. Pearson correlation coefficients and their probabilities were calculated. RESULTS: The number of cases of infantile congenital heart disease over the 132-month study period significantly correlated with solar activity (r=0.5, p<0.0001) and with cosmic ray activity (r=-0.45, p<0.0001). On analysis by year, correlations were as follows: with solar activity 1 year before delivery, r=0.71, p=0.014, n=11, and at time of delivery, r=0.66, p=0.026; with cosmic ray activity, 1 year before delivery, r=-0.66, p=0.03, and at time of delivery, r=-0.61, p=0.047, n=11. The levels of correlation and probability were higher for solar activity indices at conception (9 months or 1 year before delivery) than at birth. Significance was maintained when cases of PDA were excluded. CONCLUSION: The monthly number of infants born with congenital heart disease is directly correlated with the level of solar activity and inversely correlated with the level of cosmic ray activity during pregnancy, predominantly in the month of conception. The mechanism underlying the possible effect of solar activity on the occurrence of congenital heart disease warrants additional studies.

Correlation of vascular endothelial growth factor with the severity of thalassemia intermedia.

Several lines of evidence indicate that thalassemia intermedia is associated with disturbances in vascular endothelial cell proliferation. In addition, autopsy studies of thalassemia intermedia reported obstructive lesions in the pulmonary artery in 44% of cases, especially splenectomized patients, and a recent in-vivo study reported increased level of vascular endothelial growth factor (VEGF) in thalassemia intermedia. The aim of the present study was to determine whether VEGF levels are correlated with the severity of the disease. Blood samples were collected from 21 patients with thalassemia intermedia and assayed for VEGF by a two-site enzyme-linked immunosorbent assay. A significant correlation was noted between VEGF levels and patient age (P = 0.0022, r = 0.82), presence of splenomegaly (P = 0.004, r = 0.79) and hepatomegaly (P = 0.023, r = 0.82). VEGF levels were also significantly correlated with both left ventricular end-diastolic diameter and left ventricular end-systolic diameter (P = 0.02, r = 0.84 and P = 0.01, r = 0.86, respectively). The study indicates that VEGF levels may be related to the clinical severity of thalassemia intermedia, as expressed by the degree of hepatomegaly and splenectomy and cardiac indexes. Further and larger studies are needed to confirm these observations.

Cyclooxygenase-2 expression in primary and metastatic Merkel cell carcinoma.

Cyclooxygenase-2 (COX-2) is involved in the development and progression of many tumors, and its inhibition has been shown to block tumor growth. This study examined COX-2 expression in primary and metastatic Merkel cell carcinoma (MCC). Formalin-fixed paraffin-embedded tissues from 26 primary MCCs and 7 lymph node metastases were stained immunohistochemically with a monoclonal antibody directed against COX-2, and the percentage and intensity of staining were analyzed semiquantitatively. Immunopositivity for COX-2 was found in 20 primary tumors (77%), and was diffuse in 16 of them (80%). Staining intensity was strong in 5 tumors (19%), moderate in 6 (23%), and weak in 9 (35%). Five metastases (71%) showed similar staining. Prominent mitotic activity was associated with more diffuse COX-2 immunopositivity. No association was found between COX-2 expression and outcome. This study confirms that most MCCs express COX-2 and shows that COX-2 expression is related to one parameter of aggressive behavior--a high mitotic rate--but not to any others. The possibility of treating MCC with COX-2 inhibitors should be considered.

Minimal surgery for pilonidal disease using trephines: description of a new technique and long-term outcomes in 1,358 patients.

PURPOSE: This study describes and reports the results of a new, minimally-invasive surgical technique for pilonidal disease. METHODS: From March 1993 to January 2003, 1,358 patients (out of a total of 1,435 patients) with symptomatic pilonidal disease underwent treatment in a military surgical clinic dedicated for pilonidal disease. Patients were operated on under local anesthesia, utilizing trephines to excise pilonidal pits and to débride underlying cavities and tracts. RESULTS: One thousand three hundred fifty-eight symptomatic patients participated in the study and were mostly male (84.3 percent) and the mean age 20.9 +/- 3.6 years. Rates of postoperative infection, secondary bleeding, and early failure were 1.5, 0.2, and 4.4 percent, respectively. In patients with full postoperative clinical attendance, complete healing was observed within 3.4 +/- 1.9 weeks. Phone interview included 1,165 patients (85.8 percent) with a mean follow-up interval of 6.9 +/- 1.8 years. Recurrence rates after 1 year was 6.5 percent, 5 years was 13.2 percent, and 10 years was 16.2 percent. Mean time to recurrence was 2.7 +/- 2.6 years postoperatively. The disease-free probability estimate was 93.5 percent at one year and 86.5 percent at 5 years. CONCLUSIONS: Compared with frequently used pilonidal operations, the trephine technique is associated with a lower recurrence rate and a low postoperative morbidity rate.

Weekly infusional high-dose 5-fluorouracil and leucovorin and biweekly cisplatin: a convenient treatment option in advanced gastric cancer.

BACKGROUND: To summarize our experience using a regimen of weekly 5-FU and leucovorin (LV) and biweekly cisplatin (CDDP) in advanced gastric cancer (AGC). MATERIAL/METHODS: Patients had previously untreated histologically confirmed AGC. Treatment consisted of intravenous weekly infusional 5-FU and LV and biweekly CDDP, given for 6 weeks followed by a 2-week rest. Initially, a lower dose level was used (5-FU 2000 mg/m(2), LV 500 mg/m(2), CDDP 40 mg/m(2)), which was later increased (5-FU 2600 mg/m(2), LV 500 mg/m(2), CDDP 50 mg/m(2)). RESULTS: Forty-five patients were treated, 18 at the lower dose level and 27 at the higher dose level. The median age was 67 years and 55% were male. Grade > or =3 toxicity was documented in 37% of patients but toxicity related hospitalizations or treatment discontinuation occurred in only 22% and 13%, respectively. There were no toxic deaths. The most common hematological toxicities were anemia and neutropenia and the most common non-hematological toxicities were nausea, vomiting and fatigue. Of the 39 patients evaluable for response, 13 (33%) had partial response (PR) and 11 (28%) had stable disease (SD). Control of disease (PR+SD) was achieved in 61%. The higher dose level was associated with a higher response rate (p=0.07) and an increased toxicity (p=0.01), mostly hematological and gastrointestinal. Median progression-free survival and overall survival were 3.5 and 9.2 months, respectively. CONCLUSIONS: This regimen appears safe, with a manageable toxicity profile. Efficacy data resemble those reported for more complex and toxic regimens. The higher dose level had enhanced activity, at the expense of increased toxicity.

Predicting outcome of malignant external otitis.

OBJECTIVE: Malignant external otitis (MEO) continues to pose a diagnostic and therapeutic challenge. The lack of a diagnostic study since 1987 combined with recent findings of quinolone-resistant MEO prompted the present analysis of MEO outcome in a major tertiary medical center. METHODS: Seventy-five consecutive patients hospitalized for suspected MEO between 1990 and 2003 were divided into 2 diagnostic groups: MEO Type 1, presence of all obligatory clinical and radiologic criteria and most of the occasional criteria of Cohen and Friedman or absence of 1 obligatory criterion with failure of intensive treatment, and MEO Type 2, absence of one of the obligatory criteria with treatment response within 1 week. The groups were compared for demographic data, underlying diseases, ear parameters, culture findings, length of hospitalization, and treatment before hospitalization, obtained from the charts. RESULTS: Both types of MEO affected mostly diabetic patients and were characterized by granulations and discharge in the external ear, severe prolonged pain, soft tissue involvement and bone destruction on computed tomographic scan, and growth of Pseudomonas aeruginosa in culture. However, Type 1 MEO was associated with a significantly older patient age at presentation, higher rate of oral antidiabetic treatment, history of diabetic (vascular) complications, computed tomographic findings of nasopharyngeal involvement (soft tissue swelling, soft tissue asymmetry, or abscess formation), bone destruction, and temporomandibular joint involvement-all of which led to significantly longer treatment and shorter survival. CONCLUSION: The worse prognosis of Type 1 MEO compared with Type 2 should alert clinicians to establish earlier diagnosis and treatment.

Cyclooxygenase-2 expression in dermatofibroma and dermatofibrosarcoma protuberans.

BACKGROUND: Dermatofibroma (DF) and dermatofibrosarcoma protuberans (DFSP) occasionally resemble each other histologically but differ in histogenesis and biological behavior. This study sought to determine if these lesions can be differentiated by the quantity or quality of expression of cyclooxygenase-2 (COX-2), an enzyme associated with both reactive and neoplastic processes. PATIENTS AND METHODS: Formalin-fixed and paraffin-embedded samples from 20 DFs and 20 DFSPs were stained immunohistochemically with antibodies directed against COX-2. Staining was evaluated semiquantitatively for percentage and intensity using a three-tiered system. DFs were graded and analyzed by cellularity. Findings within the tumors were compared with fibrocyte staining in adjacent tissue. The results were analyzed. RESULTS: Nineteen DFs (95%) and 15 DFSPs (75%) were immunopositive for COX-2; this difference was not statistically significant. Highly cellular DFs showed more widespread (p = 0.0039; r = 0.614) and more intense (p = 0.0586; r = 0.429) staining than less cellular DFs and more prominent staining in adjacent fibroblasts (p = 0.044; r = 0.608). CONCLUSIONS: COX-2 immunostaining does not distinguish DFs from DFSPs. However, the enzyme is expressed more widely and more intensely in more cellular, possibly younger, DFs. The prominent expression of COX-2 in DFSP may have clinical implications for treatment with COX-2 inhibitors in tumors that are not amenable to surgery.

The culprit artery in acute myocardial infarction in different environmental physical activity levels.

BACKGROUND: The timing of acute coronary events may be related to endogenous and exogenous--environmental--factors. AIM: To check if daily levels of geomagnetic activity (GMA) and/or cosmic ray activity (CRA) measured by neutron activity (imp/min) on the Earth's surface are related by timing with specific culprit artery of AMI. PATIENTS AND METHODS: Data of PCI for AMI (n=904, 696 men) from 01/2000 to 02/2006 (2251 days) were used for analysis. Daily GMA (I-IV levels) and neutron activity in imp/min were compared with localization of the culprit artery in AMI (LAD, RCA, CRX and Diagonal). The principal consideration was concentrated in the most frequent lesions of LAD (n=422) and RCA (n=332). The cosmophysical data were derived from USA, Russia and Finland. RESULTS: Similar to the whole 2251 days, the PCI were inversely related to GMA (p=0.03) and show a strong tendency to increase at higher CRA (p=0.07). Comparing data on two high (III, IV) and low (I, II) levels of GMA shows that, at high GMA, RCA and LAD lesions were equal; at the more often low daily levels of GMA, accompanied by higher CRA (neutron) activity (p<0.0001), LAD lesions were higher by 30% (chi(2)=-4.064, p=0.04). CONCLUSION: At higher daily levels of GMA, RCA/LAD culprit lesions in AMI are equal; at low GMA and higher CRA (neutron) activity, LAD lesions are predominant.

Bone conduction in otosclerosis--operated versus non-operated ears.

OBJECTIVE: To examine whether stapes surgery improves long-term bone conduction in patients with otosclerosis. SETTING: Tertiary university hospital. METHODS: Thirty patients (52 ears) who underwent stapedectomy between 1988 and 1994. Hearing tests were performed pre-operatively and 5 years postoperatively. RESULTS: The operated ears showed significant improvement in speech reception threshold and air conduction (250-4,000 Hz). Over the follow-up period, there were no significant differences in bone conduction thresholds between the operated and non-operated ears and no deterioration during follow-up in both bilateral and unilateral disease. CONCLUSIONS: This series did not provide evidence that the deterioration in bone conduction over the follow-up period in otosclerotic ears exceeds the level that can be explained by presbycusis and the Carhart effect. However, the follow-up time may have been insufficient. Stapedectomy appears to have no effect on bone conduction in this patient group. The similar bone conduction thresholds in the non-operated and operated ears in unilateral otosclerosis at the end of follow-up suggest that the thresholds in the non-operated ears approached those in the operated ones.

Clinical cosmobiology: distribution of deaths during 180 months and cosmophysical activity. The Lithuanian study, 1990-2004. The role of cosmic rays.

UNLABELLED: The aim of this study is a next step of our previous, initial, publications--to explore the links between monthly death number (total, and for the major death causes and each gender) with levels of monthly cosmophysical activity in a long-term, big cohort observation. METHODS: Death number during 180 consecutive months from the National Registry of Lithuania for years 1990-2004 were studied. A total of 630,205 deaths were analyzed (333,035 males). For comparison, monthly indices of solar activity, geomagnetic activity, and cosmic ray activity and year and month (1-12) of the study were used. The cosmophysical data were obtained from space research centers in the USA, Russia, and Finland. Statistics. Pearson correlation coefficients (r) and their probabilities (P) between compared parameters were calculated. A multivariate model of prediction was designed. RESULTS: It was a significant correlation between total monthly death number and indices of cosmic ray activity and, inverse, of solar activity; in men stronger than in women. Monthly geomagnetic activity was significantly correlated with traffic accidents, ischemic heart disease/stroke ratio, suicide victim number. Deaths from stroke, noncardiovascular causes, suicide, traffic accidents were related with cosmic ray activity and, inverse, with solar activity. Relationship of ischemic heart disease/stroke ratio to year of observation showed additional evidence for the growing role of stroke in cardiovascular mortality. CONCLUSIONS: Monthly death number is linked to cosmic ray activity, and inverse, to solar activity. Central place of stroke-related deaths in cardiovascular mortality is emerging. Geomagnetic activity, in monthly account, plays a relatively minor role. We presume that forces antagonistic to cosmic ray activity, like solar activity and geomagnetic activity, can prevent some negative biologic effects of cosmic ray.

Characteristics and prognosis of malignant external otitis with facial paralysis.

OBJECTIVE: To compare the characteristics and prognosis of patients with malignant (necrotizing) external otitis (MEO) with and without facial nerve palsy in today's era of third-generation antibiotics. DESIGN: Comparative retrospective case series. SETTING: Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, a tertiary care medical center. PATIENTS: Forty-eight patients with MEO diagnosed and treated from 1990 to 2004. Eight had facial paralysis and 40 had normal facial nerve function. MAIN OUTCOME MEASURES: Clinical, laboratory, and imaging findings and survival. RESULTS: There was no statistically significant difference between patients with and without facial nerve involvement in terms of age, comorbidities, duration of complaints, physical findings, erythrocyte sedimentation rate, and bone scan findings. Computed tomography indicated a more progressive disease in patients with facial nerve involvement. However, no statistically significant between-group difference was found in overall survival. CONCLUSION: Although facial nerve involvement is a sign of progression of MEO, it does not, by itself, worsen prognosis.