Management of severe pediatric subglottic stenosis with glottic involvement.

OBJECTIVE: We sought to describe our experience in the management of complex glotto-subglottic stenosis in the pediatric age group. METHODS: Between 1978 and 2008, 33 children with glotto-subglottic stenosis underwent partial cricotracheal resection, and they form the focus of this study. They were compared with 67 children with isolated subglottic stenosis (no glottic involvement). The outcomes measured were need for revision open surgical intervention, delayed decannulation (>6 months), and operation-specific and overall decannulation rates. Fisher's exact test was used for comparison of outcomes. RESULTS: Results of preoperative evaluation showed Myer-Cotton grade III or IV stenosis in 32 (97%) patients and grade II stenosis in 1 patient. All patients with glotto-subglottic stenosis were treated with partial cricotracheal resection and simultaneous repair of the glottic pathology. Bilateral fixed vocal cords were seen in 19 (58%) of 33 patients, bilateral restricted abduction was seen in 7 (21%) of 33 patients, and unilateral fixed vocal cord was seen in 7 (21%) of 33 patients. Ten patients underwent single-stage partial cricotracheal resection with excision of interarytenoid scar tissue. The endotracheal tube was kept for a mean period of 7 days as a stent. Twenty-three patients underwent extended partial cricotracheal resection with LT-Mold (Bredam S.A., St. Sulpice, Switzerland) or T-tube stenting. The overall decannulation rate included 26 (79%) patients, and the operation-specific decannulation rate included 20 (61%) patients. CONCLUSIONS: Glotto-subglottic stenosis is a complex laryngeal injury associated with delayed decannulation and decreased overall and operation-specific decannulation rates when compared with those after subglottic stenosis without glottic involvement after partial cricotracheal resection.

The influence of environmental conditions on immune responses, morphology and recapture probability of nestling house martins (Delichon urbica)

Nestling birds produced later in the season are hypothesized to be of poor quality with a low probability of survival and recruitment. In a Spanish population of house martins (Delichon urbica), we first compared reproductive success, immune responses and morphological traits between the first and the second broods. Second, we investigated the effects of an ectoparasite treatment and breeding date on the recapture rate the following year. Due probably to a reverse situation in weather conditions during the experiment, with more rain during rearing of the first brood, nestlings reared during the second brood were in better condition and had stronger immune responses compared with nestlings from the first brood. Contrary to other findings on house martins, we found a similar recapture rate for chicks reared during the first and the second brood. Furthermore, ectoparasitic house martin bugs had no significant effect on the recapture rate. Recaptured birds had similar morphology but higher immunoglobulin levels when nestlings compared with non-recaptured birds. This result implies that a measure of immune function is a better predictor of survival than body condition per se.

Characterization and detection of naturally occurring antibodies against IL-1 alpha and IL-1 beta in normal human plasma.

During the development and testing of a radioreceptor assay (RRA) for human IL-1, we have detected and identified the presence of auto-antibodies to IL-1 in normal human plasma (NHP). The RRA is based on the competition between human 125I-labeled rIL-1 alpha and standard or unknown quantities of IL-1 alpha or IL-1 beta for binding to a limited amounts of IL-1 receptor (IL-1R) isolated from the EL4 mouse thymoma cell line. NHP from 20 out of 100 unselected blood donors were found to completely inhibit the binding of 125I-labeled IL-1 alpha to its receptor, suggesting the presence in these NHP samples of either abnormal amounts of IL-1 or of a factor binding to the 125I-labeled IL-1 alpha. Special care was taken to ascertain that the inhibitory factors were antibodies and not soluble IL-1 receptor antagonist. When plasma samples with inhibiting activity were incubated with labeled IL-1 alpha and chromatographed on a Sephadex G200 column, they were found to contain 125I-labeled complexes with an apparent molecular weight of 150-200kD. The IL-1 binding factor could be eliminated from plasma by incubation with protein A-Sepharose, suggesting that it consisted in IgG antibodies directed against IL-1. Furthermore, the antibody nature of the inhibiting factor was confirmed by its binding to purified rIL-1 coupled to Sepharose. Screening of 200 NHP samples by incubation with 100 pg of 125I-labeled IL-1 followed by precipitation with 12% of polyethylene glycol (PEG) confirmed that about 25% of NHP contain detectable IgG antibodies to IL-1 alpha, while only 2% of NHP contain antibodies to IL-1 beta. No correlation between the presence of these anti-IL-1 antibodies and any particular major histocompatibility complex or any pathological conditions was detected. We suggest that all serum samples assayed for IL-1 alpha or IL-1 beta content should be pretested with the PEG precipitation assay described here.

Pääjohtaja Antero Piha 30/4 1963

Kirje

A influência da televisão nos hábitos culturais Aproximação à realidade praiense

artigo2 O resulta de um estudo empírico realizado na Cidade da Praia em 2003. Destaca a influência decisiva da televisão nos dia a dia da população praiense. O estudo evidenciou entre outros a apropriação de nomes de lugares, resultante de uma influência directa da televisão.

Variation in performance across Swiss mammography screening programmes: the influence of reading strategy and experience.

[Abstract] Reading volume and mammography screening performance appear positively correlated. Performance was compared across organised Swiss screening programmes, which target relatively small populations. Except for accreditation of 2nd readers radiologists (restrictive vs non-restrictive strategy), Swiss programmes have similar screening regimen/procedures and duration, which maximises comparability. Variation in performance was explored in order to improve mammography practice and optimise screening performance. Indicators of quality and effectiveness were evaluated for about 200,000 screens performed over 4 screening rounds in the 3 longest-standing Swiss cantonal programmes (of Vaud, Geneva and Valais). Interval cancers were identified by linkage with cancer registries records. Most European standards of performance were met with a favourable cancer stage shift. Several performance indicators showed substantial variation across programmes. In subsequent rounds, compared with programmes (Vaud and Geneva) which accredited few 2nd readers to increase their individual reading volume, proportions of in situ lesions and of small cancers (? 1cm) were one third lower and halved, respectively, and the proportion of advanced lesions (stage II+) nearly 50% higher in the programme without a restrictive selection strategy. Discrepancy in second-year proportional incidence of interval cancers appears to be multicausal. Differences in performance could partly be explained by a selective strategy for 2nd readers and a prior experience in service screening, but not by the levels of opportunistic screening and programme attendance. This study provides clues for enhancing mammography screening performance in low-volume Swiss programmes.

Evaluation par des médecins installés de l'efficacité antihypertensive de la débrisoquine, de la méthyldopa et du propranolol [Evaluation by practicing physicians of the antihypertensive efficacy of debrisoquin, methyldopa and propranolol]

The antihypertensive effect of debrisoquine (20 mg/day), methyldopa (100 mg/day) and propranolol (160 mg/day) was compared to that obtained with a placebo in a controlled trial carried out by a group of 14 internists. Forty-eight patients with uncomplicated essential hypertension were included. Mefruside (25 mg/day) was first given alone for 6 weeks ("open phase" of the trial) and to this diuretic was then added in double-blind fashion and randomized sequence a placebo or an active drug. Each of the 4 blind phases lasted 4 weeks. At the end of the "open phase", blood pressure in seated position averaged 168/111 +/- 19.6/13.5 mm Hg (mean +/- SD). A significant blood pressure decrease was observed after 4 weeks of treatment with the placebo as well as with the investigated compounds. With the placebo blood pressure was reduced to 158/102 +/- 19.6/13.5 mm Hg (p less than 0.001). The magnitude of the additional blood pressure decrease induced by the active drugs was relatively small and varied from 4 (debrisoquine) to 10 mm Hg (methyldopa, p less than 0.01) for the systolic and from 3 (debrisoquine, p less than 0.05) to 5 mm Hg (propranolol, p less than 0.05) for the diastolic. The percentage of patients with systolic pressure of less than or equal to 140 mm Hg and with diastolic pressure of less than 90 mm Hg during administration of either drug was not greater than 40 to 20% respectively. Propranolol appeared to be better tolerated than the other antihypertensive agents. These rather disappointing blood pressure results suggest that the efficacy of antihypertensive agents in private practice cannot be extrapolated from studies carried out in specialized hypertension clinics.

Rajavartioston toiminnan tehostaminen

Puhe

Evaluación ambiental en la zona marino costera de Lambayeque – Perú, 2010.

Se realizaron 2 evaluaciones, en agosto y noviembre-diciembre 2010, entre la desembocadura del Dren 1000 (Bodegones) y la del río Zaña. En el intermareal se registró la mayor temperatura superficial del mar, se registró anomalías de hasta +8,1°C (desembocadura del Dren 1000). En agosto en el submareal, la temperatura promedio fue 16,3 °C; en noviembre-diciembre fue 15,9 °C. Similar tendencia en superficie y fondo se observó en el oxígeno disuelto. Mayor cantidad de sólidos suspendidos totales (SST) se registró alrededor de la desembocadura del Dren 4000 (137,93 mg/L), sobrepasando los límites permisibles para aguas de CEMC y AMC. Aceites y grasas fluctuaron entre 0 y 0,3 mg/L encontrándose dentro de los límites permisibles de CEMC y AMC. En el submareal, los Coliformes Totales (CT) y coliformes Termotolerantes (CTT) cumplieron con la Ley General de Aguas para la clase V y VI; en el intermareal la demanda bioquímica de oxigeno (DBO5) en la desembocadura del Dren 3100, sobrepasó los límites permisibles de calidad de agua. En agosto se registraron 39 especies en el bentos, en noviembre y diciembre fueron 27 especies. Los índices de diversidad de Shannon Wiener y riqueza de especies del macrobentos submareal, se incrementaron de norte a sur, debido al predominio del sustrato fango-arenoso. Los puntos de alteración ambiental fueron las desembocaduras de los drenes 1000, 3100 y 4000, que reciben aguas servidas y desechos orgánicos e industriales de los centros poblados de Lambayeque, Pimentel y Santa Rosa, respectivamente.

Plantas de cobertura de solo como fonte de nitrogênio ao milho

Durante o período de 1990/94, foi realizado um trabalho na área experimental do Departamento de Solos da Universidade Federal de Santa Maria (RS), num Argissolo Vermelho distrófico arênico, para avaliar o potencial de algumas plantas de cobertura de solo no fornecimento de N ao milho no sistema plantio direto. O delineamento experimental foi o de blocos ao acaso, com parcelas subdivididas e quatro repetições. Nas parcelas principais, foram utilizadas, em cada inverno, as leguminosas ervilhaca comum (Vicia sativa L.), ervilha forrageira (Pisum sativum var. arvense (L.) Poir), chícharo (Lathyrus sativus L.) e tremoço azul (Lupinus angustifolius L.), a gramínea aveia preta (Avena strigosa Schieb.), além de um tratamento com pousio invernal (plantas invasoras). Nas subparcelas, foram aplicadas as doses de 0, 80 e 160 kg ha-1 de N no milho, na forma de uréia. Na média dos quatro anos, as duas espécies que produziram maior quantidade de matéria seca pela parte aérea foram o tremoço azul (5.228 kg ha-1) e a aveia preta (4.417 kg ha-1), seguidas do chícharo (3.047 kg ha-1), ervilha forrageira (2.754 kg ha-1), ervilhaca comum (2.527 kg ha-1) e plantas invasoras do pousio invernal (1.197 kg ha-1). Dentre as leguminosas, a espécie tremoço azul acumulou a maior quantidade de N na parte aérea (113,7 kg ha-1 de N). Os tratamentos que adicionaram menor quantidade de N ao solo pela fitomassa foram a aveia preta (41,7 kg ha-1 de N) e o pousio invernal (20,5 kg ha-1 de N). Aproximadamente, 60% do N acumulado na parte aérea das leguminosas foi liberado durante os primeiros 30 dias após o seu manejo. Na ausência de adubação nitrogenada, o rendimento de grãos de milho foi maior após as leguminosas do que após a aveia e o pousio invernal. As leguminosas diferiram entre si quanto ao potencial de fornecimento de N ao milho. Os maiores valores de equivalência em N mineral (EqN) foram obtidos com a ervilhaca (137 kg ha-1 de N) e com o tremoço (122 kg ha-1 de N), evidenciando a possibilidade de redução das quantidades de N mineral por aplicar no milho quando ele for cultivado em sucessão a estas duas leguminosas.

Contrat de mariage de François-Adhémar de Monteil de Grignan avec Françoise-Marguerite de Sévigné. (28 janvier 1669).

Copie collationnée.

Interaction between widening of diameter of abdominal aorta and cardiovascular risk factors and atherosclerosis burden.

The aim of this study was to investigate influence of traditional cardiovascular risk factors (CVRF) and subclinical atherosclerosis (ATS) burden on early stages of abdominal aortic diameter (AAD) widening among adults. 2,052 consecutive patients (P) (39 % women), mean age 52 ± 13 years, were prospectively screened for CVRF, ATS, and AAD. B-mode ultrasound was used to evaluate the largest AAD and to detect carotid and femoral atherosclerotic plaques. Mean AAD was 15.2 ± 2.8 mm. Atherosclerotic plaques were detected in 71 % of patients. Significant univariate correlation between AAD, traditional CVRF, and ABS was found. However, multiple regression analysis showed that only seven of them were significantly and weakly correlated with AAD (R² = 0.27, p < 0.001). On the other hand, a multivariate logistic analysis was used to evaluate CVRF impact on enlarged AAD ≥25 mm (EAAD) as compared to those with AAD <25 mm. These factors did not account for more than 30 % of interaction (R² = 0.30, p = 0.001). Furthermore, despite a large proportion of patients with high number of CVRF, and subclinical ATS, rate of patients with AAD ≥25 mm was low (1 %) and scattered regardless their CHD risk score or ATS burden. In conclusion, these results suggest that although some traditional CVRF and presence of ATS are associated with early stages of EAAD, other determinants still need to be identified for a better understanding of abdominal aortic aneurysm pathogenesis.