Effectiveness of benzyl benzoate in elimination of house dust mites

The effect of elimination treatment with benzyl benzoate was examined in 30 adults with asthma caused by sensitivity to house dust mites. The patients were randomised into a control and an active group, who treated their mattresses with benzyl benzoate (Acarosan^®). The study lasted 12 months and the effect of the treatment was monitored by monthly dust sampling, analyzed for major allergens fromDermatophagoides pteronyssinus andfarinae by the ELISA method and for guanine by the Acarex^® method. The clinical effect was assessed by measuring lung function, daily peak flows, symptoms and medicine consumption as well as skin prick tests, and specific IgE to mite allergens. For both groups, a significant decrease was observed in house dust mite allergens, but there was no significant difference between the groups. No considerable differences were observed in clinical parameters within or between the groups. A good correlation was observed between ELISA and Acarex^®. but the latter showed a major variation in the different classes. In conclusion. treatment of mattresses with benzyl benzoate had no effect in a group of patients with asthma due to house dust mite allergy. Regular vacuum cleaning of the bed may reduce house dust mite allergen exposure.     

Do-not-resuscitate order. What happens after hospital discharge?

We observed 55 inpatients with "do-not-resuscitate" (DNR) orders to determine what happened to their DNR status after hospital discharge. All were admitted to the medical service of a Department of Veterans Affairs hospital. Of the 55 patients, 16 died in the hospital, 10 were discharged to inpatient hospice units, and 1 was transferred to an acute care hospital. An additional 19 patients were discharged to nursing homes. The other 9 patients (16% of the total) survived their hospital stays; 6 successful contacts were made with patients'' spouses. In 1 case the spouse thought a DNR order was no longer desirable. In the other 5 cases the spouse said the DNR status was "probably" or "definitely" still warranted, but only 1 spouse had a written DNR order at home. We contacted 9 of the 14 house officers who had cared for the patients in hospital. Only 2 had ever written a DNR order after hospital discharge. Two house officers said they routinely discussed with family members a patient''s expected dying process at home. Unwanted resuscitation is as undesirable at home as in the hospital. Physicians should discuss future resuscitation procedures with patients who have DNR orders at the time of hospital discharge. Physicians, paramedic service directors, and policymakers also should develop protocols and standardized home DNR orders so that paramedics can honor the wishes of patients in the prehospital setting.     

Nd-YAG Laser in Lung Cancer

We administered 45 Nd-YAG laser treatments in 29 patients (18 men) aged 39 to 82 years who had lung malignancy; 26 patients had primary non-oat cell lung cancer and three had metastatic airway malignancy. In all, 25 of the patients had been previously treated with combination(s) of surgical procedure, radiation therapy and chemotherapy. Indications for laser treatment included endobronchial airway obstruction with uncontrolled cough, hemoptysis, dyspnea or unresolved atelectasis-pneumonia. Of 15 patients with partially occluded tracheobronchial airway tumors, immediate palliative relief was achieved in 13 patients and lasted one to six months after a single treatment. In this group there was one postoperative death related to respiratory failure and two patients subsequently died of massive pulmonary hemorrhage. However, of 14 patients with totally obstructed airways, immediate palliative relief was achieved in only five patients and this lasted three weeks to three months after a single treatment. In this group there were two postoperative deaths related to progressive respiratory failure; in one case it was associated with endobronchial combustion of the fiberoptic bronchoscope. All three patients in both groups who died of respiratory failure were in acute respiratory distress and terminally ill before the procedure. These findings suggest that Nd-YAG laser therapy may be most beneficial in patients with partially rather than totally occluded airways due to lung malignancy.     

盐城地区未成年过敏性疾病患者吸入性过敏原IgE检测结果分析

摘要 目的：通过研究分析盐城地区未成年过敏性疾病患者吸入性过敏原特异性IgE检测结果分布变化特点,为过敏性疾病预防和临床诊疗提供科学依据。方法：自2020年1月至2021年3月期间,选择430例未成年(<18岁)过敏性疾病患者,血清检测方法采用欧蒙公司生产的过敏原特异性IgE检测试剂盒。结果：430例患者中,血清过敏原IgE阳性166例(38.60%),其中尘螨和屋尘是主要的吸入性过敏原。血清IgE阳性率男性39%,女性36% (P>0.05),中学组女性阳性率（61.11 %）高于男性（45.83 %）（P<0.05）。不同年龄组间IgE阳性率有统计学差异（P<0.05）,蟑螂、尘螨、霉菌、豚草、屋尘和年龄组间有统计学差异（P<0.05）。不同临床症状与IgE阳性率有统计学差异(P<0.05),其中呼吸道过敏症状组IgE阳性率最高（48.30 %）,不同症状组间主要过敏原都是尘螨。屋尘阳性患者均合并尘螨阳性,其中70.93 %的患者表现出了呼吸道过敏症状。结论：尘螨、屋尘是盐城地区未成年过敏性疾病患者最主要的吸入性过敏原,研究血清过敏原分布,对未成年人过敏性疾病的预防、诊疗具有重要意义。     

A Reflection of Joan

A case history is reported to demonstrate a simple psychotherapeutic approach in family practice to patients with psychoneurotic illness with somatic complaints. The patient had a two-year history of multiple aches and pains, particularly centred on her abdomen. In two interviews, a total of one and a half hours, her problem was isolated more definitely and relief was provided for her symptoms. It is suggested that this is a practical approach to such patients, who are probably a large factor in any “overutilization” of physician''s services.     

A mite survey in the dumpsters for urban solid rubbish

Summary The presence of house dust mites and storage mites in dumpsters was investigated in 3 different areas of Venice hinterland. The aim of this study was to find a relationship between some reported respiratory symptoms among 6 workers who were responsible for moving the dumpsters to the truck and the bio-aerosol released from such operation. These symptoms were closely related to the work and after allergological evaluation we found sensitisation to house dust mites in all 6 employees. The mine exposure in the workplace was assessed by a standardized sampling and analysis of dust obtained after brushing the inside surfaces of dumpsters. In 50% of the specimens (10/20) we found mites belonging to the following families: Pyroglyphidae (Dermatophagoides spp.), Acaridae (Acarus siro) and a lower amount of Cheyletidae (Cheyletus spp.). An indirect test (guanine test) was also performed and gave positivity in 16 dust samples (80%). The insides of dumpsters showed to be an optimal environment for mites survival and reproduction because of cracks and grooves on the walls, the high humidity level and the presence of mould. These mites probably come from dwelling places and other environments (markets, slaughters-houses, farms, etc.). This suggests that mites allergens can be released during rubbish discharging from the dumpsters and represent a possible risk for the employees.     

Hypertrophic osteoarthropathy in cystic fibrosis.

Seven adult patients with cystic fibrosis who had radiological evidence of hypertrophic osteoarthropathy were reviewed. In five of the patients symptoms were particularly pronounced at times of acute infective exacerbations; appropriate treatment of the infective episodes resulted in reduction or resolution of the bone pain and joint effusions. Despite this symptomatic relief periosteal changes persisted radiologically and their chronic nature was indicated by changes in the midshafts of long bones. Four of the seven patients had transient gynaecomastia or mastalgia related to infective exacerbations. It is hypothesised that a neuroendocrine mechanism--namely, release of vasoactive intestinal polypeptide--might account for the osteoarthropathy.     

Effectiveness of vacuum cleaning and wet cleaning in reducing house-dust mites,fungi and mite allergen in a cotton carpet: A case study

In order to evaluate the effect of continuous, thorough vacuuming on house dust organisms and mite allergen, a cotton carpet was vacuumed every other day, six times in total. Seven weeks later, the carpet was cleaned by means of spray extraction. Samples were taken before and after this wet cleaning.In total 1150 g of dust was collected, containing approximately 174 000 arthropods (dead and alive) and 9000×10⁶ fungal spores. In the course of the experiment, the amount of dust collected at each vacuuming decreased. The number of extracted house dust mites did not decrease significantly, but that of the predator miteCheyletus did. The number of extracted fungal spores showed a significant decrease (from 142 to 16×10⁶ spores/m² per minute vacuuming), as did the extracted mite allergen per m². After 7 weeks the number of mite eggs and complete house dust mites had increased enormously. After cleaning by spray extraction another increase in the number of complete mites and mite eggs was found, while the amount of mite allergen was diminished.The population growth of the house dust mite between the 6th and the 7th vacuuming is probably due to the decrease of their most important predator,Cheyletus. After the wet cleaning a number of extra eggs hatched, probably due to the high humidity in the carpet. The procedures used in this study to combat house dust mites may have an adverse effect in the long run.     

Fine needle aspiration cytology of benign lymph node hyperplasias. Diagnostic significance of lymphohistiocytic aggregates

The fine needle aspiration cytomorphology and the number of lymphohistiocytic aggregates were correlated with five categories of benign lymph node histologies. Of 187 patients who had benign lymph node aspiration diagnoses made from 1975 to 1982 at the Medical College of Virginia, 26 had a subsequent lymph node biopsy. Excluded from the study were four cases with the biopsy site different from the aspiration site, three cases with evidence of metastatic carcinoma and one case of fistula at the site of biopsy. Of the remaining 18 cases, 13 (72%) had lymphohistiocytic aggregates on the aspiration slides. The mean number of lymphohistiocytic aggregates on the aspiration slides was greater in cases with histologic evidence of follicular hyperplasia (6.1) than in those with some other predominating benign histology (1.6).     

CANCER OF THE LUNG IN WOMEN

Cancer of the lung in women has the same signs and symptoms as in men, but the disease seems to advance more rapidly. Of 35 female patients, half were under radiation therapy (for inoperable tumor) within four months after the first manifestation. In three of the five who had no symptoms, the cancer when diagnosed was inoperable.Scalene node biopsy confirmed metastasis in nine of the eleven cases in which it was used, and this procedure should be used after diagnosis whenever metastasis is not evident.Of the 35 women, two received only chemotherapy, 32 radiotherapy. Only four were alive at the time of report—one without evidence of disease at 20 months, one with symptoms of disease at 11 months, two under chemotherapy at two months, For 29 who received palliative or radical irradiation to the primary tumor site, the median survival time was 26 weeks.     

Commentary: assessing the effects of environmental pollution when people know that they have been exposed.

OBJECTIVE: To examine the effectiveness of routine clinic review in detecting relapse after treatment for Hodgkin''s disease. DESIGN: Review of hospital records. SETTING: Regional centre for cancer treatment and research. SUBJECTS: 210 patients with Hodgkin''s disease recruited to a chemotherapy trial protocol between 1984 and the end of 1990 who had achieved a complete or partial remission after treatment. MAIN OUTCOME MEASURES: The number of clinic visits made by patients over the period of observation, the number of relapses occurring during that time, and the route by which relapse was detected. RESULTS: The 210 patients generated 2512 outpatient reviews, and 37 relapses were detected. Thirty relapses (81%) were diagnosed in patients who described symptoms, which in 15 cases had resulted in an earlier appointment being arranged. In only four cases (11%; 95% confidence interval 4% to 25%) was relapse detected as a result of routine physical examination on investigation of a patient who did not have symptoms. CONCLUSIONS: Relapse of Hodgkin''s disease after treatment is usually detected as a result of the investigation of symptoms rather than by routine screening of asymptomatic patients. It is therefore proposed that the frequency of routine follow up visits should be reduced and greater emphasis placed on patient education. This should underline the importance of symptoms and encourage patients to arrange an earlier appointment if these develop.     

Mithramycin therapy in Paget's disease

Nine patients with symptomatic Paget''s disease were treated with mithramycin in doses of 15 μg/kg/day for 10 days. All but one had considerable symptomatic improvement and, in some, pain relief was dramatic after only a few days. A progressive decrease in serum alkaline phosphatase levels and urinary hydroxyproline excretion was seen at the same time. Bone scans with technetium-99m stannous polyphosphate were performed in six patients and were grossly abnormal in all, showing increased uptake in areas approximately co-extensive with the radiological changes. In five cases improvement in the scans was seen during therapy. In those cases in which the scans had not returned to normal by the end of therapy the improvement continued and was associated with a further decrease in serum alkaline phosphatase levels. We suggest that mithramycin is effective therapy for Paget''s disease and, in the dose used, is safe.     

ADENOMA OF THE ISLETS OF LANGERHANS

An adenoma of the islets of Langerhans may be found anywhere in the pancreas but is more common in the body and tail, and more than one tumor may be present. When such a tumor produces insulin the symptoms observed are those of hyperinsulinism, varying from pallor, sweating, weakness and amnesia in mild cases to coma and convulsions in the more severe.The diagnosis rests largely on Whipple''s triad, namely, the onset of symptoms during the fasting period or after exertion, sugar content in the blood of less than 50 mg. per 100 cc. during an attack, and immediate relief of symptoms upon the administration of glucose in one form or another.Surgical removal of an adenoma is the only known cure, and unless it is done the patient will eventually die of the effects of prolonged hyperinsulinism. The procedure entailed may be relatively simple, or fraught with great difficulties and postoperative complications of a major nature.The literature indicates that there has been a mortality rate of 8 or 9 per cent associated with the surgical treatment of this condition.     

CONGENITAL CARDIAC DEFECTS—Indications for Surgical Repair

The optimum ages for the operative repair of the various congenital defects have not as yet been definitely established. With certain exceptions, it has generally been the authors'' preference to delay elective operations until after the age of 18 months. In the usual case, the optimum age for the closure of septal defects is believed to be three to five years. Operative relief of stenosis of the aortic or pulmonic valves, however, is related entirely to the extent of the obstruction, age not being a factor. Although the surgical treatment of coarctation of the aorta is probably best delayed beyond the period of infancy, it is the authors'' belief that in the presence of extreme hypertension, cardiomegaly or cardiac failure, early resection of the aortic block should be accomplished. As to the treatment of tetralogy of Fallot, the authors'' policy is to delay operation until such time as definitive repair becomes less hazardous. Patients with severe symptoms, however, are given the benefit of some form of operative relief as soon as possible. Whether this is palliative or corrective depends upon the characteristics of the individual case.Definitive diagnostic studies are of great aid in assessing the urgency of operative intervention. The fact that approximately one-third of the patients dealt with required operation at less than 18 months of age suggests that, in selected cases, these studies should be performed early in infancy.     

n of 1 trials comparing a non-steroidal anti-inflammatory drug with paracetamol in osteoarthritis.

OBJECTIVE--To evaluate the efficacy of paracetamol and a non-steroidal anti-inflammatory drug for symptom relief in osteoarthritis. DESIGN--Double blind, randomised, controlled trials in individual patients (n of 1 trials). Three treatment cycles with two weeks'' each of paracetamol (1 g twice daily) and diclofenac (50 mg twice daily) prepared in identical gelatin capsules. SETTING--General practices in metropolitan Sydney, Australia. SUBJECTS--25 patients (median age 64 years) with pain of osteoarthritis (median duration of disease eight years) considered by their general practitioners to require regular treatment. 20 were already taking non-steroidal anti-inflammatory drugs. MAIN OUTCOME MEASURES--Diary of pain and stiffness, function, and side effects. RESULTS--15 patients completed the study, five withdrew early but had made a therapeutic decision, and five dropped out very early. Results from 20 patients were analysed. Several patterns of response evolved. Eight of the 20 patients found no clear difference, symptoms being adequately controlled by paracetamol; five indicated a clear preference for the non-steroidal anti-inflammatory drug; two showed control of symptoms after their initial two weeks of the non-steroidal anti-inflammatory drug which continued throughout subsequent treatment changes; in five the non-steroidal anti-inflammatory drug may have been better but neither agent gave satisfactory control. After three months nine of the 20 patients had adequate symptom control with paracetamol alone. CONCLUSIONS--Of 1 studies--that is, randomised trials in individual patients--are clinically useful in deciding treatment in heterogeneous conditions which require long term symptomatic relief. In osteoarthritis many patients currently receiving or being considered for non-steroidal anti-inflammatory drugs may achieve adequate control with paracetamol.     

ACUTE GALLBLADDER DISEASE—Experiences with 103 Consecutive Cases

One hundred and three cases of acute cholecystitis in patients ranging in age from 19 to 88 years were reviewed. Operation was done in all cases. Seventy per cent of the patients were women.Primary cholecystectomy was done in 72.8 per cent of the series. Primary cholecystostomy was performed in the remainder, and one-fourth of these patients had a secondary cholecystectomy. No specific time, with relation to interval after onset of symptoms, was chosen for operation.Jaundice was present in 14.5 per cent of patients at the time of admittance to hospital. Serum amylase was above normal in five of 27 patients on whom this determination was carried out. All five were women.The gallbladder was perforated in 13 cases. Common duct exploration was done in 25 cases and in 12 of them stones were found.The morbidity rate for the series was 11.6 per cent; the mortality rate 9.7 per cent.     

急性病毒性肝炎的发病率慢性肝炎患病率和肝病死亡率的研究

1984～1987年,在黑龙江、河北、河南、湖南、上海五个省市城乡10.08855人口中进行急性肝炎发病率、慢性肝炎患病率、与病毒性肝炎有关的肝病死亡率的研究。急性肝炎标化发病率为152.19/10万,主要发生在20～50岁组人群;因无甲肝暴发流行,除上海外各点季节发病率分布均衡。慢性肝炎标化患病率为158.25/10万(诊断标准为6个月前有明确急性肝炎病史,现有明显的临床症状或体征,肝功能异常,故实际慢肝患病率要高于此数字);与病毒性肝炎有关的肝病死亡(包括肝癌)标化率为22.65/10万,其中肝病为 13.14/10万。男性死亡率显著高于女性。     

COMPLICATIONS OF TATTOOING

Pathologic consequence of tattooing is relatively rare, but in light of the great number of persons in military service, where tattooing seems to be popular, consideration of the complications seems worth while.Four unusual cases of patients with cutaneous lesions in tattoos are reported. One patient had Boeck''s sarcoid, in which the cutaneous eruption was limited solely to the tattooed areas on the body and involved all the various colors of the tattoo. The cutaneous eruption was only a single manifestation of generalized sarcoidosis.Another patient had secondary syphilis with the cutaneous lesions involving multi-colored tattoos, including the red areas. These tattoos were applied in Hawaii, and presumably the red dye was not the usual cinnabar (mercuric sulfide). As a general rule, the cutaneous lesions of secondary syphilis do not involve the red areas because of the treponomicidal action of mercuric sulfide.In the third case the characteristic eruption of discoid lupus erythematosus was present. It began over the red areas of a tattoo on the patient''s forearm. It has been stated that mercuric sulfide is a photo-sensitizing agent, and it is believed that this explains the localization of the eruption in this case.The fourth patient had eruption, caused by mercury sensitivity, in an area of tattoo. The eruption was noted soon after the tattooing was done, and it persisted for seven years.     

TREATMENT OF ITCHING—A Preliminary Report on Results with a New Oral Antipruritic

A new antipruritic, trimeprazine, was used in the treatment of itching associated with a variety of dermatologic disorders in 215 patients.Good to excellent relief of itching was experienced by 71 per cent of the patients, fair relief by 15 per cent and poor relief by 14 per cent.Side effects included mild and transient drowsiness or dizziness that cleared spontaneously; six cases of drowsiness that necessitated discontinuance of the drug; three cases of drowsiness that was controlled by reduction of the dosage; and one case of generalized eruption that cleared upon discontinuance of the drug.     

LAMINECTOMY FOR HERNIATED INTERVERTEBRAL DISC

In a study of 59 patients surgically treated by various surgeons for relief of herniated lumbar intervertebral disc accompanied by symptoms that persistently recurred or had become resistant to conservative therapy, it was noted from review of hospital and office records that laminectomy either greatly relieved or entirely abated symptoms in 83 per cent of the cases.Postoperative complications reported by the surgeons who did the operations consisted of one death and five wound infections. Contrast myelography and electromyography, used in almost all cases in the series, appeared to be valuable adjuncts in the diagnosis of herniated lumbar intervertebral discs. The most common site of the lesion in this series was between the fourth and fifth lumbar vertebrae. Strain upon lifting was the most commonly reported precipitating factor.