- Email: [email protected]
Quantitative assessment of mast cells in recurrent aphthous ulcers (RAU)
216
CURRENT LITERATURE
measurement of ryanodine contractures in skeletal muscle, where the time to development of contracture may help distinguish the category of malignant hypertherma-equiuocal as susceptible or nonsusceptible. MH has been limited to chromosomes 17q, 7q, 3q, and lq. Central core disease is a rare, nonprogressive myopathy, presenting in infancy, which is characterized by hypotonia and proximal muscle weakness. Additional variable clinical features include pes cavus, kyphoscoliosis, foot deformities, congenital hip dislocation, and joint contractures, or it may come to attention after a MH reaction. Central core disease is inherited as a autosomal dominant trait with variable penetrance.-R.H. HAUG Reprint requests to Dr MacLennan: search, C.H. Best Institute, University Toronto, Ontario, Canada M5G lL6.
Department of Toronto,
of Medical Re112 College St,
An Inexpensive Self Fabricated Pressure Clip for the Earlobe. Agrawal K, Panda KN, Arumugam A. Br J Plast Surg 51:122, 1998 Pressure therapy is well established as a treatment modality for the management of hypertrophic and keloid scars. Pressure therapy has been shown to promote early maturation of scar tissue. Ear keloids present a particular challenge as they are not amenable to pressure therapy. Expensive, light-pressure earrings have been used in the past with good results. The authors have used a self-fabricated pressure clip made from cold-cure polymethylmethacrylate and 19 gauge orthodontic wire. This clip has been used in 41 earlobe keloids in 26 patients along with postexcisional triamcinolone acetonide therapy, 5 earlobe reconstructions and 2 cases of earlobe clefts over an &year period. The clip is applied 2 weeks postsurgery and maintained continuously a minimum of 6 months. A total of 27 earlobes in 18 patients with ear keloids have undergone ear piercing after 6 to 18 months of pressure therapy. Two patients developed pressure ulcerations while using the clip, but these resolved spontaneously after temporary cessation of the clip.-C.E. PEOPLESIII Reprint requests to Dr Agrawal: Departments of Plastic Surgery and Dentistry, Jawaharlal Institute of Postgraduate and Research, Pondicherry, India.
Evaluation of Bleeding Disorders. Postgrad Med 103:209, 1998
Medical
Education
Sallah S, Kato
G.
Defects in any component of the different biological systems that contribute to the arrest of bleeding at the site of tissue injury may result in a bleeding disorder. A patient’s history is the most important element of evaluation of such disorders but a basic knowledge of the normal hemostatic mechanisms
is essential
for
accurate
interpretation
ary hemostasis is assessed via the partial thromboplastin test, prothrombin time, and thrombin time tests. The partial thromboplastin test evaluates the intrinsic and common pathways and the normal is between 25 and 35 seconds, depending on the reagent used. The prothrombin time evaluates the extrinsic and common pathways and is used to monitor patients receiving oral anticoagulants. The international normalized ratio has been developed to correct for differences in the reagents used. A normal international normalized ratio is less than or equal to 1.2 and the usual therapeutic range is 2.0 to 3.0 for most conditions. The thrombin time measures the conversion of fibrinogen to fibrin but is only used when heparin contamination is suspected. Tertiary hemostasis (fibrinolysis) is assessed by the clot lysis time and by plasminogen and tPA assays. These tests are not available at all laboratories. The authors emphasize that most abnormal bleeding can be evaluated through a detailed patient history and they discuss the various elements of such a history.-ROGER E. ALEXANDER Reprint requests to Dr SaIlah: Division ogy, East Carolina University School
of Hematology and Oncolof Medicine, SE-127 Brody
Medical Science Building, Greenville, NC 27858. Quantitative Assessment of Mast Ce& in Recurrent Aphthous Ulcers (RAU). Natah SS, Hayrinen-Immonen R, Hietanen J, et al. J Oral Path01 Med 27:124, 1998 Recurrent aphthous ulcers (RAUs) affect the oral mucosal membranes of 17.7% of the population. Predisposing factors are stress, food, drugs, hormonal changes, trauma, and infections. There is great similarity between the triggering factors for occurrence of RAU and those causing mast cell (MC) degranulation. The role of MCs as releasing mediators has been recognized recently. A study was carried out to detect the quantity of MCs in RAUs (n = 15) compared with induced oral traumatic ulcers (TUs) (n = 9) with the healthy oral mucosa (n = 15) as a control group. Immunohistochemical studies were carried out on the biopsy specimens obtained from these three groups of patients. The immunoreactive MCs were detected with a microscope at 400X in different fields from the ulcer base, subepithelial lamina propria, inflammatory infiltrates and connective tissue areas. MCs were counted as MCs/mn? tissue and found to be increased in RAUs (116 t 26 cells/mm*) when compared with TUs (72 ? 11 cells/mm’) and controls (71 2 16 cells/ mmz). Interestingly, there was no significant increase in the number of MCs in TUs compared with the control group. When immunoglobulin E reactivity was detected, the number of immunoglobulin E cells was also higher in the RAUs than TUs and control group. In conclusion, activation and degranulation of MCs in RAUs is suggestive of their active role in the pathogenesis of this lesion.-MUHTAR GUROL
of the
dif?erent laboratory tests. No single test will evaluate all components in the complex interactions of the system. In this paper, the authors first review normal hemostasis (primary and secondary) and explain how the common screening tests evaluate those responses. Primary hemostatic competency is assessed primarily by measuring the platelet count and the bleeding time. Thrombocytopenia is, by definition, a count less than 15O,OOO/yL and should be confirmed by examination of the blood smear. A prolonged bleeding time is usually reflective of a vessel-wall or platelet defect. The latter can be effected by certain medications or technician error. The test should never be used to screen asymptomatic patients with no history of bleeding. Second-
Reprint Ryhma),
requests to Dr Natah: Inflammation Research group (Tules Institute of Biomedicine, PO Box 9 (Siltavuorenpenger 2OA), FIN-00014, University of Helsinki, Helsinki, Finland.
Increased Risk of Salivary Gland Tumors After LowDose Irradiation. Modan B, Chetrit E, Tamir A. Laryngoscope 108:1095,1998 Limited studies have shown that salivary glands are radiosensitive to carcinogenesis. A model for this study was provided by the results of scalp irradiation in children between 1949 and 1959, with the subsequent increased risk for development of head and neck tumors in general. The
CURRENT LITERATURE
measurement of ryanodine contractures in skeletal muscle, where the time to development of contracture may help distinguish the category of malignant hypertherma-equiuocal as susceptible or nonsusceptible. MH has been limited to chromosomes 17q, 7q, 3q, and lq. Central core disease is a rare, nonprogressive myopathy, presenting in infancy, which is characterized by hypotonia and proximal muscle weakness. Additional variable clinical features include pes cavus, kyphoscoliosis, foot deformities, congenital hip dislocation, and joint contractures, or it may come to attention after a MH reaction. Central core disease is inherited as a autosomal dominant trait with variable penetrance.-R.H. HAUG Reprint requests to Dr MacLennan: search, C.H. Best Institute, University Toronto, Ontario, Canada M5G lL6.
Department of Toronto,
of Medical Re112 College St,
An Inexpensive Self Fabricated Pressure Clip for the Earlobe. Agrawal K, Panda KN, Arumugam A. Br J Plast Surg 51:122, 1998 Pressure therapy is well established as a treatment modality for the management of hypertrophic and keloid scars. Pressure therapy has been shown to promote early maturation of scar tissue. Ear keloids present a particular challenge as they are not amenable to pressure therapy. Expensive, light-pressure earrings have been used in the past with good results. The authors have used a self-fabricated pressure clip made from cold-cure polymethylmethacrylate and 19 gauge orthodontic wire. This clip has been used in 41 earlobe keloids in 26 patients along with postexcisional triamcinolone acetonide therapy, 5 earlobe reconstructions and 2 cases of earlobe clefts over an &year period. The clip is applied 2 weeks postsurgery and maintained continuously a minimum of 6 months. A total of 27 earlobes in 18 patients with ear keloids have undergone ear piercing after 6 to 18 months of pressure therapy. Two patients developed pressure ulcerations while using the clip, but these resolved spontaneously after temporary cessation of the clip.-C.E. PEOPLESIII Reprint requests to Dr Agrawal: Departments of Plastic Surgery and Dentistry, Jawaharlal Institute of Postgraduate and Research, Pondicherry, India.
Evaluation of Bleeding Disorders. Postgrad Med 103:209, 1998
Medical
Education
Sallah S, Kato
G.
Defects in any component of the different biological systems that contribute to the arrest of bleeding at the site of tissue injury may result in a bleeding disorder. A patient’s history is the most important element of evaluation of such disorders but a basic knowledge of the normal hemostatic mechanisms
is essential
for
accurate
interpretation
ary hemostasis is assessed via the partial thromboplastin test, prothrombin time, and thrombin time tests. The partial thromboplastin test evaluates the intrinsic and common pathways and the normal is between 25 and 35 seconds, depending on the reagent used. The prothrombin time evaluates the extrinsic and common pathways and is used to monitor patients receiving oral anticoagulants. The international normalized ratio has been developed to correct for differences in the reagents used. A normal international normalized ratio is less than or equal to 1.2 and the usual therapeutic range is 2.0 to 3.0 for most conditions. The thrombin time measures the conversion of fibrinogen to fibrin but is only used when heparin contamination is suspected. Tertiary hemostasis (fibrinolysis) is assessed by the clot lysis time and by plasminogen and tPA assays. These tests are not available at all laboratories. The authors emphasize that most abnormal bleeding can be evaluated through a detailed patient history and they discuss the various elements of such a history.-ROGER E. ALEXANDER Reprint requests to Dr SaIlah: Division ogy, East Carolina University School
of Hematology and Oncolof Medicine, SE-127 Brody
Medical Science Building, Greenville, NC 27858. Quantitative Assessment of Mast Ce& in Recurrent Aphthous Ulcers (RAU). Natah SS, Hayrinen-Immonen R, Hietanen J, et al. J Oral Path01 Med 27:124, 1998 Recurrent aphthous ulcers (RAUs) affect the oral mucosal membranes of 17.7% of the population. Predisposing factors are stress, food, drugs, hormonal changes, trauma, and infections. There is great similarity between the triggering factors for occurrence of RAU and those causing mast cell (MC) degranulation. The role of MCs as releasing mediators has been recognized recently. A study was carried out to detect the quantity of MCs in RAUs (n = 15) compared with induced oral traumatic ulcers (TUs) (n = 9) with the healthy oral mucosa (n = 15) as a control group. Immunohistochemical studies were carried out on the biopsy specimens obtained from these three groups of patients. The immunoreactive MCs were detected with a microscope at 400X in different fields from the ulcer base, subepithelial lamina propria, inflammatory infiltrates and connective tissue areas. MCs were counted as MCs/mn? tissue and found to be increased in RAUs (116 t 26 cells/mm*) when compared with TUs (72 ? 11 cells/mm’) and controls (71 2 16 cells/ mmz). Interestingly, there was no significant increase in the number of MCs in TUs compared with the control group. When immunoglobulin E reactivity was detected, the number of immunoglobulin E cells was also higher in the RAUs than TUs and control group. In conclusion, activation and degranulation of MCs in RAUs is suggestive of their active role in the pathogenesis of this lesion.-MUHTAR GUROL
of the
dif?erent laboratory tests. No single test will evaluate all components in the complex interactions of the system. In this paper, the authors first review normal hemostasis (primary and secondary) and explain how the common screening tests evaluate those responses. Primary hemostatic competency is assessed primarily by measuring the platelet count and the bleeding time. Thrombocytopenia is, by definition, a count less than 15O,OOO/yL and should be confirmed by examination of the blood smear. A prolonged bleeding time is usually reflective of a vessel-wall or platelet defect. The latter can be effected by certain medications or technician error. The test should never be used to screen asymptomatic patients with no history of bleeding. Second-
Reprint Ryhma),
requests to Dr Natah: Inflammation Research group (Tules Institute of Biomedicine, PO Box 9 (Siltavuorenpenger 2OA), FIN-00014, University of Helsinki, Helsinki, Finland.
Increased Risk of Salivary Gland Tumors After LowDose Irradiation. Modan B, Chetrit E, Tamir A. Laryngoscope 108:1095,1998 Limited studies have shown that salivary glands are radiosensitive to carcinogenesis. A model for this study was provided by the results of scalp irradiation in children between 1949 and 1959, with the subsequent increased risk for development of head and neck tumors in general. The