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Salivary autoantibodies in HIV-associated salivary gland disease
95
CURRENT LITERATURE
Does Obesity Influence Early Target Organ Damage in Hypertensive Patients? Schmieder RE, Messerli FH. Circulation 87: 1482, 1993
Both obesity and hypertension have been well established as independent risk factors for heart disease. Recently, however, there have been several large-scale studies that indicate a protective effect in obese hypertensives, seemingly endowing these patients with a lower risk of cardiovascular disease than their lean counterparts. There is a question as to whether or not obesity may lessen the impact of hypertension on coronary arteries and there have been numerous recent conflicting studies on this subject. This study examines the protective effects of obesity on systemic circulation, renal vasculature, and cardiac structure in early hypertension. More than 200 patients were studied, classified as either normotensive or hypertensive, and grouped according to body mass index as lean or obese. Measurements were made of cardiac output, renal blood flow, mean arterial pressure, and ventricular structure and function. Early target organ damage was evaluated by means of systemic and renal vascular resistance, large artery compliance, and left ventricular mass. Results showed a decrease in total peripheral resistance and an increase in compliance in obese hypertensives compared with lean hypertensives. Obesity did not appear to influence renal circulation but hypertension did elevate renal vascular resistance. Left ventricular hypertrophy was also increased in hypertensive patients and was greater with obesity. However, obesity did not effect left ventricular function. Thus, these findings negate the concept that obesity exerts a protective effect on early target organ damage caused by hypertension on the heart or kidney.-M.J. RISSER
can mimic SjGgren’s syndrome (SS). Both show focal lymphocytic infiltration, but HIV-SGD has a CD8ST cell predominance whereas SS has CD4+T cell. Peripheral blood changes are also similar in the two groups. However, one difference has been suggested with regard to the circulating autoantibodies. The purpose of this study was to attempt to isolate the specific autoantibodies of the HIV-SGD patients. Saliva from 11 HIV-SGD+ patients, 13 HIV+ patients without HIV-SGD, 14 HIV- patients, and 11 SS patients was evaluated. In 10 of the 11 SS patients either anti-SS-A/Ro and/or anti-SS-B/La autoantibodies were present. None of the HIV-SGD patients had these autoantibodies. Five of the HIV-SGD patients had antibodies that recognized the cytoplasm of the HSG salivary cell and HEP-2 salivary cell, but no specific cytoplasmic antigen recognized by salivary autoantibodies could be detected. There was no relationship between circulating salivary autoantibodies in any of the HIV infected patients. These findings suggest that although glandular polyclonal expansion occurs in both HIV-SGD and SS, different autoantibodies are produced. Further studies to isolate the specific antibodies should include mucosal samples as well as salivary Samples-MARK ALAN PLANT Reprint requests to Dr Atkinson: National Institute of Dental Research, 9000 Rockville Pike, Bldg 10, Room IN- 113, Bethesda, MD 20892. Population-Based Study of Fall Injuries in Children or Adolescents Resulting in Hospitalization or Death. Rivara FP,
Alexander B, Johnston B, et al. Pediatrics 92:6 1, 1993
Path01 Med 22~203, 1993
Children are most frequently brought to the emergency room because of fall-related injuries. Fortunately few of these injuries are fatal. In 1986, only 322 patients younger than 19 years died from fall-related injuries. This study was undertaken to examine population-based rates of fall-related injuries and determine the cost of medical care associated with such injuries. The data came from all Washington State hospitals (excluding VA and military medical centers and any state residents treated out of the state). In all, 9,036 patients younger than 19 years were admitted during 1989 and 1990. Twenty Nine and four tenths percent of the admissions were because of fall-related injuries, and the victims tended to be younger. Males had nearly twice the rate of hospitalization as females. The overall fatality rate for hospitalized children with fall-related injuries was 1.I %, and only one child younger than 10 years died. The most common type of fall was from one level to another (eg, on a playground, otit of beds, off of tables, etc), accounting for 37.5% of the injuries. By contrast, older children tended to get injured from falls on the same level (eg, slipping on a floor, etc). The most common injuries were fractures and dislocations (73.6%), followed by head injuries (22%). Head injuries were especially common in preschool children (42%). Other studies have shown head trauma rates in 54% of the cases, followed by other skeletal trauma in 33% of the cases. The most common surgical procedure performed was open reduction and internal fixation; closed reductions were second. The authors then discuss ways in which structures, stairways, and windows can be made safer. They also point out that it appears that great height (> 10 feet) and/or more unforgiving surfaces are needed to produce significant injuries in children. Falls on stairways are problems at the extremes of age. The annual cost ofthese injuries in Washington state was $4.5 million.R.E. ALEXANDER
It has been shown that a subset of patients with HIV-l infections develop salivary gland disease (HIV-SGD) which
Reprint requests to Dr Rivara: Harborview Injury Prevention and Research Center, 325 Ninth Ave, Seattle, WA 98104.
Reprint requests to Dr Schmieder, Department of Medicine, University of Erlangen-Numberg, Kontumazgarten 14-18.8500 Numberg 80, Germany. Fractures of the Frontal Sinus: A Rationale of Treatment.
Ioannides C, Freihofer HP, Friens J. Br J Plast Surg 46:208, 1993 A treatment protocol was developed for the treatment of frontal sinus fractures based on experience with 7 1 patients. Follow-up was for as long as 10 years. The main objective of treatment was isolation of intracranial structures with cessation of cerebral spinal fluid leakage, prevention of posttraumatic infection, and restoration of facial esthetics. If posterior wall fracture is extensive with loss of bone, the sinus should be cranialied. All other posterior wall fractures should be obliterated after mucosal stripping. Autogenous cancellous bone from the iliac crest was the material of choice for obliteration. Isolated anterior wall fractures should be repaired with plates or wires and using either iliac crest or calvarial bone for grafting if necessary. Silicon drain placement in the nasofrontal duct is recommended for all cases. Broad spectrum antibiotics, such as amoxicillin, should be administered prophylactically. Long-term follow-up is mandatory.-L.C. METZGER
Reprint requests to Dr Ioannides: Department of Head and Neck Surgery, University Hospital Sint-Rafael, Kapucijnenvoer 33, 3000 Leuven, Belgium. Salivary Autoantibodies in HIV-Associated Salivary Gland Disease. Atkinson J, Schiodt M, Robataille S, et al. J Oral
CURRENT LITERATURE
Does Obesity Influence Early Target Organ Damage in Hypertensive Patients? Schmieder RE, Messerli FH. Circulation 87: 1482, 1993
Both obesity and hypertension have been well established as independent risk factors for heart disease. Recently, however, there have been several large-scale studies that indicate a protective effect in obese hypertensives, seemingly endowing these patients with a lower risk of cardiovascular disease than their lean counterparts. There is a question as to whether or not obesity may lessen the impact of hypertension on coronary arteries and there have been numerous recent conflicting studies on this subject. This study examines the protective effects of obesity on systemic circulation, renal vasculature, and cardiac structure in early hypertension. More than 200 patients were studied, classified as either normotensive or hypertensive, and grouped according to body mass index as lean or obese. Measurements were made of cardiac output, renal blood flow, mean arterial pressure, and ventricular structure and function. Early target organ damage was evaluated by means of systemic and renal vascular resistance, large artery compliance, and left ventricular mass. Results showed a decrease in total peripheral resistance and an increase in compliance in obese hypertensives compared with lean hypertensives. Obesity did not appear to influence renal circulation but hypertension did elevate renal vascular resistance. Left ventricular hypertrophy was also increased in hypertensive patients and was greater with obesity. However, obesity did not effect left ventricular function. Thus, these findings negate the concept that obesity exerts a protective effect on early target organ damage caused by hypertension on the heart or kidney.-M.J. RISSER
can mimic SjGgren’s syndrome (SS). Both show focal lymphocytic infiltration, but HIV-SGD has a CD8ST cell predominance whereas SS has CD4+T cell. Peripheral blood changes are also similar in the two groups. However, one difference has been suggested with regard to the circulating autoantibodies. The purpose of this study was to attempt to isolate the specific autoantibodies of the HIV-SGD patients. Saliva from 11 HIV-SGD+ patients, 13 HIV+ patients without HIV-SGD, 14 HIV- patients, and 11 SS patients was evaluated. In 10 of the 11 SS patients either anti-SS-A/Ro and/or anti-SS-B/La autoantibodies were present. None of the HIV-SGD patients had these autoantibodies. Five of the HIV-SGD patients had antibodies that recognized the cytoplasm of the HSG salivary cell and HEP-2 salivary cell, but no specific cytoplasmic antigen recognized by salivary autoantibodies could be detected. There was no relationship between circulating salivary autoantibodies in any of the HIV infected patients. These findings suggest that although glandular polyclonal expansion occurs in both HIV-SGD and SS, different autoantibodies are produced. Further studies to isolate the specific antibodies should include mucosal samples as well as salivary Samples-MARK ALAN PLANT Reprint requests to Dr Atkinson: National Institute of Dental Research, 9000 Rockville Pike, Bldg 10, Room IN- 113, Bethesda, MD 20892. Population-Based Study of Fall Injuries in Children or Adolescents Resulting in Hospitalization or Death. Rivara FP,
Alexander B, Johnston B, et al. Pediatrics 92:6 1, 1993
Path01 Med 22~203, 1993
Children are most frequently brought to the emergency room because of fall-related injuries. Fortunately few of these injuries are fatal. In 1986, only 322 patients younger than 19 years died from fall-related injuries. This study was undertaken to examine population-based rates of fall-related injuries and determine the cost of medical care associated with such injuries. The data came from all Washington State hospitals (excluding VA and military medical centers and any state residents treated out of the state). In all, 9,036 patients younger than 19 years were admitted during 1989 and 1990. Twenty Nine and four tenths percent of the admissions were because of fall-related injuries, and the victims tended to be younger. Males had nearly twice the rate of hospitalization as females. The overall fatality rate for hospitalized children with fall-related injuries was 1.I %, and only one child younger than 10 years died. The most common type of fall was from one level to another (eg, on a playground, otit of beds, off of tables, etc), accounting for 37.5% of the injuries. By contrast, older children tended to get injured from falls on the same level (eg, slipping on a floor, etc). The most common injuries were fractures and dislocations (73.6%), followed by head injuries (22%). Head injuries were especially common in preschool children (42%). Other studies have shown head trauma rates in 54% of the cases, followed by other skeletal trauma in 33% of the cases. The most common surgical procedure performed was open reduction and internal fixation; closed reductions were second. The authors then discuss ways in which structures, stairways, and windows can be made safer. They also point out that it appears that great height (> 10 feet) and/or more unforgiving surfaces are needed to produce significant injuries in children. Falls on stairways are problems at the extremes of age. The annual cost ofthese injuries in Washington state was $4.5 million.R.E. ALEXANDER
It has been shown that a subset of patients with HIV-l infections develop salivary gland disease (HIV-SGD) which
Reprint requests to Dr Rivara: Harborview Injury Prevention and Research Center, 325 Ninth Ave, Seattle, WA 98104.
Reprint requests to Dr Schmieder, Department of Medicine, University of Erlangen-Numberg, Kontumazgarten 14-18.8500 Numberg 80, Germany. Fractures of the Frontal Sinus: A Rationale of Treatment.
Ioannides C, Freihofer HP, Friens J. Br J Plast Surg 46:208, 1993 A treatment protocol was developed for the treatment of frontal sinus fractures based on experience with 7 1 patients. Follow-up was for as long as 10 years. The main objective of treatment was isolation of intracranial structures with cessation of cerebral spinal fluid leakage, prevention of posttraumatic infection, and restoration of facial esthetics. If posterior wall fracture is extensive with loss of bone, the sinus should be cranialied. All other posterior wall fractures should be obliterated after mucosal stripping. Autogenous cancellous bone from the iliac crest was the material of choice for obliteration. Isolated anterior wall fractures should be repaired with plates or wires and using either iliac crest or calvarial bone for grafting if necessary. Silicon drain placement in the nasofrontal duct is recommended for all cases. Broad spectrum antibiotics, such as amoxicillin, should be administered prophylactically. Long-term follow-up is mandatory.-L.C. METZGER
Reprint requests to Dr Ioannides: Department of Head and Neck Surgery, University Hospital Sint-Rafael, Kapucijnenvoer 33, 3000 Leuven, Belgium. Salivary Autoantibodies in HIV-Associated Salivary Gland Disease. Atkinson J, Schiodt M, Robataille S, et al. J Oral