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INTRODUCTION: Decidual leukocytes are critical to the development of the fetomaternal interface, regulating tolerance to the semi-allogeneic fetus and vascular transformation of the uterine spiral arteries. Despite the continuation of these processes beyond the first trimester of pregnancy, the second trimester has largely been unstudied, with investigation focusing on early gestation and term tissues. We sought to characterize changes in decidual leukocyte populations from first to second trimester. METHODS: Multicolor flow cytometry was performed on isolated decidual leukocytes from elective terminations of pregnancy between 6 and 20 weeks of gestation for study of first (6-12 weeks) and second trimesters (13-20 weeks). Specific subpopulations were identified by comparison to isotype and fluorescent-minus-one (FMO) controls. RESULTS: Decidual natural killer cells (CD56(+)CD16(-)CD3(-)) did not change in number, although a population of dNK with decreased CD56 brightness was observed in second trimester decidua. CD14(+)HLA-DR(+) macrophage numbers declined from first to second trimester (p = 0.031), yet a CD163(+)CD206(+) subset designating alternatively activated M2-like macrophages increased during the same period (p = 0.015). Intermediate CD205(+) dendritic cells demonstrated significant decline (p = 0.022), but immature CD209(+) and mature CD83(+) dendritic cells did not differ between trimesters. Total CD3(+) and CD3(+)CD4(+) T lymphocytes increased (p = 0.0079, p = 0.0028); CD3(+)CD8(+) T cells trended towards increase but did not differ significantly. CONCLUSION: Several changes in leukocyte subsets are observed in the second trimester that promote a tolerogenic and angiogenic decidual microenvironment through mid-gestation.

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OBJECTIVES: The management of advanced laryngeal cancer has evolved in the last century, from total laryngectomy to chemoradiation. The aim of this study was to examine our experience with supracricoid partial laryngectomy as a possible solution for patients with advanced laryngeal tumours, with a focus on the oncological safety of the procedure and the functionality of the preserved larynges. STUDY DESIGN: We reviewed the medical records of patients with laryngeal cancer who had undergone primary or salvage supracricoid partial laryngectomy at our department between 1998 and 2004. RESULTS: Twenty-three patients treated with supracricoid partial laryngectomy for endolaryngeal squamous cell carcinoma were identified. Median follow-up time was 35 months. Twelve patients had advanced laryngeal tumours. Eight patients were radiation failures. These factors were not associated with increased local recurrence or with decreased survival. CONCLUSION: Supracricoid partial laryngectomy appears to be a feasible option for the treatment of laryngeal tumours, even in the advanced stage or after failure of radiation therapy.

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It has been suggested that the rotatory test using videonystagmoscopy can also be applied for identification of vestibular canal paresis. In this study, we test this hypothesis by comparing the results of a canal impulse rotatory test with those of the caloric test using the method described by Freyss. Our study indicates that only in 38% of all tested patients, the same results between the two tests have been obtained. Furthermore, when the group with abnormal findings is observed separately, in 24% patients only these two test methods lead to the same results. Consequently, the canal impulse rotatory test cannot replace the caloric test.

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It has been suggested that the rotatory test using videosnystagmoscopy can also be applied for identification of vestibular canal paresis. In this study, we test this hypothesis by comparing the results of a canal impulse rotatory test with those of the caloric test using the method described by Freyss. Our study indicates that only in 38% of all tested patients, the same results between the two tests have been obtained. Furthermore, which the group with abnormal findings is observed separately, in 24% patients only these two test methods lead to the same results. Consequently, the canal impulse rotatory test cannot replace the caloric test.

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Endoscopy has changed many of surgical procedures concerning nasal and paranasal cavities. It has been proposed for transnasal removal of pituitary adenomas. The authors report their experience concerning four pituitary macroadenomas operated with the neurosurgical team of Sainte-Anne hospital. The endonasal trans-septal route seemed to be more anatomical and less traumatic than the rhinoseptal sublabial route. The 30 degrees rigid Hopkins endoscope was a good help for controlling the absence of any tumor remnant in the supra and parasellar regions after complete removal of the tumor performed through the endoscope or with the operating microscope. The authors discuss the advantages and limitations of such endoscopic procedures in the light of recent literature.

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We analyzed atelectasic processes occurring in the maxillary sinus. Several publications in the literature have tempted to analyze the pathogenesis. Clinically the processes are often silent and only revealed when the major opthalmological complication, enophthalmia, becomes patent. In other cases there is a long history of chronic sinusitis. There is a spectacular retraction of the maxillary sinus walls leading to collapse of the orbital floor and enophthalmia. We report four cases of maxillary sinusitis with atelectasia of the sinus walls at different stages of progression. These observations and data in the literature emphasize the importance, whatever the state of development, of endoscopic osteal decompression to avoid ophthalmological complications.

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We report 3 cases of undifferentiated carcinomas of nasopharyngeal type (UCNT) found in unusual sites and compare them with histologically identical tumors found in the nasopharynx. Using viral serology and viral marquers found in the tumor cells, we looked for a link with the Epstein Barr Virus (EBV) which exists in the nasopharyngeal site. It appears that UCNT found in unusual sites have a poorer prognostic than the same nasopharyngeal tumors; no link was found with EBV. The number of published cases is too small to form a conclusion, therefore, we propose a systematic search for EBV, presenting our protocol, each time is discovered UCNT in an unusual site.

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We report two cases of frontal and ethmoidal mucocele revealed by severe ophtalmologic complications and present the clinical data and computed tomography and magnetic resonance imaging results together with the treatment. The surgical approach and technique are discussed. Recovery of ophtalmologic deficiency was excellent.

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OBJECTIVES: This study was undertaken to identify the content of tobacco industry smokers' rights publications and to analyze their major themes. METHODS: Fifty-eight issues of smokers' rights publications from 1987 to 1992 were selected at random and analyzed. The number of publications per year, number of mentions (sentences) in different thematic categories per year, and number of mentions per category per publication were examined. RESULTS: The number of smokers' rights publications increased rapidly from 1987 to 1992. The number of mentions across all thematic categories increased over time, with the largest numbers appearing in 1990, 1991, and 1992. The category of Political and Social Action comprised the highest average number of mentions across years. CONCLUSIONS: These publications appear to be consistent with past and present tobacco industry strategies to counter tobacco control efforts and negative public perceptions by attempting to refute scientific evidence about the health impact of environmental tobacco smoke. Additionally, they serve the industry goals of encouraging smokers to take action to protect their rights, mobilizing public opinion, and delaying societal rejection of smoking and secondhand smoke and acceptance of smoking restrictions.

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This study examined trends in tobacco use in a random sample of 2 of the 20 top-grossing US films each year from 1960 through 1990 (62 films). The overall rate of tobacco use did not change. Films continue to portray smokers as successful, attractive White males. Smoking groups became larger, smoking alone declined, hostility and stress reduction were increasingly associated with smoking, and smoking by minor characters increased. Although smoking among elite characters fell, it remained nearly three times as prevalent as in actual population data during the 3 decades. Events involving young people more than doubled. Films do not accurately represent smoking in the United States.

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Sand rats were used as a model for nutritionally induced type II (non-insulin-dependent) diabetes in an effort to evaluate the effect of acarbose on carbohydrate digestion. Daily plasma glucose profiles, insulin levels and weekly cararact development were determined following long-term feeding with a diet containing acarbose (20 or 40 mg/100 g diet). Acarbose not only dramatically decreased daily plasma glucose and insulin levels (p < 0.05) but also delayed, and possibly prevented, cataract formation in sand rats. The effect of acarbose persisted for 150 days. The control of daily plasma glucose levels and reduction of insulin levels obtained with acarbose may lead to the delay of cataract formation in sand rats. These results could have potential applications to diabetic patients as an adjunct treatment.

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In this study we analyzed a commercial dietary fiber blend known as Fiber-Plus and a dietary fiber mixture (DFM) prepared in our lab (10% apple pectin, 10% orange pectin, 36% locust bean gum and 44% corncob composed of 56% fiber). DFM provided greater inhibition of starch digestion and glucose absorption (p < 0.05) than did Fiber-Plus. DFM was also found to be significantly more efficient (p < 0.05) than Fiber-Plus at reducing the glycemic response following starch loading. Rats fed DFM or corncob demonstrated a much lower glycemic response following a test meal as compared to those fed a fiber-free diet. Both fiber sources decreased fasting cholesterol and triglyceride concentrations; transit time was shortened and fecal values were higher than those of controls. beta-glucuronidase activity in intestinal segment contents and feces was lower in rats fed fiber. We conclude that DFM is effective in controlling plasma glucose and lipid levels. Corncob, a novel fiber source, could be beneficial in the treatment of gastrointestinal tract disorders and in the elimination of carcinogenic elements.

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The effect of two alpha - glucosidase inhibitors, acarbose and miglitol, on postprandial glucose levels following wheat and potato starch loading was evaluated in sand rats with resultant dramatically reduced postprandial glucose levels. The inhibitory effect on starch digestion was dose concentration-dependent. Eighty-six and 72% inhibition was reached with 1 mg of miglitol and acarbose, respectively. Daily plasma glucose profiles and cataract formation were determined following long-term feeding with a diet containing acarbose and miglitol. Both drugs led to a significant reduction in glucose levels, acarbose being more potent, possibly via inhibition and delay of carbohydrate digestion. Acarbose caused a marked decrease in cataract incidence; the mechanism for this effect requires more elucidation. Since acarbose delayed and possibly prevented cataract formation in sand rats, we support the concept of its use as an adjuvant in the treatment of diabetic patients.

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The campaign for passage and implementation of Pittsburgh's Smoking Control Ordinance in 1987 illustrates the role controversy plays in tobacco control. Proponents of the ordinance sought at first to keep it noncontroversial, while the tobacco industry tried to defeat the ordinance by generating controversy, claiming that severe economic and social disruption would occur. After the ordinance had been in force for a year, Philip Morris tried to take over its implementation, seeking to redefine the central issue as one of social accommodation rather than health. To succeed, Philip Morris's effort had to be widely accepted and noncontroversial. Proponents of the ordinance countered with controversy to undermine the campaign and expose the company's intentions. The controversy made the established health organizations uncomfortable, causing them to play only a marginal role. Surprisingly, the people who prevailed were the nonsmokers' rights activists, a small group with limited resources.

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During the past 20 years, sheltered care homes have become the primary supervised community residence for mentally ill patients outside of licensed hospitals. To determine factors associated with sheltered care operators' remaining in business, follow-up interviews were conducted in 1985 with operators of 151 sheltered care facilities in California whose operators had been surveyed in 1973. Fifty-five of the original operators continued to operate the facility at 12-year follow-up, and 96 were new to the facilities since 1973. Compared with the original operators, the new operators were younger and better educated, were more likely to be men, and were more likely to be totally dependent on the business for their income. Operators who were members of local associations for sheltered care operators were more likely to have remained in business over the 12-year period, as were those who owned facilities with more than six beds.

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