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Pythiosis occurs in animals and humans who encounter aquatic habitats that harbor Pythium insidiosum. Drug therapy for deeply invasive infections with this organism has been ineffective in humans and animals; patients have been cured only by radical surgical debridement. A 2-year-old boy developed periorbital cellulitis unresponsive to antibiotic and antifungal therapy. The cellulitis extended to the nasopharynx, compromising the airway and necessitating a gastrostomy for feeding. P. insidiosum was isolated from surgical biopsy specimens of the affected tissue. On the basis of in vitro susceptibility studies of the isolate, the patient was treated with a combination of terbinafine and itraconazole. The infection resolved over a period of a few months. The patient remained well 1.5 years after completing a 1-year course of therapy. Cure of deep P. insidiosum infection is feasible with drug therapy.

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The preliminary results of treating recurrent respiratory papillomatosis with indole-3-carbinol holds promise. Longer follow-up of this patient group and a blinded, controlled trial are required. We conclude that indole-3-carbinol appears to be safe and well tolerated and may be an efficacious treatment for recurrent respiratory papillomatosis.

Summary and conclusionsAn 11-week crossover study was carried out in which 12 subjects smoked high-nicotine (1-84 mg standard yield) and low-nicotine (0-6 mg) cigarettes after an initial period of smoking their usual brands with a medium-nicotine yield (mean 1-4 mg). Plasma and urine nicotine concentrations, carboxyhaemoglobin (COHb) concentration, puffing behaviour, 24-hour cigarette consumption, and butt nicotine content were measured. The changes in plasma nicotine and blood COHb concentrations showed that the smokers compensated for about two-thirds of the difference in standard yields when switched to either high-or low-nicotine cigarettes. Thus, compared with the medium-nicotine brand, the intake of nicotine and carbon monoxide was only about 10% higher when subjects smoked the high-nicotine cigarettes, which had a standard yield 30-40% higher than the medium brands; and only about 15% lower when they smoked the lownicotine cigarettes, which had a standard yield about 50% lower than the medium brands. Butt nicotine content and urine nicotine concentrations followed a similar pattern. Changes in puffing behaviour and in 24-hour cigarette consumption were only slight.The results show clear evidence of both upward and downward self-titration of nicotine and carbon monoxide (and tar) intakes when smokers change to cigarettes with standard yields that differ over the range studied.Introduction Do smokers adjust their nicotine intake to some habitual optimal level when smoking cigarettes of different strengths ? Evidence concerning this self-titration hypothesis is conflicting, but a clear answer is important in planning and evaluating the effects of safer-smoking strategies in which smokers are advised to switch to cigarettes of decreased nicotine, tar, and carbon

No abstract

It is now established that surviving axons in incompletely denervated striated muscle extend their existing fields of innervation by a process of collateral sprouting, thereby accounting for the functional recovery which occurs (for review see Edds, 1953). A similar process also occurs in skin partly deprived of its sensory nerve supply (Weddell, Guttmann & Gutmann, 1941). Although the phenomenon has not been directly observed in the sympathetic nervous system, there is evidence of remarkable recovery of function after incomplete denervation (Simeone, Cannon & Rosenblueth, 1938;Geohegan & Aidar, 1942).In the present work, partial denervation of the superior cervical ganglion in the cat was performed by severing rami communicantes from their respective thoracic nerves. Subsequently, sprouts arise within the ganglion from the remaining intact preganglionic fibres and form synapses with ganglion cells denervated by the preliminary operation. This spatial increment in the field of innervation of the remaining preganglionic fibres results in an almost complete functional recovery of the ganglion even when as many as 90 % of the fibres have been divided. Experiments have been performed so as to correlate the histological and functional changes within the ganglion, including the time course of the sprouting process and its effect on the acetylcholine release, electrical and pharmacological responses. It seems most likely that under similar conditions post-ganglionic fibres also respond by collateral sprouting.The factors responsible for the efficiency of the sprouting process in the sympathetic nervous system are discussed. A preliminary account of this work has already been published (Murray & Thompson, 1956).

Inverting papilloma of the nose and paranasal sinuses can sometimes be very difficult to distinguish from other nasal tumors, and the confusion ranges from allergic nasal polyposis to carcinoma. They are also certainly characterized by multiple recurrence, particularly after limited operations. The experience with 34 cases seen at UCLA over the past two decades is analyzed and a philosophy of treatment is outlined. We favor wide local excision which generally necessitates a lateral rhinotomy and medial maxillectomy. The operative approach will be described in detail.