Bilateral submandibular duct transposition is one of several surgical methods described to control sialorrhoea in the paediatric patient. The purpose of this study is to assess the effect of submandibular duct repositioning surgery on the quality of life of children using the Glasgow Benefit Inventory outcome measure. Consecutive children who underwent submandibular duct repositioning surgery were invited to participate in the study. The parents or guardians of children who gave consent were interviewed. The carer's opinion of the change in salivation, responses to the items in the Glasgow Benefit Inventory score and report of the complications were recorded. Nine children aged two and a half to 16 years were studied. The mean follow-up time was four years. The mean Glasgow Benefit Inventory score of +33 related to the procedure demonstrates that submandibular duct repositioning leads to a substantial measurable improvement in the quality of life (QoL) of the drooling child.

The functional significance of protease-activated receptors (PARs) in endothelial cells is largely undefined, and the intracellular consequences of their activation are poorly understood. Here, we show that the serine protease thrombin, a PAR-1-selective peptide (TFLLRN), and SLIGKV ( PAR-2-selective peptide) induce cyclooxygenase-2 (COX-2) protein and mRNA expression in human endothelial cells without modifying COX-1 expression. COX-2 induction was accompanied by sustained production of 6-keto-PGF(1 alpha), the stable hydrolysis product of prostacyclin, and this was inhibited by indomethacin and the COX-2-selective inhibitor NS398. PAR-1 and PAR-2 stimulation rapidly activated both ERK1/2 and p38(MAPK), and pharmacological blockade of MEK with either PD98059 or U0126 or of p38(MAPK) by SB203580 or SB202190 strongly inhibited thrombin- and SLIGKV-induced COX-2 expression and 6-keto-PGF(1 alpha) formation. Thrombin and peptide agonists of PAR-1 and PAR-2 increased luciferase activity in human umbilical vein endothelial cells infected with an NF-kappa B-dependent luciferase reporter adenovirus, and this, as well as PAR-induced 6-keto-PGF(1 alpha) synthesis, was inhibited by co-infection with adenovirus encoding wild-type or mutated (Y42F) I kappa B alpha. Thrombin- and SLIGKV-induced COX-2 expression and 6-keto-PGF(1 alpha) generation were markedly attenuated by the NF-kappa B inhibitor PG490 and partially inhibited by the proteasome pathway inhibitor MG-132. Activation of PAR-1 or PAR-2 promoted nuclear translocation and phosphorylation of p65-NF-kappa B, and thrombin- induced but not PAR-2-induced p65-NF-kappa B phosphorylation was reduced by inhibition of MEK or p38MAPK. Activation of PAR-4 by AYPGKF increased phosphorylation of ERK1/2 and p38MAPK without modifying NF-kappa B activation or COX-2 induction. Our data show that PAR-1 and PAR-2, but not PAR-4, are coupled with COX-2 expression and sustained endothelial production of vasculoprotective prostacyclin by mechanisms that depend on ERK1/2, p38(MAPK), and I kappa B alpha-dependent NF-kappa B activation.

The objective of this study was to assess the efficacy of topical lignocaine in reducing the pain of pack removal after nasal surgery. Fifty-eight patients with Merocel nasal packs in situ after nasal surgery were randomized to receive 10 ml of either 2 per cent lignocaine or 0.9 per cent saline on the packs 10 minutes prior to their removal and thepain experienced on their removal was recorded on a visual analogue scale. The median pain score was 3.4 in the lignocaine group and 2.9 in the saline group with no statistical evidence of adifference between the two groups. There was no statistical evidence of an association between the group and the operation performed, the use of intra-operative Moffat’s solution or the use of post-operative oral analgesia. We conclude that lignocaine used in this way does not reduce the pain of pack removal after nasal surgery.

Plasma cholesterol efflux capacity is stimulated during postprandial (PP) hypertriglycerdemia. Plasma cholesteryl ester transfer protein (CETP) and phospholipid transfer protein (PLTP) are the key proteins in lipoprotein metabolism and remodelling, but their role during the PP cholesterol efflux process remains indeterminate. The aim of this study was to determine the effect of a fatty meal intake on plasma CETP and PLTP activities, and the capacity of plasma to promote cholesterol efflux, as well as to evaluate the relationship between these three key mechanisms of the reverse cholesterol transport process.CETP and PLTP activities and the cholesterol efflux capacity of plasma were measured over eight hours following a fatty meal (1000 kcal, 62% fat) in 13 normolipidemic men. CETP activity and the cholesterol efflux capacity of plasma from Fu5AH cells increased after the meal, reaching a maximum after eight hours (respectively 32%, p = 0.06, and 6.5%, p = 0.045), whereas PLTP activity remained unchanged. CETP and PLTP activities did not correlate with plasma cholesterol efflux capacity in the fasting or PP state. Plasma CETP activity in the fasting state positively correlated with the plasma non-esterified fatty acid (NEFA) levels, but no correlation was found with any lipid or apolipoprotein postprandially. The cholesterol efflux capacity of plasma correlated positively with high-density lipoprotein (HDL) components, the best correlation being with the HDL phospholipid fraction in both the fasting and PP states.These findings suggest that plasma CETP and PLTP activities in healthy normolipidemic subjects are differently regulated in the PP state, and are not correlated with the increased cholesterol efflux capacity of PP plasma. HDL-phospholipid remains the key factor in the regulation of the capacity of plasma to promote Fu5AH cell cholesterol efflux.

Les maladies cardiovasculaires représentent le premier problème de santé publique des pays occidentaux. Des études récentes de prévention secondaire ont montré que des régimes maintenant un apport en acide oléique de 10 à 13% de l’apport énergétique total (AET) pouvaient protéger de l’apparition d’accidents cardio-vasculaires [8], mais augmenter cet apport d’acide oléique à plus de 20% de l’AET pourrait limiter cet effet bénéfique en induisant une augmentation du LDL-C [12, 34]. Grundy, dans le but de clarifier le ratio nécessaire entre acides gras saturés et insaturés (mono and poly), concluait en 1997 à d’« insufficient data for recommended Oleic intake », et proposait pour le moment 15-16% d’acide oléique à titre de « reasonable compromise ». L’objectif de notre étude était de définir des rapports entre acides oléique, linoléique et alphalinolénique (OL/LA/ALA ratio) et de valider l’apport oléique après avoir stabilisé le rapport linoléique/alphalinolénique du régime d’hommes normolipidémiques (n = 40). Pour atteindre 11, 13 et 16% de l’AET sous forme d’acide oléique, nous avons utilisé des huiles de tournesol, de tournesol oléique (HOSO) et de colza pour obtenir des mélanges spécifiques ajustés à l’apport en acides gras proposés au protocole. Chacun de ces trois régimes (comportant 11, 13 et 16% d’acide oléique) a été suivi pendant 16 semaines et l’épuration postprandiale d’un repas gras (1 000 Kcal, 62,5% lipides) a été suivie pendant 8 heures à la fin de chaque période de régime. Les résultats indiquent que la stabilité des paramètres d’athérogenèse évalués à jeun et en postprandial est maintenue à un niveau favorable après ces régimes à 11, 13 et 16% d’apport en acide oléique : il n’y a pas de différences statistiques significatives sur les concentrations à jeun de LDL-C, non-HDL-C, HDL-C, TG, ApoB, ApoAI ou sur l’amplitude de la réponse postprandiale des TG. Ainsi les rapports ApoB/AI, LDL-C/HDL-C et non-HDL-C/HDL-C sont stabilisés. Ces observations permettent de conclure que la consommation d’acide oléique comprise entre 11 et 16% d’AET (soit 28 g à 44 g) de la ration alimentaire pourrait correspondre aux limites de flexibilité de ces apports, dans le cadre d’un apport calorique total de l’ordre de 2 000 à 2 500 Kcal et compte tenu des autres éléments entrant dans la composition du régime. Les limites de flexibilité des apports en acides oléique, linoléique et alphalinolénique en pourcentage d’AET du régime alimentaire pourraient être définies comme suit : 11-16% (soit 28 g à 44 g) d’acide oléique, 4-6% (soit 9 g à 13 g) d’acide linoléique, 1% (soit 1,5 g à 3 g) d’alphalinolénique (pour 60% en position sn2). Soit des rapports 18:1/18:2n-6/18:3n-3 de l’ordre de 11-16/4-6/1 en % de l’AET.