Patients' level of education, tangible support, depression, problem-solving coping, dysfunctional coping and internal locus of control were associated with pain and functional outcomes after knee replacement. The findings suggest that, in addition to medical management, perioperative psychosocial evaluation and intervention are crucial in enhancing knee replacement outcomes.

An in vitro model for oral cancer was used to examine the growth inhibitory effects of chemopreventive agents when used singly and in combination. The model consists of primary cultures of normal oral epithelial cells, newly established cell lines derived from dysplastic leukoplakia and squamous cell carcinoma. Two naturally occurring substances, (-)-epigallocatechin-3-gallate (EGCG) from green tea and curcumin from the spice turmeric were tested. Cells were treated singly and in combination and effects on growth determined in 5-day growth assays and by cell cycle analysis. Effective dose 50s and the combination index were calculated with the computerized Chou-Talalay method which is based on the median-effect principle. Agents were shown to differ in their inhibitory potency. EGCG was less effective with cell progression; the cancer cells were more resistant than normal or dysplastic cells. In contrast, curcumin was equally effective regardless of the cell type tested. Cell cycle analysis indicated that EGCG blocked cells in G1, whereas curcumin blocked cells in S/G2M. The combination of both agents showed synergistic interactions in growth inhibition and increased sigmoidicity (steepness) of the dose-effect curves, a response that was dose and cell type dependent. Combinations allowed for a dose reduction of 4.4-8.5-fold for EGCG and 2.2-2.8-fold for curcumin at ED50s as indicated by the dose reduction index (DRI). Even greater DRI values were observed above ED50 levels. Our results demonstrate that this model which includes normal, premalignant and malignant oral cells can be used to analyse the relative potential of various chemopreventive agents. Two such naturally-occurring agents, EGCG and curcumin, were noted to inhibit growth by different mechanisms, a factor which may account for their demonstrable interactive synergistic effect.

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Based on a review of the literature and analysis of six new cases, three categories of enlarged, aerated sinuses are defined, namely: hypersinus, pneumosinus dilatans, and pneumocele. The information gained by our study of the area variation of the frontal sinuses in a normal population (part I of this paper) was utilized to define the term hypersinus. In this condition there is generalized enlargement of the sinus beyond the upper limit of normal in an asymptomatic patient. The principal difference between pneumosinus dilatans and a pneumocele is the presence of bony thinning or erosion in the latter entity. The clinical findings and the possible etiologies of these conditions are discussed.

Like other organs, the nose changes as the body ages. A review of the literature reveals a basic understanding of the aging process in the nose but a paucity of documentation and few organized studies. This study was designed to identify systematically the agerelated changes in the normal, nondiseased adult nose. A nasal-sinus laboratory was created, and a computerized patient database was developed. Four separate investigations were conducted. First, 111 subjects ranging in age from 21 to 94 years of age were studied prospectively using 135 variables. The following data were collected: history, symptoms, physical examination, rhinomanometry, ciliary beat frequency, smell testing, and incentive spirometry. Second, photographs of a separate group of 105 subjects 20 to 86 years of age were studied to ascertain the facial cephalometric changes that occur with aging. Third, a histopathologic examination of the nasal septum was performed in 20 additional subjects to evaluate the cellular changes that accompany aging. Finally, an epidemiologic study analyzing the prevalence of various nasal complaints by age was conducted, based on a review of more than 11,000 patient charts from surgeries and office visits. A number of specific age-related changes in the nose were identified, including an increased likelihood of certain nasal complaints, a pattern of increasing airflow resistance, and a decrease in physical abnormalities in the nasopharynx. The appearance of the nose, as measured by the nasolabial angle and the height/length ratio, was also found to change with age.