CURRENT LITERATURE 1385

tailoring language to the patient, repetition, request for written questions, and body language. Problems with nurse- physician communications include: unclear instructions, unsupervised procedures, and a poor understanding of proper evaluation and prioritization of emergencies. Al- though the telephone may be a tool of convenience, it is also a potential source of liability. Documentation can defend disagreements.-R.H. HAUG

Reprint requests to Dr Gorney: 185 Greenwood Rd, Napa, CA 94558.

Inhibitory Effect of Erythromycin on Interleukin-8 Secretion From Exudative Cells in the Nasal Discharge of Patients With Chronic Sinusitis. Suzuki H, Asada Y, Ikeda K, et al. Laryngoscope 109:407, 1999

Previous reports found that the positive feedback of neutrophil exudate and the generation of chemotactic mediators, including interleukin-8 (IL-@, by the exudative cells in the inflamed site are responsible for the persistent local purnlence in chronic sinusitis. Clinical studies have documented the efficacy of long-term, low-dose macrolide administration for the treatment of chronic sinusitis. Al- though the exact mechanism is not fully understood, obser- vations suggest that blocking IL-S generation in situ is one of the most important mechanisms of efficacy for this therapy. The authors studied the inhibitory effect of erythromycin on IL-8 secretion from exudative cells in the nasal discharge of patients with chronic sinusitis. Exudative cells, more than 90% of which were neutrophils, in the nasal discharge were isolated with or without erythromycin in the presence of 10 pg/mL of lipopolysaccharide. The IL-S concentrations in the culture supernatants were measured by enzyme-linked immu- noassay. The amount of secreted IL-S in the absence of erythromycin was 682 pg/106 cells/24 hours. The amount of secreted IL-8 was significantly reduced to 66% and 46% of the control in the presence of 10e6 and 10m5 mol/L of erythromycin, respectively. This indicated that erythromy- tin may act as a biological modulator that inhibits IL-8 secretion from exudative cells and thereby blocks the vicious circle of neutrophil recruitment and IL-8 generation in the inflammatory site in chronic sinusitis.-A.J. LIBUNAO

Reprint requests to Dr Suzuki: Department of Otolaryngology, Sendai National Hospital, 2-S-8 Miyagino, Miyagino-ku, Sendai 983- 8520, Japan.

Traumatic Dental Injuries in Brazilian Pre-School Chil- dren. Mestrinho HD, Bezerra AC, Carvalho JC. Braz Dent J 9:101, 1998

The purpose of this study was to estimate the prevalence of traumatic dental injuries in a sample of Brazilian pre- school children (age range, 1 to 5 years) with limited access to dental care.

The children attended public nursery schools in the Federal District of Brazil that comprise the city of Brasilia and 6 satellite cities. Data were collected from 1993 to 1995 by the authors. Clinical injuries were categorized as follows: 1) uncomplicated crown fracture, 2) complicated fracture, 3) crown discoloration, 4) intrusive luxation, 5) extrusive luxation, 6) exarticulation or extraction after trauma, and 7) subluxation. In Brazilian children, the prevalence of dental injuries based on clinical evaluation ranged from 10% (52 years), 12% (3 to 4 years), and 20% (5 years). Boys and girls were similarly affected. Dental injuries were almost re-

stricted to upper central incisors (88%). Single tooth injury was predominant in all ages. In the youngest group, crown fracture (69%) and crown discoloration (48%) were the most common injury.-LuIs QUEVEDO

The Insurance Carrier’s Viewpoint: Practicing Brinks- manship. Gorney M. Clin Plast Surg 26:21,1999

Most physicians practicing in the United States today have only a dim familiarity with the principles on which profes- sional liability insurance is based, and understandably, even less so with operational details. The insurance company is in the business of risk: not only must it cover its current expenses, but its long-term survival literally depends on its ability to foresee potential losses and prepare now for what may occur later. Pure loss is determined by considering the geographic territory where the doctor lives and the loss history within the doctors specialty in the territory. Ex- penses that vary from state to state, such as taxes, licenses, fees, and commissions, are added to pure loss. Incurred losses are both paid and known reserved losses occurring within a specific period of time. Claim expenses are ex- penses related to the adjusting and settling of a claim, excluding any actual claim payment. An allocated claim expense is one assigned to and recorded within a specific claim. Loss experience is the difference between earned premium and incurred losses plus the allocated loss adminis- trative expenses. Maturity addresses the observation that the longer the period of active practice the more risk the doctor accumulates. Reserves are premiums that are not used immediately. The premium-to-surplus ratio reflects the com- pany’s financial strength and future solvency. Premium income and expenses are combined with investment in- come, administrative expenses, and taxes to calculate profit and loss. Reinsurance is an agreement between insurance companies under which one accepts all or part of the risk or loss of the other. The reserves-to-surplus ratio measures a company’s financial ability to pay claims if reserves prove to be inadequate. Re-underwriting is a review of an insurer’s policy file to determine whether the doctor continues to qualify for insurance. Spreading the risk means that all premium dollars are placed in a common pool. Surplus is the amount that a company’s assets exceed its liabilities. -R.H. HAUG

Reprint requests to Dr Gomey: The Doctors Company, 185 Green- wood Rd, Napa, CA 94558.

Improved Nerve Regeneration With Neutralization of Transforming Growth Factor-pl. Davison SP, McCaffrey TV, Porter MN. Laryngoscope 109:63 1,1999

The authors attempted to identify the presence of trans- forming growth factor-p 1 (TGF-P 1) in regenerating periph- eral nerve and to measure motor nerve regeneration by the neutralization of TGF-61 in neural wounds. The recovery of injured peripheral nerves depends on a balance between Schwann cell regeneration and scar formation. TGF-P1 has been implicated in the stimulation of scar formation. This

study took the form of a randomized, prospective trial. Sciatic nerve axotomy was performed in the rat model after which serial immunohistochemical staining with anti- TGF-PI at 12 to 216 hours. Two groups with sciatic axotomy and epineural repair were treated with a -/-day perineural administration of neutralizing antibody to TGF-P 1 or saline carrier via subcutaneous silicon infusion port. A control group without axotomy and epineural repair with