Rat mandibular distraction osteogenesis: Part I. Histologic and radiographic analysis

The application of distraction osteogenesis to craniofacial surgery has altered the approach and treatment of congenital and acquired craniofacial defects. Although the histologic and ultrastructural changes associated with distraction osteogenesis have been described extensively, relatively little is known about the molecular regulation of this process. The elucidation of the molecular mechanisms of distraction osteogenesis has important clinical implications because it may facilitate the use of recombinant proteins or gene therapy to accelerate bone regeneration. Molecular analysis of distraction osteogenesis has been hindered by the use of large animal models in which only limited genetic information is available. In this study, a rat model of mandibular distraction osteogenesis is described. This report includes a pilot study (n = 50) to develop an appropriate distraction device and to determine the optimal placement of the osteotomy. The study subsequently included 80 animals, 35 of which were distracted at a rate of 0.25 mm per day for 6 days (1.5 mm total) and 35 that were distracted at a rate of 0.25 mm twice per day (3.0 mm total). These animals were killed at various time points (after latency and during the distraction and consolidation periods) and displayed histologic and radiographic findings of membranous bone distraction osteogenesis that were consistent with those in large ,animal and clinical models. In addition, five animals each were acutely lengthened 1.5 mm and 3.0 mm and demonstrated a fibrous nonunion. Furthermore, the utility of this model is demonstrated in the analysis of the molecular mechanisms of distraction osteogenesis by applying the polymerase chain reaction to total cellular RNA isolated from normal and distracted rat mandibles. In conclusion, it is believed that the rat model of distraction osteogenesis has significant advantages over traditional models, including decreased costs and facilitation of molecular analysis.     

The fate of teeth in mandibular fracture lines. A clinical and radiographic follow-up study

We used a new card procedure to evaluate binocular contrast sensitivity (CS) in 24- and 36-month-old children. The test consists of 40 large (50 by 28 cm) matteboard cards, each of which contains a sine wave grafting with 1 of 5 spatial frequencies (0.4, 0.8, 1.6, 3.2, and 4.8 cpd at 80 cm) and with 1 of 8 contrast levels [from 33% (CS = 3) to 0.4% (CS = 260)]. Estimates of subjects' CS to each spatial frequency were obtained with a modified forced-choice preferential looking (FPL) technique similar to that developed for the Teller Acuity Cards (TAC). All 36-month-olds and 74% of the 24-month-olds completed the entire procedure in an average of 12 min per child. For both groups, the shape of the mean constant sensitivity functions (CSF's) resembled the characteristic inverted U shown by normal adults, except that the toddlers' functions were shifted to lower contrasts and spatial frequencies. Combined with previous results, it appears that the CS cards hold promise as a time-efficient means of assessing CS in infants and young children, and may provide the prototype for a clinical tool to help detect early visual and neurological dysfunction.     

A radiographic study of the development of the human mandibular dentition

This paper presents new data on the absolute timing of the growth of the mandibular permanent teeth, with an emphasis on the timing of the completion of the enamel crown. Two collections of cranio-dental radiographs were analyzed: (1) 267 juveniles from a contemporary pediatric dental clinic (Case Western Reserve University School of Dentistry, Cleveland, Ohio), and (2) 36 individuals sampled longitudinally from the Bolton-Brush Growth Study Center. The ages of the individuals span from three months to 18 years of age and the study includes both cross-sectional and longitudinal data. Comparisons of the ages of attainment of the Cleveland samples with other schedules of dental development are made. The relative contribution of the multiple underlying sources of variation producing the differences between the radiographically based developmental schedules remain elusive.     

Prolonged pregnancy. Review of the literature

There have been various estimations of the frequency of postdate pregnancies. On the average, 10% of all pregnancies exceed 42 weeks amenorrhoea with a range from 4 to 14% according to the authors. Rates vary with use of ultrasound examinations early, avoiding false dating and induced labour. A pregnancy becomes a pregnancy at risk at the end of the 41st week of amenorrhoea. Fetal maturity may be affected by a disease process or due to individual or ethnic variations. The potential danger of prolonged pregnancy is inhalation of meconium prepartum. Expulsion of meconium is both a frequent consequence of fetal distress and the result of increased intestinal reactivity. There does not appear to be agreement on the degree of risk of sudden death at the end of pregnancy, although the risk does appear to exist. Surveillance should include recording fetal heart rate under basal conditions and an assessment of the amniotic fluid volume with ultrasounds. The Doppler technique is currently under study. When the status of the cervix is favourable, labour may be induced by rupturing the membranes of with a perfusion of Syntocinon. When the status of the cervix is unfavourable, prostaglandin E2 is applied intravaginally or intracervically with a gel. Therapeutic trial published to date do not demonstrate any advantage over cesarean section or fetal morbidity. The safety of the procedure has not been proven. Randomized trials comparing systematic induction of labour with a wait-and-see attitude have not given a definitive answer. Only two trial have shown a significant advantage of systematic induction of labour. The others have shown that the rate of cesarean section and neonatal morbidity are comparable in the two groups.     

Coffin-Siris syndrome. Review of the literature

A great deal of new information has become available in the field of hypertension since the JNC report of 1988. The JNC V report has changed the categorization of blood pressure, modified suggested drugs for initial therapy, and recommended that diuretics or beta blockers be considered the first-line drugs of choice. Information concerning the J curve and end-stage renal disease has made therapeutic goals more challenging. One of the most important additions to this report is the new information on treating elderly patients, which had been lacking until last year. The report calls on pharmacists to assist with detecting, evaluating, and referring hypertensive patients. Pharmacists must take a leadership role in promoting compliance with antihypertensive therapy and can assist other health-care professionals by suggesting therapeutic alternatives to improve efficacy, reduce the frequency of administration, and lower costs. The complete JNC V report is an essential reference for the files of any pharmacist who is responsible for the care of hypertensive patients.     

Acute and chronic sphenoid sinusitis. Review of the literature

Isolated involvement of the sphenoid sinus is a relatively uncommon entity. We present a review of the most important series. Acute and chronic diseases are separated. Acute sphenoid sinusitis is a potentially catastrophic infectious disease. It is frequently initially misdiagnosed, and, due to the severe intracranial complications, a genuine medical and surgical treatment is recommended. Chronic sphenoid lesions may pose a problem of etiologic diagnosis. It may be difficult to differentiate between benign and malignant lesions. The most common presenting symptom is headache, followed by visual symptoms and cranial nerves palsies. Radiographically, computed tomography is the gold standard. Treatment includes antibiotic therapy and surgical drainage. This drainage is now done through an endoscopic approach.     

A radiographic analysis of the mandibular canal of the edentulous mandible in different racial and gender groups

Studies on the mandibular canal in the edentulous mandible have rarely been correlated with mandibular canal position, mandibular body width, mandibular canal width, thickness of bony plates, gender and race. The aim of this investigation was to examine the above parameters by studying the bucco-lingual relationship of the mandibular canal in dry edentulous mandibles of Black and White, males and females (n = 13 in each group), of similar age (mean 58, 17 yrs). The mandibles were radiographed cross-sectionally. The position of the mandibular canal in relation to the buccal and lingual cortical plates, and the widths of the mandibular canal and mandibular body, measured at selected distances, were recorded and the values statistically analysed. Race and gender do not seem to influence the position of the mandibular canal in the bucco-lingual plane. The location of the canal is predominantly closer to the lingual cortex in the bucco-lingual plane. It was found that the widths of the left and right halves of the mandibular body are not statistically significantly different but widths of the left and right mandibular canal are significantly different.     

Home rehabilitation after stroke. Review of the literature

To find an answer to the question whether domiciliary rehabilitation after stroke is better or cheaper than alternative forms of rehabilitation, a systematic literature review of controlled trials was performed. Three large and two smaller, more preliminary studies of all together a thousand patients were found and regarded methodologically acceptable. Efficacy as regards functional, emotional and qualitative outcome of patients was equivalent for various modes of care. So was the degree of stress, social function and quality of life for the main carers. Home treatment costed less than regular day care but more than routine care including a mixture of outpatient and day care, as considered required. Domiciliary rehabilitation seems to be a good and cost effective alternative for stroke patients who need and cannot manage frequent out-patients visits without ambulance or other exhausting and expensive transports.     

Melanoma of the oral cavity. Review of the literature

The location of melanoma in the oral cavity is extremely rare: its frequency varies between 0.2 and 8%. Oral melanoma strikes mainly male subjects and is more frequently seen at the level of the hard palate and gingiva. Today the clinicopathological classification of oral melanoma is not yet clearly outlined, and that is why the skin form is often taken as a reference. The acral lentiginous subtype proves to be the most common in this seat. In many cases (up to 50%) the diagnosis of melanoma is made on lesions which have evolved from the pre-existing pigmented lesions: as a consequence, every pigmented lesion of undetermined origin must be biopsied as a routine. The prognosis often proves poor and the surgical approach, combined with the chemotherapeutic one, is the first choice treatment. Lymph node dissection is not routinely practiced.     

Attenuation of x-ray in muscle and alveolar bone during mandibular premolar periapical radiographic procedure

The main purpose of this study is to find out the degree of attenuation when the x-ray entrances the skin and reaches the film at the bone area near the mandibular premolar root apex. In this study we used thermaluminescent dosimeters (TLDs) to measure the entrance dose and exit dose directly at the area of interest and calculated the penetration value P. We also simulated the attenuation process and calculated the P value in similar conditions. The results indicate that the mean P value of direct measurement from patient is 0.071 +/- 0.018 (60kVp, HVL = 1.5mm Al), while that for theoretical calculation is 0.06458 at 27keV. We concluded that P value of direct measurement can match with the theoretical value and further studies in jaw bone density and other related portions is worthwhile.     

Characteristics of immunoreactivity in neonates and young children. Review of the literature

A collective of 131 suicides of physicians (n = 40), female and male nurses (n = 38), pharmacists/chemist/biologists (n = 17) and medical/chemical assistant personnel (n = 36) was evaluated with regard to the method of suicide. Preferred methods were ingestion of medicaments orally (29%) and by infusion/injection (18%), hanging (13%), cyanide poisoning (10%), jumping from great height (10%) and drowning (8%). The results were compared with a control group (n = 739: hanging 32%, oral ingestion of medicaments 16%, jumping from great height 13%, shooting 9%, drowning 8%, railway suicides 7%). Methods such as infusion/injection (anesthesiologists) and cyanide poisoning (chemists/chemical staff) being typical of occupation were over-represented within the first group, however, at the same time concentrated on specialized subgroups. Intoxications by infusion/injection and medicaments predominated even more clearly in physicians (58%) than in the total collective. CONCLUSION: The tendency to a method of suicide being typical of the profession rises among physicians and related occupations with the degree of specialization (increasing knowledge, easier access to appropriate drugs and methods). Medical/chemical education and occupation alone is not yet associated with such a predisposition.     

Counseling and psychotherapy with Asian-Americans: Review of the literature.

Reviews the existing literature on counseling and psychotherapy with Asian-Americans and discusses research needs and recommendations for future research. Diagnosis and assessment issues include symptom expression, therapist bias, problems with the use of interpreters, and problems with the use of clinical and personality tests. Client variables in counseling and psychotherapy involve the personality of Asian-Americans, language problems, the acculturation process, and counseling expectations. Therapist variables involve therapist bias, training bias, lack of intercultural skills, and culture-specific knowledge. In a discussion of process and outcome, the author reviews empirical studies, clinical case studies, and articles with treatment strategies and recommendations. Research recommendations for each of the areas reviewed are identified. (3 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Saliva: clinical and diagnostic usefulness. Review of the literature

Modern clinical pathology is mainly based on the analysis of blood samples, carried out through more and more sophisticated techniques. Being the blood test an invasive technique, it certainly reduces the possibility of carrying out blood analysis, especially in patients such as children, old people, handicapped people and every person who needs continuous biochemical or pharmacological monitoring. In these cases it is very important to find other body fluids that can be easily obtained and that can offer the same reliable data as blood. Due to some of its characteristics, sometime saliva may be a good alternative to venous blood, as it presents the same features of plasma or urine. The chemical analysis of saliva provides some information that are useful for metabolic, inflammatory, neoplastic and genetic diseases; furthermore radioimmunological dosages allow to assess small concentrations of active substances. On the basis of an accurate review of literature, the aim of this study is to analyse the importance of saliva in diagnosing and monitoring certain systemic diseases, the utilization of saliva in hormonal and pharmacological dosages and the use of saliva in some epidemiological studies. Finally, it is emphasized that saliva in monitoring may help to manage several clinical conditions.     

Candida costochondral osteomyelitis, report of a case and review of the literature

A 49-year-old man was admitted to the hospital with swelling and redness overlying the left anterior chest wall. He had been treated by percutaneous transluminal coronary recanalization for acute myocardial infarction with central venous catheter one year and four months earlier. Since then, he had had no symptoms. An incision and drainage was performed and specimen showed acute and chronic granulation tissue containing pus with involvement of underlying left third rib and cartilage. Candida albicans was cultured from the drainage specimen. Treatment with fluconazole was began. The lesion failed to clear following incision and drainage, continuing to exude pus, then open surgical excision and curettage of the cartilage and rib was performed. After 2 months of therapy, the lesion had resolved. This is a rare case of candida costochondral osteomyelitis without a definite proof of former hematogenous candida infection.     

Liver injury in abdominal trauma. Review of the literature and personal observations

The association of infantile diarrhoea with the occurrence of Candida species and their different morphological cell forms (pseudohyphae and/or blastospores) in faeces was studied in children of 0-15 months in a developing community (Lahore, Pakistan) where malnutrition is prevalent. Stool samples from 119 patients admitted to the Diarrhoea Treatment Unit, Department of Pediatrics, King Edward Medical College, and 46 healthy children were investigated for yeasts, bacteria, viruses and parasites. Salmonella and enteropathogenic Escherichia coli were seen in 13 (11%) each of the cases while Candida was the most frequent micro-organism, grown in cultures from 38 (32%) of the diarrhoea cases. C. tropicalis dominated (19%) over C. albicans (6%) and C. parapsilosis (3%). However, in a great number of cases (23, equals 19%), Candida did not grow in cultures but blastospores and/or pseudohyphae were seen on microscopical examination. Other Candida species and yeasts were relatively more common in the control group. Candida albicans, C. tropicalis and C. parapsilosis were the only identified agents in 23 of the cases (19%). The characteristic clinical findings in children with Candida as the only identified pathogen were malnutrition (69%), age less than 8 months (90%), and microscopically identified pseudohyphae in faecal smears (71%).     

Pharmacologic therapy of cranio-cervico-mandibular disorders. Review of the literature

Enzymes are essential to life and catalyze various metabolic activities. They find application in a number of diseased conditions, and their scope is being widened as knowledge develops.     

Drug therapy of hemiballism. Review of the literature and personal observations

Hemiballism is a rare hyperkinetic disorder which is characterized by irregular vigorous rotatory movements of the limbs of one side of the body. The disabling and exhausting movements with their high risk of severe injuries require an acute drug treatment. However, there are no common guidelines for the treatment of this disorder. Therefore we reviewed the available literature to establish a concept for a rational symptomatic drug treatment. Furthermore, own observations in 6 patients with hemiballism of different origins are reported.