Cervical spine fractures associated with maxillofacial trauma: A 3-year-long study in the Greek population.

BACKGROUND: Maxillofacial fractures have been recognized as high risk trauma for concomitant cervical spine or spinal cord injury. OBJECTIVE: To investigate the incidence of concomitant cervical spine fractures (CSF) in patients with maxillofacial trauma and elucidate their relationship, guiding diagnosis and pointing their implications in maxillofacial trauma repair. MATERIAL AND METHODS: An analysis of 432 patients with maxillofacial fractures, treated at the Department of Oral and Maxillofacial Surgery of the "KAT" General Hospital of Attica during a three-year-long period, was conducted to investigate concomitant CSF. RESULTS: 22 patients or 5.1% (14 male/8 female, mean age 39.81 years) sustained a total of 29 concomitant CSF. In 77.3% of the cases the injury mechanism was motor vehicle accidents. The most frequent levels of CSF were C6-C7 (55.17%) and C1-C2 (27.58%). Regarding the type/site of maxillofacial fractures, 5 patients (22.73%) had sustained isolated zygomatoorbital, 5 (22.73%) isolated mandibular and 12 (54.54%) combined fractures. Concomitant injuries (i.e. intracranial hemorrhage, cerebral concussion, etc) were registered in 14 patients; additional thoracic/lumbar spine fractures in 5. Hospital stay ranged from 6 to 86 days (mean 27.6 days). CONCLUSIONS: Maxillofacial surgeons should be aware of the relationship between CSF and maxillofacial fractures, having implications in their patients' treatment.

Lateral orbitotomy: a useful technique in the management of severe traumatic disruption of the lateral orbital skeleton.

Lateral orbitotomy is a well-recognized method of improving orbital access for the removal of orbital tumours and foreign bodies, and has been used in orbital decompression in dysthyroid eye disease. The technique has received less attention in the management of orbital trauma. Lateral orbitotomy is useful in the management of selected cases of orbital trauma, in particular severe disruption of the lateral orbit requiring extensive dissection in the region of the superior orbital fissure. It is used in patients with globe rupture, with lateral orbital disruption, in helping to reduce the amount of globe retraction when the lateral orbital fractures are reduced and fixed.

Injuries to the head and neck in Homer's Iliad.

We have found and reported on all injuries to the head and neck described in Homer's Iliad, and give several particularly graphic examples.

Impact of experimental trauma and niflumic acid administration on antimicrobials' concentration in serum and mandible of rats.

Administration of antibiotics and analgesics in surgery or trauma is of great importance for an effective treatment. Trauma, as stress stimulus, causes alterations in various functions of the organism as well as in drug pharmacokinetics. The aim of this study was to determine the effect of trauma upon the serum and bone levels of the antimicrobial ampicillin and cefapirin, with and without co-administration of a non-steroidal anti-inflammatory analgesic (NSAIDs). Fifty-six male Wistar rats were divided into two groups A (control) and B (experimental). Each group consisted of 4 subgroups (n=7) receiving ampicillin, ampicillin with niflunic acid, cefapirin, and cefapirin with niflunic acid. In group B traumatic injury was performed by incision (7 mm length) in the right cheek. The levels of the antibiotics were estimated by the inhibition zone of B. subtilis. An increase in antibiotic levels was observed in group B, being statistically significant only for cefapirin level in the mandible. Upon niflumic acid co-administration a statistically significant rise in serum ampicillin and mandible cefapirin levels was observed in both control and experimental groups (student t-test). It can be concluded that the combination of antibiotics and non-steroid antiinflammatory drugs (NSAIDs) may enhance the antibacterial drug concentration.

Decreased vascular reactivity to alpha1 adrenergic stimulation in the presence of hypothyroid state: a part of an adaptive response?

AIM: A hypothyroid state frequently accompanies cardiac illnesses but its physiological significance for the cardiovascular hemodynamics remains largely unknown. Therefore, the present study investigated possible physiological consequences on vascular function in an experimental model of low thyroid hormone state. METHODS: Hypothyroidism was induced in rats by the administration of 6-n-propyl-2-thiouracil in drinking water (final concentration of 0.05%) for 3 weeks, HYPO rats, and untreated rats served as controls (Control). Isolated aortic rings with or without endothelium (E+, E-) were contracted with KCl (10 to 60 mM) and phenylephrine (PE) (10(-10) to 10(-5) M). Maximal tension (Tmax) in g and EC(50) in response to PE and KCl were measured. RESULTS: Tmax was significantly lower while EC(50) was significantly higher in response to PE in HYPO(E+) than in Control(E+). Upon endothelium removal, Tmax was not significantly different between the groups but EC(50) was still significantly higher in HYPO(E-) than in Control(E-). EC(50) in response to KCl was significantly higher in HYPO with or without endothelium and no difference was found in Tmax. CONCLUSIONS: Hypothyroid aortic rings respond less to a1 adrenergic stimulation probably due to the endothelium modulatory effect as well as to intrinsic smooth muscle defect. This seems to be of important clinical relevance.

Cell proliferation and apoptosis culminate in early stages of oral oncogenesis.

Markers of cell proliferation (Ki-67 antigen) and apoptosis (Bax, Bcl-2) were studied in an experimental system of induced oral carcinogenesis in Syrian golden hamsters. Thirty-seven animals were divided into one control group and three experimental groups, which were treated with a carcinogen and sacrificed at 10, 14 and 19 weeks after treatment. The histological status of the lesions in the three experimental groups corresponded well with tumour advancement (from oral mucosal dysplasia to moderately differentiated squamous cell carcinoma). Tumour sections were studied using monoclonal antibodies against Bax, Bcl-2 and Ki-67 proteins. Pro-apoptotic Bax expression maintained high levels during all stages of oral carcinogenesis. Anti-apoptotic Bcl-2 expression decreased significantly in dysplastic and early invasion lesions and consequently increased almost to normal tissue level in consequent stages. Finally, Ki-67 expression increased sharply in initial stages of oral carcinogenesis, but significantly decreased in later stages.

Ketamine-induced changes in metabolic and endocrine parameters of normal and 2-kidney 1-clip rats.

BACKGROUND AND OBJECTIVE: The aim of this study was to investigate the effect of ketamine on the endocrine and lipid metabolic status of the renal-banded animals. METHODS: Forty male rats were randomly divided into four groups. Group A served as control, Group B animals received ketamine intraperitoneally at a dose of 100 mg kg(-1), Group C was submitted to 2-kidney 1-clip experimental hypertension and Group D received ketamine as above, as well as being submitted to renal artery clipping. Atrial natriuretic peptide, angiotensin II and free fatty acid concentrations were measured in serum. In addition, adipose tissue lipoprotein lipase activity and angiotensin II content were determined, while the left ventricular weight relative to body weight was used as a cardiac hypertrophy index. RESULTS: In renal-banded rats (Groups C and D) serum atrial natriuretic peptide, free fatty acid and angiotensin II concentrations as well as ventricular weight were increased, while adipose tissue lipoprotein lipase activity was lower than in control animals (Groups A and B). Ketamine administration did not influence angiotensin II concentrations either in normal (Group B) or banded rats (Group D). Ketamine increased serum atrial natriuretic peptide and free fatty acid concentrations only in normal animals (Group B). It had no influence on adipose tissue lipoprotein lipase activity either in normal (Group B) or banded animals (Group D). Adipose angiotensin II content did not differ between the four groups. CONCLUSION: Ketamine increased the atrial natriuretic peptide and free fatty acid concentration in normal rats. In 2-kidney 1-clip animals, ketamine did not elicit an additional response of serum atrial natriuretic peptide or free fatty acids levels. Its contribution to these factors was not significant.

Blockade of angiotensin II type 1 receptor diminishes cardiac hypertrophy, but does not abolish thyroxin-induced preconditioning.

Growth and stress seem to share common intracellular pathways and activation of growth signaling can increase resistance to stress. Thyroid hormone induces cardiac hypertrophy and preconditions the myocardium against ischemia reperfusion injury. The present study investigated whether this response is mediated by renin-angiotensin system (RAS). RAS is shown to be activated in hyperthyroidism and is involved in the development of cardiac hypertrophy. Male Wistar rats were treated with L-thyroxin (25 microg/100 g, sc, od) for fourteen days, while normal rats served as controls. In addition, irbesartan (150 mg/kg po), a potent blocker of angiotensin II type 1 receptor (AT1), was given with L-thyroxin for fourteen days. Isolated hearts were perfused in Langendorff mode; after stabilization, they were subjected to 20 min zero-flow global ischemia and 45 min of reperfusion. Thyroxin induced cardiac hypertrophy, which was diminished with irbesartan administration. Post-ischemic recovery of function was increased in thyroxin-treated hearts as compared to controls while ischemic contracture was accelerated and intensified. Irbesartan did not abolish this response. In conclusion, blockade of angiotensin II type 1 receptor with irbesartan preserves thyroxin-induced cardioprotection while diminishing cardiac hypertrophy. It is likely that thyroxin-induced cardioprotection is due to a direct effect of thyroid hormone.

Sports-related maxillofacial fractures: a retrospective study of 125 patients.

This study assessed the spectrum of maxillofacial fractures sustained during sports in Greece, discuss the aetiology in different sports and suggest protective measures. One hundred and twenty-five patients suffered facial fractures as a result of different sport activities. The factors evaluated were: type of sport involved, age, sex, mechanism of injury, site of fractures, associated non-maxillofacial injuries and mode of treatment. The ratio male to female was 9:1 and the highest incidence of sport-related facial fractures was found in the 21-30 year age group. Football was the most common sport-related to facial fractures and the main mechanism of injury was that of impact against another player's head. The most common were the mandibular fractures, followed by zygoma fractures. Furthermore, the angle of the mandible is the highest risk region for fracture. The majority of patients needed surgical treatment. Facial fractures during sports mainly affect the young and the majority of the patients are amateur athletes. Although these injuries are not usually severe, initial hospitalisation and surgical interventions may be required. Team sports are responsible for the majority of facial fractures.

Mechanisms of ketamine action on lipid metabolism in rats.

BACKGROUND AND OBJECTIVE: This study was conducted to determine the effect of ketamine on metabolic homoeostasis and particularly in lipoprotein lipase (LPL) activity in adipose tissue. METHODS: Sixty male Wistar rats were divided into six groups of 10 each. Group A served as controls, while Groups B-F received, respectively, ketamine 60, 80, 100, 120 and 140 mg kg(-1) intraperitoneally. The animals were sacrificed 20 min after the administration of ketamine. Insulin concentrations in plasma and total cholesterol, triglyceride, high-density lipoprotein (HDL) and free fatty acid (FFA) concentrations in serum were measured. LPL activity in adipose tissue and medium-chain acyl-CoA dehydrogenase (MCAD) content in muscle were determined. RESULTS: FFA concentrations in serum significantly increased from the second lowest dose of ketamine. Insulin concentrations in plasma did not exhibit any significant difference between groups. MCAD levels were 0.5-fold more in Group F than in Group A, while there were no significant differences between control group and Groups B-E. Furthermore, high concentrations (120 and 140 mg kg(-1)) of ketamine interfered with in metabolic homoeostasis by significantly reducing LPL activity, thus elevating triglyceride concentrations in serum without affecting cholesterol and HDL metabolism. CONCLUSIONS: Ketamine induces various metabolic effects due to changes in adipose LPL activity and MCAD levels in muscles. These findings seem to be significant only at high doses.

Light induced changes in quinolone levels in rat serum and tissues.

Circadian rhythm may induce alterations of the pharmacokinetic properties of several drugs in clinical use. The aim of the study was to investigate whether lighting conditions alter the quinolone (pefloxacin) levels in serum and tissues and to determine any accumulation of the drug in the skin. Thirty male Wistar rats were divided into groups A, B, C, (n=10). The animals of group A were housed under 12h light/12h dark conditions, group B under 24h UV and group C was kept in complete darkness. All animals received 5 doses of 11mg/Kg pefloxacin every 8h for 48h.Pefloxacin levels were determined in serum, skin and femur by the inhibition zone in E.coli. in vitro. Pefloxacin concentrations in serum were increased in 24h darkness living status and decreased in 24h UV conditions as compared to group A animals. Additionally, both skin and femur pefloxacin levels were decreased under dark and UV conditions. In conclusion total light as well as total dark exposure may lead to pefloxacin pharmacokinetic changes which may have implications in the effectiveness of the drug in tissues.

Effect of losartan on insulin plasma concentrations and LPL activity in adipose tissue of hypertensive rats.

The aim of this study is to determine the effect of losartan on insulin and angiotensin II (Ang II) concentrations in plasma as well as on lipoprotein lipase activity (LPL) and angiotensin II content in the adipose tissue of hypertensive rats. Fifty male rats were divided in five groups. Group A served as controls. Group B underwent renal artery stenosis. Group C were administered losartan (10 mg/kg/day) per os, while rats in group D were submitted to renal artery stenosis and were treated with losartan as above. Group E was used as sham-operated control. The animals were sacrificed at day 21. Blood samples were collected, and perirenal adipose tissue was isolated. Furthermore, adrenal's were removed and their relative weight (adrenal weight/body weight) was used as an index of sympathetic stimulation. According to our results, renovascular hypertension resulted in lower insulin concentrations and higher Ang II content in plasma. In hypertensive rats, LPL activity was decreased, while the adrenals' relative weight was elevated. On the other hand, losartan administration resulted in normalization of insulin concentrations in plasma and adrenals' relative weight, with consequent up regulation of LPL activity in adipose tissue. In conclusion, renovascular hypertension interferes in lipid metabolism by reducing LPL activity in adipose tissue, while losartan administration reverses this effect by enhancing insulin release and reducing sympathetic nervous system (SNS) stimulation.

Morphological changes of parotid glands following adjuvant arthritis and ibuprofen treatment in rats.

Drug administration and numerous systemic diseases may cause morphological changes of the parotid gland. The aim of this study was to investigate the possible relationship between experimental adjuvant arthritis following ibuprofen treatment and morphological alterations of the parotid glands in rats. Freud's adjuvant was injected intradermally into the plantar surface of the hind paw of the animals to induce experimental arthritis. Ibuprofen was administrated per os (17 mg/kg/day). Both adrenals and parotid glands were isolated and their absolute and relative weights were evaluated. A full histological examination of parotid glands took place. The diameter of the foot as well as the serum levels of rheumatoid factor was measured. In conclusion, both experimental adjuvant arthritis and ibuprofen treatment induce morphological changes of the parotid tissues, which are related to macro- and micro-structure of the gland.

Quinolone levels in serum and maxillofacial tissues under ibuprofen co-administration following surgical trauma.

Administration of antibiotics is considered to be an important factor, during or after operational procedures in the maxillofacial area, in order to avoid post-surgical complications. Furthermore, administration of anti-inflammatory drugs is often prescribed for control of the post-operative pain. The aim of this study was to determine the levels of quinolones in serum and tissues (parotid gland, tongue, mandible), during traumatic injury in the oral cavity, with or without co-administration of ibuprofen, a non-steroidal anti-inflammatory drug. Four groups of Wistar rats, (A, B control), (C, D experimental) were used. In the experimental group, traumatic injury was performed through the whole length of the cheek. Groups B and D received ibuprofen. The quinolone levels in serum and tissues were estimated by the inhibition zone of B. subtilis. Free fatty acid (FFA) levels and the adrenal weight, considered as a stress index, were increased in trauma groups. Quinolone concentrations in serum and in most of the tissues were significantly higher in the experimental groups compared to the controls. However, the co-administration of ibuprofen caused a higher increase of the quinolone levels in the control animals than in the experimental groups.

Cerebellar infarct: secondary to arteriography for the diagnosis of a buccal hemangioma.

Angiography is a reliable diagnostic method for most of the vascular lesions. The method however is associated with complications and it is the aim of this report to present a cerebellum infarct resulting from angiography for the diagnosis of a buccal hemangioma.

Stress-induced lidocaine modification in serum and tissues.

The aim of this study is to examine the influence of acute (trauma) and chronic (cold swimming and adjuvant rheumatoid arthritis) stress on lidocaine concentrations in plasma. Forty male Wistar rats were used. The animals were divided into four groups. Group A served as control. Group B underwent mandible osteotomy. Group C was submitted to swimming stress in cold water 4 degrees C for ten minutes daily for 15 minutes, while group D underwent experimental arthritis with Freud's adjuvant. All groups received lidocaine i.m (2.5 mg/kg). Blood samples were collected and FFA (free fatty acid), unbound-lidocaine, albumin and a1-acid glycoprotein concentrations were estimated. Furthermore, the adrenals, heart and liver were isolated. The adrenals' relative weight (adrenal weight/body weight) was assessed, while lidocaine concentrations in the heart and the liver incubation medium were measured by intertechnic a-counter. Lidocaine and FFA levels in serum as well as the adrenal weights demonstrated a significant elevation in stress-groups as compared to the control group. Furthermore, in the stress-groups, lidocaine concentrations in heart tissue were significantly increased, whereas in the liver they were significantly reduced as compared to the control group. Our results indicate that stress can alter lidocaine levels in plasma and tissues, suggesting that stress should be considered an important factor when determining the dosage of lidocaine in clinical application.