A Prospective Comparison of Computed Tomography and Magnetic Resonance Imaging as a Diagnostic tool for Maxillofacial Space Infections.

AIMS AND OBJECTIVES: The aim of this work was to assess the advantages and disadvantages of magnetic resonance imaging (MRI) versus computed tomography (CT) in the initial evaluation of maxillofacial space infections by comparing various parameters of the imaging studies and comparing them on a three-point scale. MATERIALS AND METHODS: We prospectively evaluated 15 patients with head and neck space infections. All patients underwent CT and MRI using similar slice thickness. We reviewed all imaging studies with special attention to location, extension, source of infection, extent of bone involvement, odontogenic or nonodontogenic, and presence of gas/calcium in the lesions. All the parameters were graded based on a three-point scale and were compared statistically by paired t-test. RESULTS: According to the results we arrived at, MRI was superior to CT in regard to lesion conspicuity, extension, number of anatomic spaces involved, and source on infection. Although not significant, MRI detected a greater number of abscess collections. However, in the aspects of detection of intralesional gas and calcium and motion artifacts, CT was superior to MRI. However, these advantages of CT over MRI are not significantly better than those of MRI. CONCLUSION: MRI was considered superior to CT in the initial evaluation of head and neck space infections. Our study thus concludes that MRI may be used as the primary modality to evaluate patients with head and neck infections when clinically feasible.

Prospective analysis of secondary alveolar bone grafting in cleft lip and palate patients.

BACKGROUND: To assess the success of the uptake of bone graft in cleft alveolus of the cleft lip and palate patients, quantitatively through computed tomography (CT) scan 6 months postoperative. To assess the successful eruption of permanent lateral incisor or canine in the bone grafted area. MATERIALS AND METHODS: The children age group of 9-21 years with unilateral cleft lip and palate came to the hospital, needing secondary alveolar bone grafting. A detailed history and clinical examination of the patient was taken. A 3D CT scan was taken and the volume of the cleft was measured pre-operatively. After ambulatory period, 3D CT scan of the alveolar cleft region was taken and volume of the bone grafted was measured and patient was discharged from the hospital. After 6 months, patient was recalled and again 3D CT scan was taken and the volume of remaining bone was measured. RESULTS: The mean volume of the defect pre-operatively is 0.80 cm(3) with a standard deviation of 0.36 cm(3) with minimum volume of the defect 0.44 cm(3) and maximum volume of the defect 1.60 cm(3). The mean volume of the bone post-operative immediately after grafting is 1.01 cm(3) with a standard deviation of 0.52 cm(3) with minimum of bone volume is 0.48 cm(3) and maximum of 2.06 cm(3). The mean volume of the bone after 6 months after bone grafting is 0.54 cm(3) with a standard deviation of 0.33 cm(3), minimum bone volume of 0.22 cm(3) and maximum bone volume of 1.42 cm(3). CONCLUSION: The CT scan is a valuable radiographic imaging modality to assess and follow the clinical outcome of secondary alveolar bone grafting.

Submitral aneurysm of the left ventricle.

Submitral aneurysm is a rare cardiac pathology of uncertain origin with varied clinical manifestations. Recent studies have revealed a congenital basis of this pathology, although genetic link has been suspected because of the racial predilection. The other suggested aetiologies are infection and inflammation. The case reported here is that of a young female with a large submitral aneurysm presenting in a state of cardiogenic shock. In addition, the presence of raised inflammatory parameters indicates that the cause of origin of this aneurysm is related to inflammation.

Developments in polymeric devices for oral insulin delivery.

BACKGROUND: Development of improved oral insulin administration is necessary for the treatment of diabetes mellitus, to overcome the problem of daily subcutaneous injections. The vast amount of literature data on oral insulin delivery prompted us to cover this area in a review. OBJECTIVE: Insulin delivery using polymeric devices is discussed, with an ultimate aim of addressing the technological development in this area. METHODS: The development of oral delivery devices for insulin using hydrogels and micro/nanoparticles is discussed with reference to polymers. These efforts must be directed to increase the residence time of insulin near the intestinal absorptive cells. RESULTS/CONCLUSION: The published results on oral insulin delivery devices, particularly on inter-polymer complexes of the grafted copolymers, are discussed in greater depth. The use of absorption enhancers like cyclodextrins, bile salts and surfactants is covered. The state-of-the-art technology and challenges in this area are discussed, with typical examples.

Nano/micro technologies for delivering macromolecular therapeutics using poly(D,L-lactide-co-glycolide) and its derivatives.

Biodegradable nano/microparticles of poly(D,L-lactide-co-glycolide) (PLGA) and PLGA-based polymers are widely explored as carriers for controlled delivery of macromolecular therapeutics such as proteins, peptides, vaccines, genes, antigens, growth factors, etc. These devices are mainly produced by emulsion or double-emulsion technique followed by solvent evaporation or spray drying. Drug encapsulation, particle size, additives added during formulation, molecular weight, ratio of lactide to glycolide moieties in PLGA and surface morphology could influence the release characteristics. Encapsulation efficiency and release rates through nano/microparticle-mediated drug delivery devices can be optimized to improve their therapeutic efficacy. In this review, important findings of the past decade on the encapsulation and release profiles of macromolecular therapeutics from PLGA and PLGA-based nano/microparticles are discussed critically in relation to nature and type of bioactive molecule, carrier polymer and experimental variables that influence the delivery of macromolecular therapeutics. Even though extensive research on biodegradable microparticles containing macromolecular drugs has greatly advanced to the level of production know-how, the effects of critical parameters influencing drug encapsulation are not sufficiently investigated for nano-scaled carriers. The present review attempts to address some important data on nano/microparticle-based delivery systems of PLGA and PLGA-derived polymers with reference to macromolecular drugs.

Development of 5-fluorouracil loaded poly(acrylamide-co-methylmethacrylate) novel core-shell microspheres: in vitro release studies.

Novel poly(acrylamide-methylmethacrylate) copolymeric core-shell microspheres crosslinked with N,N'-methylene bisacrylamide have been prepared by free radical emulsion polymerization using varying amounts of acrylamide (AAm), methylmethacrylate (MMA) and N,N'-methylene bisacrylamide (NNMBA). 5-Fluorouracil was loaded into these microspheres during in situ polymerization (method-I) as well as by the absorption and adsorption technique (method-II). The core-shell microspheres have been characterized by differential scanning calorimetry (DSC) and X-ray diffractometry (X-RD) to understand about the drug dispersion in microspheres. Scanning electron microscopy (SEM) was used to assess the surface morphology of particles prepared. In vitro release of 5-fluorouracil has been studied in terms of core-shell composition, amount of crosslinking agent and amount of 5-fluorouracil in the microspheres. Core-shell microspheres with different copolymer compositions have been prepared in yields ranging 80-85%. DSC and X-RD techniques indicated a uniform distribution of 5-fluorouracil particles in core-shell microspheres, whereas SEM suggested the formation of well-defined core-shell structures. The in vitro drug release indicated that particle size and release kinetics depend upon copolymer composition, amount of crosslinking agent used and amount of 5-fluorouracil present in the microspheres. Prolonged and controlled release of 5-fluorouracil was achieved when drug was loaded by method-I instead of method-II.

Encapsulation efficiency and controlled release characteristics of crosslinked polyacrylamide particles.

Polyacrylamide (pAAm) particles crosslinked with N,N-methylenebis-acrylamide/ethylene glycol dimethacrylate (NNMBA/EGDMA) have been prepared in water-methanol medium by the dispersion polymerization using poly(vinyl pyrrolidone), PVP as a steric stabilizer. 5-fluorouracil an anticancer drug, has been loaded in situ into the crosslinked pAAm particles. Plain as well as drug loaded microparticles have been characterized by differential scanning calorimetry (DSC) and X-ray diffraction studies (XRD) and scanning electron microscopy (SEM). DSC and XRD studies have indicated a molecular level dispersion of the drug in pAAm particles during in situ loading and SEM pictures have shown the formation of spherical and oval-shaped particles. In vitro release of 5-fluorouracil from the crosslinked pAAm particles has been carried out in 7.4 pH buffer medium. Both encapsulation efficiency and release patterns are found to depend on the nature of the crosslinking agent, amount of crosslinking agent used and the amount of drug loaded. In vitro release studies indicated the controlled release of 5-fluorouracil up to 12 h.