Surgical management of double lip: A case report.

BACKGROUND: Double lip is a rare developmental anomaly that mainly affects the upper lip. It is characterised by the presence of excess hyperplastic tissue that gives an illusion of double organ. It may occur independently or as a component of a set of defects, mainly in Ascher's syndrome, which presentes with blepharochalasis, non-toxic thyroid enlargement and double upper lip. The aim of this article is the presentation of a case report. CASE REPORT: The case of a 15-year-old patient with double lip treated surgically for cosmetic reasons is reported. Surgical excision under general anaesthesia was performed, without any complications neither during the surgery nor postoperatively, with no recurrence at the 2-year follow-up. Histopathological analysis showed normal oral mucosa with numerous hypertrophic mucosal glands, capillaries, and lymphocytic and plasmocytic infiltration. CONCLUSION: Due to the lack of unambiguous, clear recommendations and comparative studies in the literature, the choice of the incision depends on the experience and preferences of the operator. Regular follow-ups after the surgery are crucial; though recurrences are observed rarely, long-term, regular follow-ups are suggested due to the risk of developing additional symptoms characteristic for Ascher's syndrome.

Search for the rare decay B-->pil+ l-.

We have performed a search for the flavor-changing neutral-current decays B-->pil+ l-, where l+ l- is either e+ e- or mu+ mu-, using a sample of 230 x 10(6) Upsilon(4S)-->BB decays collected with the BABAR detector. We observe no evidence of a signal and measure the upper limit on the isospin-averaged branching fraction to be B(B-->pil+ l-)<9.1 x 10(-8) at 90% confidence level. We also search for the lepton-flavor-violating decays B-->pie+/- mu-/+ and measure an upper limit on the isospin-averaged branching fraction of B(B-->pie+/- mu-/+)<9.2 x 10(-8) at 90% confidence level.

Thrombosis in the emergency department: use of a clinical diagnosis model to safely avoid the need for urgent radiological investigation.

CONTEXT: The management of patients presenting to hospital emergency departments with suspected deep vein thrombosis (DVT) is problematic because urgent diagnostic imaging capability is sometimes unavailable. Experienced physicians using clinical skills alone can classify patients with suspected DVT into low-, moderate-, and high-probability categories. OBJECTIVES: To determine the accuracy of an explicit clinical model for the diagnosis of DVT when applied by emergency department physicians and to assess the safety and feasibility of a management strategy based on the clinical pretest probability for patients presenting to the emergency department with suspected DVT outside of regular hospital staff work hours. METHODS: A prospective cohort study was performed in the emergency departments of 2 tertiary care institutions involving 344 patients with suspected DVT. Patient conditions were evaluated by an emergency department physician who determined the pretest probability for DVT to be low, moderate, or high using an explicit clinical model. Patients for whom DVT was considered a low pretest probability were discharged from the emergency department and returned the following day for venous compression ultrasound imaging of the affected leg. Patients for whom DVT was considered a moderate pre-test probability received a single, weight-adjusted dose of subcutaneous unfractionated heparin sodium (between 12 500 and 20 000 U), were discharged from the emergency department, and returned the next morning to undergo ultrasonography. Patients for whom DVT was considered a high pretest probability were admitted to the hospital, administered intravenous unfractionated heparin, and ultrasonography was arranged within 24 hours. Patients with positive ultrasonographic findings were diagnosed with DVT, except for those with low pretest probability for whom confirmatory venography was performed. Patients with DVT excluded in the initial evaluation period did not receive anticoagulant therapy. All patients were followed up for 90 days to monitor development of thromboembolic or bleeding complications. RESULTS: Twenty-four (49.0% [95% confidence interval (CI), 34.5%-63.6%]) of 49 patients in the high-probability category, 15 (14.3% [95% CI, 8.3%-22.4%]) of 105 in the moderate-, and 6 (3.2% [95% CI, 1.2%-6.7%]) of 190 in the low-probability category were confirmed to have DVT. Overall, 45 (13.1%) of 344 patients were confirmed to have DVT. No patient developed pulmonary embolism or major bleeding complications within 48 hours of initial evaluation in the emergency department. Of the 301 patients who had DVT excluded during the initial evaluation period, only 2 (0.7% [95% CI, 0.1%-2.3%]) developed venous thromboembolic complications (calf vein thromboses in both) in the 3-month follow-up period. CONCLUSIONS: Using an explicit clinical model, emergency department physicians can accurately classify patients with suspected DVT into high-, moderate-, and low-probability groups. A management plan based on probability for DVT that avoids the need for urgent diagnostic imaging is safe and feasible in the emergency department setting.

A prospective study of ultrasound localization for renal shielding.

Accurate and reproducible shielding of sensitive tissues is essential in clinical radiotherapy. Renal localization is necessary when the kidneys are to be shielded during upper or whole abdominal radiotherapy. Despite extensive clinical experience with intravenous contrast media for renal localization, ultrasound has been proposed as a safer, more cost-effective alternative. In a prospective study, we assessed the accuracy of renal localization by ultrasound. Results show that ultrasound localization covers only 56.5 +/- 27.0% of the renal outline on average; moreover, the ultrasound designed shield results in 57.2 +/- 20.4% of its area being superfluous. Possible explanations and modifications are discussed. We urge others using ultrasound localization for renal shielding to assess its accuracy before using these shields in clinical practice.

Application of a diagnostic clinical model for the management of hospitalized patients with suspected deep-vein thrombosis.

The purpose of this study was to evaluate whether the determination of pretest probability using a simple clinical model and the SimpliRED D-dimer could be used to improve the management of hospitalized patients with suspected deep-vein thrombosis. Consecutive hospitalized patients with suspected deep-vein thrombosis, had their pretest probability determined using a clinical model and had a SimpliRED D-dimer assay. Patients at low pretest probability underwent a single ultrasound test. A negative ultrasound excluded the diagnosis of deep-vein thrombosis whereas a positive ultrasound was confirmed by venography. Patients at moderate pretest probability with a positive ultrasound were treated for deep-vein thrombosis whereas patients with an initial negative ultrasound underwent a single follow-up ultrasound one week later. Patients at high pretest probability with a positive ultrasound were treated whereas those with negative ultrasound underwent venography. All patients were followed for three months for the development of venous thromboembolic complications. Overall, 28% (42/150), and 10% (5/50), 21% (14/71) and 76% (22/29) of the low, moderate and high pretest probability patients. respectively, had deep vein thrombosis. Two of 111 (1.8%; 95% CI = 0.02% to 6.4%) patients considered to have deep vein thrombosis excluded had events during three-month follow-up. Overall 13 of 150 (8.7%) required venography and serial testing was limited to 58 of 150 (38.7%) patients. The negative predictive value of the SimpliRED D-dimer in patients with low pretest probability was 96.2%, which is not statistically different from the negative predictive value of a negative ultrasound result in low pretest probability patients (97.8%). Management of hospitalized patients with suspected deep-vein thrombosis based on clinical probability and ultrasound of the proximal deep veins is safe and feasible.

Management of patients with suspected deep vein thrombosis in the emergency department: combining use of a clinical diagnosis model with D-dimer testing.

The management of patients presenting to hospital Emergency Departments with suspected deep vein thrombosis is problematic since urgent diagnostic imaging is at times unavailable. We evaluated the accuracy of a rapidly available D-dimer test and the potential of combining D-dimer testing with an explicit clinical model to improve the management of patients with suspected deep vein thrombosis. Two hundred and fourteen patients with suspected deep vein thrombosis presenting to the Emergency Departments of two tertiary care institutions were enrolled in this prospective cohort study. Patients were evaluated by an Emergency Physician who determined the pre-test probability for deep vein thrombosis to be either low, moderate, or high using an explicit clinical model. Patients were managed according to their pre-test probability category by specific algorithms that in all cases included venous ultrasound imaging within 24 h and a 90-day follow-up for the development of thromboembolic complications. Patients also underwent fingerstick SimpliRED(R) whole blood agglutination D-dimer testing; however, D-dimer results did not influence subsequent patient management. D-dimer had a sensitivity of 82.5% and a specificity of 84.9% for the diagnosis of deep vein thrombosis. The observed negative predictive value of D-dimer was 96.9% (95% CI, 93.0% to 99.1%) overall, and 100% (95% CI, 96.3% to 100%) in low probability patients, 94.1% (95% CI, 83.8% to 98.8%) in moderate probability patients, and 86.7% (95% CI, 59.4% to 98.3%) in high probability patients. SimpliRED(R) D-dimer has a high negative predictive value and may be useful in excluding the diagnosis in patients at low pre-test probability for deep vein thrombosis.

[A case of primary cardiac myosarcoma]. / Przypadek pierwotnego pråzkowanokomórkowego miesaka serca.

The case of the very rare, primary malignant neoplasm of a cardiac origin was presented. Authors discussed diagnostic difficulties and clinical symptoms of a disease.

[Clinical analysis and therapeutic results of peripheral giant cell granuloma]. / Analiza kliniczna i wyniki leczenia obwodowych olbrzymiokomórkowych ziarniniaków naprawczych.

The author presented clinical analysis and theraputic results of 105 cases of the peripheral giant cell granuloma treated in Division of Maxillofacial Surgery Regional Hospital in Rzeszów. In the 16 cases (15, 3%) this disease recurences in all prabability after non radical operation was observed. The author thinks that electrosurgical removal of the tumour is the treatment of choice. In the advanced stage of peripheral giant cell granuloma indicated excision tumour and the surrounding margin of healthy tissue with resection of the part of the alveolar process. Therapeutic indication to the extraction of the teeth neighbouring to the granuloma should be teken into consideration according to individual cases.

[Difficulties in diagnosis of facial and perimaxillary tissue actinomycosis]. / Trudnosci w rozpoznawaniu promienicy twarzy i tkanek okoloszczekowych.

The authors according to literature data, discuss some difficulties in diagnosis of three cases of facial and perimaxillary tissue actinomycosis. The histopathological examination of changed tissue is the most important point in diagnostic procedure in relation to clinical symptoms.

[Primary management of facial skeleton injuries in patients treated at the maxillofacial surgery ward]. / Pierwotne zaopatrzenie obrazen czaszki twarzowej w materiale Oddzialu Chirurgii Szczekowo-Twarzowej.

This study aimed at discussing 278 patients with facial skull fractures and injuries, being managed at the Maxillofacial Surgery Ward of the Voivodeship Specialist Hospital in Rzeszów within 1991-1998. There have been 201 male, 65 female and 12 paediatric patients, aged between 6 and 67 years. The majority of injures in 161 (57.9%) patients required simultaneous treatment of fractures and soft tissue lesions. 68 (24.6%) patients have had closed injuries and face wounds. In 49 (17.6%) patients reposition and immobilisation of fractures have been necessary. In most cases injures have been dressed at emergency room. Fractures of facial skull, coexisting with face injures and wounds, often required specialist treatment provided by the maxillofacial surgeon, laryngologist and ophthalmologist, combining reposition and immobilisation of fracture with the wire, Nichrominox plates and Champy miniplates, followed by wound dressing, according to the commonly approved rules of the primary medical care.

[Problems with diagnosis and treatment of an odontogenic fistula of facial skin]. / Zagadnienie rozpoznawania i leczenia zebopochodnych przetok skóry twarzy.

Out of 16 patients with odontogenic fistulae of the facial skin, treated with in the last two years in the Department of Maxillofacial Surgery, Province Hospital No 1 in Rzeszów, the authors subjected to detailed analysis seven patients in whom, during the period preceding specialist stomatological treatment, difficulties occurred in the diagnosis and treatment. In all cases of development of facial skin fistulae, odontogenic origin should be considered in the first place.

[Rapid clinical course of glomerulonephritis accompanying postinfectious reactive arthritis]. / Pozakazne reaktywne zapalenie stawów z zewnatrzwlosniczkowym klebuszkowym zapaleniem nerek o gwaltownym przebiegu klinicznym.

A case of 17 years old patient, hospitalized for evaluation of bilateral ankle arthritis and polyarticular arthralgia, that developed soon after upper respiratory tract infection, was described. In few weeks of hospitalization, rapid progress of glomerulonephritis in course of reactive arthritis, was observed. In spite of treatment with antibiotics, steroids and immunosuppressive agents, patient's state showed no improvement. After 3 months extracorporeal dialysis became necessary. Now patient is waiting for renal transplantation.

[A case of long-lasting foreign body in the submandibular and pterygo-mandibular space]. / Przypadek dlugozalegajacego ciala obcego w przestrzeni podzuchwowej i skrzydlwo-zuchwowej.

Authors reported a case of a foreign body in the 70-years old man, located in the submandibular and pterygo-mandibular space in the left side. The case is worthy of notice because of a long-lasting treatment in the period previous to admission to the hospital department, and because of not explained cause and way of the introduction to the tissues of a facial skeleton.

In vivo demonstration of a self-sustaining, implantable, stimulated-muscle-powered piezoelectric generator prototype.

An implantable, stimulated-muscle-powered piezoelectric active energy harvesting generator was previously designed to exploit the fact that the mechanical output power of muscle is substantially greater than the electrical power necessary to stimulate the muscle's motor nerve. We reduced to practice the concept by building a prototype generator and stimulator. We demonstrated its feasibility in vivo, using rabbit quadriceps to drive the generator. The generated power was sufficient for self-sustaining operation of the stimulator and additional harnessed power was dissipated through a load resistor. The prototype generator was developed and the power generating capabilities were tested with a mechanical muscle analog. In vivo generated power matched the mechanical muscle analog, verifying its usefulness as a test-bed for generator development. Generator output power was dependent on the muscle stimulation parameters. Simulations and in vivo testing demonstrated that for a fixed number of stimuli/minute, two stimuli applied at a high frequency generated greater power than single stimuli or tetanic contractions. Larger muscles and circuitry improvements are expected to increase available power. An implanted, self-replenishing power source has the potential to augment implanted battery or transcutaneously powered electronic medical devices.

Measurement of the absolute branching fraction of D0-->K-pi+.

We measure the absolute branching fraction for D(0)-->K(-)pi(+) using partial reconstruction of B(0)-->D(*+)Xl(-)nu(l) decays, in which only the charged lepton and the pion from the decay D(*+)-->D(0)pi(+) are used. Based on a data sample of 230 x 10(6) BB pairs collected at the Upsilon(4S) resonance with the BABAR detector at the PEP-II asymmetric-energy B factory at SLAC, we obtain B(D(0)-->K(-)pi(+)) = (4.007+/-0.037+/-0.072)%, where the first uncertainty is statistical and the second is systematic.