Evidence to support the hypothesis of tuberculosis as a cause of extreme osteonecrosis and osteomyelitis of the mandible in a West African population.

Maxillofacial tuberculosis (TB) is rare. The cases of 19 patients showing extreme bony destruction in the mandible, collected over a 3-month period in West Africa, are presented. Clinical, radiographic, and histological evidence indicated Mycobacterium tuberculosis as a possible cause. Further studies are in progress.

Clinical characteristics of renal cell carcinoma: Five years review from a tertiary hospital in Eastern India.

BACKGROUND: Renal cell carcinoma (RCC) is the one of the dreadful urological carcinoma. In comparison to the West, it is very rarely seen in Asia as well in India. Very small number of studies is available in this geographical area. AIMS: We studied the demographic pattern, presentation, risk factors and survival of RCC in an Eastern Indian institution. We characterized and compared these data with available literature Settings and Design: Retrospective study. MATERIALS AND METHODS: A total of 81 patients of RCC from January 2008 to December 2012 were enrolled. Their pre-operative data were reviewed. They were followed as per institutional follow-up protocol. STATISTICAL ANALYSIS USED: Kaplan-Meier plot was constructed for survival analysis. Comparison of survival curves was performed by Logrank test. P < 0.05 was considered to be significant. RESULTS: A total of 75 patients were analyzed with a mean follow-up of 26.3 ± 17.7 months. The mean age of presentation in our study was 52.79 years with a peak at 5th decade. Nearly 73.33% patients having one or more risk factors. 9 out of 10 had presented with some symptoms. The survival for localized RCC was 100% and significantly greater than advanced RCC (P < 0.0001). Similarly in the stage III, significant greater survival (P < 0.0001) was noted compare to stage IV. CONCLUSIONS: The age of presentation of RCC in India has been found in 5th decade, which is a decade earlier than the western countries. Symptomatic RCC is still majority in India. Organ confined tumors have good prognosis. When it metastasizes to lymph node or distant organ, the outcome is poor. Our results may form the basis for further studies and it may be used as future reference.

Quantification of thallium-201 scintigrams in acute myocardial infarction.

A method has been developed for measurement of myocardial infarct size from thallium-201 scintigrams that depends on computer measurement of levels of radioactivity in the myocardium. In 16 dogs, thallium-201 scintigrams were obtained in the left lateral and left anterior oblique projections 48 hours after ligation of the left anterior descending coronary artery. Scintigraphic results were obtained by two independent observers and were compared with tissue measurements of infarct volume calculated from thallium autoradiograms and nitro-blue tetrazolium (NBT)-stained tissue slices. Infarct volumes derived from tissue measurements were used to develop criteria for the computer scintigraphic technique. There was no significant difference in the scintigraphic measurements made by the two observers. Scintigraphic infarct size in the left lateral and left anterior oblique projections correlated with tissue infarct size with r values of 0.88 and 0.75, respectively, for thallium autoradiography and 0.71 and 0.70, respectively, for NBT tissue staining. The range of infarct volume was 3.3 to 14.8 percent of the left ventricular mass. Results of this study suggest that scintigraphic quantitation of infarct size is feasible in this dog model.

Thyrotoxicosis in a patient with submandibular thyroid.

Ectopic thyroid glands generally appear in the midline due to abnormal median migration; their presence lateral to the midline is rare. We report the case of a 42-year-old female who presented with symptoms of thyrotoxicosis and an expanding submandibular swelling. Tc-99m-sodium pertechnetate scanning showed thyroid tissue in the left submandibular region, while no thyroid tissue was seen in the normal site. The patient was treated with 10 mCi of 131I and subsequently became euthyroid. Literature review revealed seven cases of lateral aberrant thyroid tissue. The theories to explain lateral aberrant thyroid are presented.

Colon cancer screening. Sigmoidoscopy or colonoscopy.

Colorectal cancer is a common neoplasia with high morbidity and mortality. With endoscopy it is possible to identify its precursor lesion, the adenoma, and early localized cancer. Early detection and removal of adenomas can reduce the incidence and mortality of this disease. Studies using fecal occult blood testing (FOBT) and sigmoidoscopy for screening asymptomatic patients demonstrate a reduction in mortality from colorectal cancer. Colonoscopy, however, has the highest yield for detecting polyps. Most authorities and organizations now recommend screening the asymptomatic population over age 50 for colorectal neoplasia. The estimated cost of colon cancer screening is well within the benchmark figure of $40,000 per year of life saved, which is considered by the government to be cost effective. Controversies still exist regarding which colon cancer screening strategy is the most sensitive, specific, acceptable to the population, and cost effective. The American Cancer Society recommends a combination of FOBT and flexible sigmoidoscopy, but some experts believe that a one-time colonoscopy at age 60 may be a more cost-effective method. If the costs of colonoscopy are reduced, it is more cost effective than other techniques. Colonoscopy also may help to stratify at-risk patients, and those with negative initial colonoscopy may not need further screening. Advances in molecular biology may provide markers for screening or identifying people who are at high risk for colorectal neoplasia. This development may allow screening to be directed at high-risk groups.

Gastric outlet obstruction.

Acquired gastric outlet obstruction is more commonly owing to malignancy than ulcer disease. Endoscopy is the preferred method for diagnosis. Surgical palliation for malignant disease has poor results and high rates of morbidity and mortality. Initial experiences with endoscopic palliation with expandable metallic endoprostheses appear promising. Peptic ulcer-induced gastric outlet obstruction can be treated safely with endoscopic balloon dilation. About 65% of patients have sustained symptom relief, but many require more than one dilation session. Outcomes may be improved with effective ulcer therapy with acid reduction and eradication of H. pylori. Surgery is associated with significant morbidity and mortality and should be reserved for endoscopic treatment failures.

Quantification of myocardial ischemia and infarction with 201thallium scintigraphy.

A quantitative method for the analysis of 201thallium myocardial scintigrams, developed in an experimental infarcted dog heart model, has been compared with two nonquantitative methods for interpretation of stress myocardial scintigrams in two groups of patients studied with coronary angiography: 11 with normal coronary arteries and 14 with coronary artery disease. Three independent observers interpreted scintigrams which were 1) not computer processed; 2) corrected for background activity in lungs and chest wall; and 3) processed by a computer method which uses a uniform threshold of counts determined from the dog model to define perfusion defects. Interobserver variability as well as sensitivity and specificity of detecting coronary disease were examined. In patients with coronary artery disease interobserver variability was improved by using the computer technique: observers agreed as to the existence of a perfusion defect in 93% of the scintigrams as compared to 55% and 81% for the unprocessed and background-subtracted images respectively. No false positive indications of coronary disease were obtained by any of the three techniques. Use of the computer method did not improve the sensitivity of detecting coronary disease, however--71% compared to 64% for unprocessed images and 79% for background-substracted images. The advantages of this quantitative computer method are increased consistency of interpretation and lack of false positive diagnoses of coronary disease. An improved sensitivity of detection may be gained by varying thallium count thresholds according to anatomic location in the heart.

Clinical perspective: the importance of imaging in diffuse liver disease and hepatic vascular disorders.

The diagnosis of hepatobiliary disorders is based on the patient's history and physical examination and is augmented by laboratory findings, imaging studies, and histology. Radiographic imaging is especially helpful for identifying structural lesions and vascular abnormalities. In cholestatic disease, imaging of the biliary tree is essential to identify extrahepatic biliary obstruction. In hepatocellular diseases, imaging studies narrow the differential diagnosis and guide further testing. In this clinical overview, the role of radiographic imaging in hepatobiliary disorders is reviewed.

Effect of low-level laser treatment on neurosensory deficits subsequent to sagittal split ramus osteotomy.

OBJECTIVES: Low-level laser treatment has been advocated as a possible treatment for patients with paresthesia. An objectively verified improvement in sensory function is relevant if, at the same time, it is perceived as a subjective improvement by the patient. The aim of this double blind clinical study was to see if low-level laser treatment with a GaAlAs laser (820 nm, Rønvig, Denmark) resulted in objectively verified improvement in sensory function and whether this correlated with the patient's subjective evaluation subsequent to treatment. STUDY DESIGN: The 13 patients in this study had all undergone saggittal split ramus osteotomy resulting in either compression or traction of the inferior alveolar nerve as reported by the surgery notes. The material was collected from a consecutive series of patients at the Karolinska Hospital, all of whom had shown reduced sensibility at their final 2-year postoperative checkup. The patients were randomly divided into two groups; one (eight subjects) group received real low-level laser treatment (4 x 6 J per treatment along the distribution of the inferior alveolar nerve, at the following points extraoral: lateral third of lower lip, intraoral; buccally to the apex of the second premolar tooth and the apex of the second molar tooth; lingually in the region of the mandibular foramen; for a total of 20 treatments). The other group received an equivalent placebo treatment. The study was conducted in a double blind fashion for both patient and doctor as the low-level laser equipment had two settings, A and B, one of which was an unknown void setting. The degree of mechanoceptor neurosensory deficit was assessed by Semmes Weinstein monofilaments (North Coast Medical, USA) and the degree of thermoceptor neurosensory deficit was assessed by a Thermotester (Somedic, Sweden). The degree of subjective neurosensory deficit was assessed by means of a visual analogue scale. Both variables and the degree of subjective injury were comparable between the two groups before starting treatment. RESULTS: The patients in the real low-level laser treatment group experienced a subjective improvement in both lip (p = 0.01) and chin (p = 0.02) after completion of the course of treatment. In addition, this group showed a significant decrease in the area of mechanoperception neurosensory deficit (p = 0.01) compared with no difference in the placebo group. The real low-level laser treatment group exhibited a strong tendency toward improvement in mechanoreceptor neurosensory deficit in the areas of most damage for both lip and chin. This improvement was especially pronounced in the lip region (p = 0.06). No similar tendency was demonstrated in the placebo group. Neither group showed any significant change or tendency to improvement in thermoception on completion of the course of treatment. CONCLUSION: In conclusion GaAlAs low-level laser treatment results in both a subjective and objective improvement in mechanical sensory perception in long-standing neurosensory deficit in the inferior alveolar nerve.

Thyroid hemangioma: a case report with a review of the literature.

A 53-year-old man was found serendipitously to have increased blood-pool uptake in the right lobe of the thyroid during a radionuclide ventriculography study for left ventricular function. Primary thyroid hemangioma is a rare condition, with only two cases reported in the literature. Secondary hemangioma may occur as a result of fine-needle aspiration. This technique may cause hematoma formation, which generally resolves normally, but on rare occasions it can lead to cavernous hemangioma formation. In patients with a thyroid swelling who have a cold nodule on a thyroid scan and only blood on repeated fine-needle aspiration, Tc-99m erythrocyte blood-pool imaging may be performed to diagnose hemangioma.

Dual thyroid ectopy: case report and review of the literature.

Dual ectopic thyroid glands rarely occur, and only six cases have been reported in the literature. The authors describe a 14-year-boy who had a midline neck swelling for 8 to 9 years. The swelling increased gradually, but he had no pressure symptoms. The thyroid hormone profile showed a moderately increased thyroid-stimulating hormone value and normal T3 and T4 levels. A Tc-99m sodium pertechnetate thyroid scan showed dual ectopic thyroid glands in the sublingual and subhyoid regions.

Bone scanning for bone metastasis in carcinoma cervix.

AIM: Bone metastasis in cervical cancer is rare. With the aim of defining the frequency of bony metastasis in patients of carcinoma cervix, with clinical suspicion of metastasis, we performed bone scan in 38 such patients. RESULTS: Twelve out of the 38 patients were confirmed as having metastasis. All the patients were also detected by bone scan (100% sensitivity). CONCLUSION: Bone scan should be investigation of choice for screening patients of carcinoma cervix with symptoms suggestive of metastasis in all stage of the disease. Bone scan is the most sensitive method for detection of bone metastasis. Bone scan offers the additional advantages of allowing a review of the kidney size to look for ureteric involvement and subsequent hydronephrosis.

Sixty cases of extreme osteonecrosis and osteomyelitis of the mandible and maxilla in a West African population.

A description of 60 cases of extreme osteonecrosis and osteomyelitis of the jaws is presented. The patients attended the dental clinics of the medical charity organisation Mercy Ships, over a 2.5-year period when the hospital ship the 'Africa Mercy' was docked in the West African countries of Liberia, Benin and Togo. Possible reasons for the development of these clinical conditions are discussed including aetiologies, genetics (coagulopathies, osteopetrosis), Gorham's disease, infective conditions (tuberculosis, herpes zoster, HIV infection, osteomyelitis), toxicity (bisphosphonates, spider bites), and environmental effects (phossy jaw, radium jaw). The possible causes of these cases of osteonecrosis and osteomyelitis of the jaw are under investigation.

Adenomatosis of minor salivary glands. Report of a case.

An account is given of a patient who had multiple canalicular adenomas in the upper lip and adjacent oral mucosa. A few months after these had been excised, several more tumors of the same type developed. Microscopic examination also revealed numerous tiny foci of adenomatous proliferation within otherwise normal salivary gland lobules. We suggest that this phenomenon represents a field neoplastic change although it appears to be benign.

Usefulness of systolic time intervals in differential diagnosis of constrictive pericarditis and restrictive cardiomyopathy.

Systolic time intervals in 15 patients with constrictive pericarditis and seven patients with restrictive cardiomyopathy were compared in order to assess their value in the differential diagnosis of the two disorders. Clinical examination had failed to make the distinction. Right heart catheterization was helpful in diagnosing restriction but failed to differentiate patients with constrictive pericarditis from those with restrictive cardiomyopathy. The systolic time intervals clearly separated the two groups. The PEP/LVET was normal in all patients with constrictive pericarditis (0.34 +/- 0.01) and abnormal in all patients with restrictive cardiomyopathy (0.70 +/- 0.09, P less than 0.001). In 13 patients (five with restrictive cardiomyopathy and eight with constrictive pericarditis) the results of quantitative left ventricular angiocardiography were available. A high correlation (r=-0.90, P less than 0.01) between the PEP/LVET and the ejection fraction confirmed the validity of the PEP/LVET as a measure of left ventricular performance in these patients. Thus the systolic time intervals clearly distinguished between constrictive pericarditis and restrictive cardiomyopathy and are a reliable non-invasive technique for making the difficult differential diagnosis.

Where to look? Automating attending behaviors of virtual human characters.

This research proposes a computational framework for generating visual attending behavior in an embodied simulated human agent. Such behaviors directly control eye and head motions, and guide other actions such as locomotion and reach. The implementation of these concepts, referred to as the AVA, draws on empirical and qualitative observations known from psychology, human factors and computer vision. Deliberate behaviors, the analogs of scanpaths in visual psychology, compete with involuntary attention capture and lapses into idling or free viewing. Insights provided by implementing this framework are: a defined set of parameters that impact the observable effects of attention, a defined vocabulary of looking behaviors for certain motor and cognitive activity, a defined hierarchy of three levels of eye behavior (endogenous, exogenous and idling) and a proposed method of how these types interact.

The effects of low level laser treatment on recovery of nerve conduction and motor function after compression injury in the rat sciatic nerve.

An animal study is presented examining the effect of low level laser (LLL) treatment on nerve regeneration following axonotmesis. Twenty animals received a standardised injury to the right sciatic nerve using a time, load and length sequence (10 min, 150 N, 5 mm) known to cause extensive axonal degeneration of the rat sciatic nerve. The LLL treatment was administered using a hand-held laser probe in light contact with the skin on the dorsal aspect of the hind leg overlying the site of the axonotmesis injury to the sciatic nerve. A group of 10 animals were treated with 6J of LLL (GaAlAs 830 nm) daily for a period of 28 d. Ten more animals were treated daily with a sham exposure setting and served as controls. Nerve function was assessed by a recognised method of walking tract print analysis; the "Sciatic Functional Index" (SFI), and nerve regeneration was assessed by recording the evoked compound action potentials (cAP) in the common peroneal nerve. At 21 d post-injury, the laser-treated group had a significantly lower median SFI than the sham laser-treated group, indicating that the real laser treatment had improved functional recovery in the nerve. However, no differences were found between the evoked cAP parameters that were measured in the laser-treated and sham laser-treated groups. Histological examination reiterated the lack of difference between the two groups. Consequently, the effects of LLL on recovery must have occurred more peripherally to the point measured.