Incidental findings on MRI of the temporomandibular joint.

OBJECTIVES: The aim of this study was to determine the prevalence of incidental findings in MRI of the temporomandibular joint (TMJ). METHODS: MRI reports of 730 patients were assessed. The reports were analysed by one consultant and one clinical lecturer in dental and maxillofacial radiology. The prevalence of intracranial and extracranial incidental findings was recorded and categorized. RESULTS: There were 53 (7.3%) incidental findings, of which 11 (1.5%) were intracranial and 42 (5.7%) were extracranial (divided into paranasal sinuses, mastoid air cells, muscle hypertrophy, lymphadenopathy and salivary glands). A total number of eight intracranial findings needed further dedicated imaging and/or specialist clinical opinion. Only one tumour (a meningioma) was found and required surgical intervention. CONCLUSIONS: Incidental findings on TMJ MRI are rare but not unheard of. The clinical relevance of incidental findings can be significant, and it is therefore important to ensure that the full data set of images is inspected, including any scout slices. A close working relationship between the areas of dental and maxillofacial radiology and neuroradiology is essential in expediting a second opinion relating to intracranial findings. All incidental findings should be communicated to referring clinicians in a timely manner, based on their urgency and clinical significance.

Is there a therapeutic role for cranioplasty?

Cranioplasty is often undertaken as a joint neurosurgical and maxillofacial procedure. The principal aims remain to improve cosmesis and to protect the underlying brain. We report two cases of cranioplasty with subsequent improvement in neurological function and discuss the possible therapeutic role of cranioplasty.

Mechanisms and management of vision loss following orbital and facial trauma.

PURPOSE OF REVIEW: To examine the proposed mechanisms of vision-threatening injuries occurring secondary to orbital and facial trauma: traumatic optic neuropathy (TON), retrobulbar haemorrhage (RBH) and penetrating eye injury. To evaluate the evidence supporting different management options for traumatic vision-threatening injury. RECENT FINDINGS: Despite considerable debate over the roles of surgical decompression and systemic steroid therapy for TON, these interventions have not been proved to be more effective than conservative management and there is limited evidence that the use of steroids may be associated with an adverse outcome. Lateral canthotomy and inferior cantholysis have been proven to be effective treatments for RBH. Orbital exploration and surgical evacuation of haematoma remains a second line intervention. Open globe injuries require immediate primary surgical exploration and repair. Irretrievable devastating globe injuries require either enucleation or evisceration. There is no consensus as to which is the best treatment with recent surveys indicating that enucleation is preferred in the USA and evisceration in the United Kingdom. SUMMARY: Conservative management is the first line treatment for TON. The evidence strongly supports lateral canthotomy and inferior cantholysis as best treatment for RBH. There is no consensus as to whether enucleation or evisceration is the best treatment for irretrievable devastating globe injury. The choice of management is currently determined by surgeon preference.

Persistence of extracellular baculoviral DNA in aquatic microcosms: extraction, purification, and amplification by the polymerase chain reaction (PCR).

Genetically-modified baculoviruses have potential uses as bio-pesticides in forestry. However, the baculoviral occlusion bodies (OBs) may release genetically-modified DNA into the forest environment. In this research, outdoor aquatic microcosms, spiked with 673 microg of genomic DNA (4.4 x 10(12) target copies) from the genetically modified baculovirus Choristoneura fumiferana MNPVegt-/lacZ+, were exposed to natural summer conditions. A 530 bp DNA fragment from the genome of CfMNPVegt-/lacZ+ was detected in field microcosm water samples for about 24 h. The introduced DNA may have persisted for a longer time, but was below the detection limit of the PCR analysis (13.5 pg DNA or 8.9 x 10(4) target copies ml(-1) water). The detection limit of PCR was determined by spiking water samples with a dilution series of CfMNPVegt-/lacZ+ genomic DNA, extracting and purifying the DNA, and then PCR analysis. This study provides some of the first information on the persistence and detection limits of this viral DNA under aquatic ecological conditions, and the methods that can be used to conduct such a molecular-based field study.

Extraction, detection and persistence of extracellular DNA in forest litter microcosms.

A DNA extraction method was developed that preferentially extracted extracellular DNA rather than intracellular DNA from forest litter. The method purposely avoided the use of harsh chemicals and physical disruption steps used in total DNA extraction to release DNA from cells. The detection limit of PCR, determined by spiking forest litter samples with a dilution series of Choristoneura fumiferana MNPVegt(-)/lacZ(+) genomic DNA, was about 1 ng DNA or 6.85 x 10(6) target copies 0.5 g(-1) moist forest litter or 0.14 g(-1) dry forest litter. In this study, outdoor terrestrial microcosms, each spiked with 49.2 microg of genomic DNA (from the baculovirus CfMNPVegt(-)/lacZ(+)), were exposed to summer conditions. A 530 bp DNA fragment from the genome of the baculovirus CfMNPVegt(-)/lacZ(+) was detected in these microcosms for about 3 months. The DNA may have persisted for a longer period but was below the detection limit of the PCR analysis.

Caregivers' attitudes toward their family members' participation in Alzheimer disease research: implications for recruitment and retention.

Current levels of participation in Alzheimer disease (AD) research are inadequate, particularly among nonwhites. This study was conducted to examine caregivers' attitudes toward their family members' participation in AD research. Six focus group interviews were conducted with 38 white and 12 African-American caregivers of participants enrolled in clinical research projects. Both white and African-American families participated in research to help their care recipients and future generations, receive support from the clinical and research staff, and obtain feedback about patient status and research results. Among white caregivers, primary barriers to participation in research included the potential for no direct benefit, problems with the procedures and tests involved, lack of time and resources, and difficulty accepting the diagnosis. Among African-American caregivers, primary barriers included general skepticism about the research process and firmly established attitudes about medical treatment and help seeking that serve as disincentives to research participation. To maximize the perceived benefits of research participation, potential participants should have access to regular personal contact with staff, information about health status changes in the care recipient, and the short-term and long-term results of the research studies in which they are participants. In addition, researchers should be sensitive to the concerns that may serve as barriers to participation, particularly among African Americans.

Percutaneous osteosynthesis of the zygomatic buttress.

We describe a technique of percutaneous miniplate osteosynthesis of the zygoma, using the transbuccal approach. It can be used in conjunction with an extraoral approach, or in isolation. Excellent access was achieved to the posterior zygomatic buttress and arch of zygoma, and the infraorbital rim. No complications developed in the two cases presented. This technique is a useful addition to the armamentarium of maxillofacial surgeons.

Extraction and detection of baculoviral DNA from lake water, detritus and forest litter.

AIMS: This paper describes a quick, reproducible, sensitive method for baculoviral DNA extraction, purification and detection from freshwater and forest litter environments. METHODS AND RESULTS: The extraction protocol utilizes enzymatic and chemical lysis and physical disruption. To assess the efficiency of the extraction and purification protocol, PCR was used to detect a 530 bp DNA fragment from the genome of a genetically-modified baculovirus, Choristoneura fumiferana NPVegt-/lacZ+. The detection limit of PCR amplification was routinely about 4.1 x 102 occlusion bodies (OBs) 450 microl-1 lake water. Template DNA from the detritus and forest litter samples required 100-fold dilutions before use in PCR reactions. The detection limits for detritus and forest litter samples were routinely about 7.41 x 103 and 2.08 x 104 OBs 0.5 g-1 dry weight, respectively. CONCLUSION: The DNA extraction and purification methodology is reproducible, sensitive and can be used in lieu of, or in conjunction with, insect bioassays. SIGNIFICANCE AND IMPACT OF THE STUDY: The DNA extraction and purification protocol described in this paper will facilitate risk assessment and ecological studies of both wild-type and genetically-modified baculoviruses.

Squamous cell carcinoma presenting as a peritonsillar abscess.

Peritonsillar abscess is a rare presentation of squamous cell carcinoma of the tonsil. We report two cases illustrating the need to be aware of the possibility and reinforcing the need to send all excised tissue for histopathological diagnosis.

Hyponatraemia and seizures after ecstasy use.

A patient presented to our unit with seizures and profound hyponatraemia after ingestion of a single tablet of ecstasy. The seizures proved resistant to therapy and ventilation on the intensive care unit was required. Resolution of the seizures occurred on correction of the metabolic abnormalities. The pathogenesis of seizures and hyponatraemia after ecstasy use is discussed. Ecstasy use should be considered in any young patient presenting with unexplained seizures and attention should be directed towards electrolyte levels, particularly sodium.

Advanced practice nursing role: clinical nurse specialist.

The public continues to demand quality health care that focuses on the achievement of quality patient outcomes. The clinical nurse specialist is an advanced practice role that originated in the early 1900s as a result of similar public demand, and continues to evolve to meet quality health care needs. Advanced practice nurses have many opportunities to create expanded nursing roles. Orthopaedic nurses also continue to refine their practice roles, and the clinical nurse specialist is one such example.

Infectivity and effects of gypsy moth and spruce budworm nuclear polyhedrosis viruses ingested by rainbow trout.

Rainbow trout fingerlings were fed dried krill injected with gypsy moth or spruce budworm nuclear polyhedrosis virus (LdNPV and CfNPV, respectively) at a total dose of 1.4 x 10(7) occlusion bodies (OBs) per fish. By the end of the 21-day experimental period there were no adverse effects on fish survival or behavior and no significant differences in feeding rates or growth between treated and control fish. The internal organs of all fish were examined at the end of the experiment and there were no signs of lesions, discoloration, swelling, hemorrhaging, or other aberrations. Visceral tissues were analyzed with a horseradish peroxidase-labeled whole genomic DNA probe (enhanced chemiluminescence procedure) to detect infection by the NPVs. There were no indications of NPV infection (no positive signals) in stomach and intestinal tract tissues of treated fish. High background signals were obtained from liver samples, but further analyses indicated that these were not due to the presence of LdNPV or CfNPV. The protocols outlined here should be applicable to determining infectivity and effects of genetically modified insect viruses on fish.

Comparison of forest soil microcosm and acute toxicity studies for determining effects of fenitrothion on earthworms.

The effects of the organophosphate pesticide fenitrothion on Eisenia fetida Savigny and Dendrobaena octaedra Savigny were studied using the OECD acute toxicity test and microcosms containing forest organic matter. In the acute toxicity study, both species were relatively susceptible to fenitrothion, although D. octaedra (LC50 = 393.9 ml/cm2) was approximately eight times more sensitive than E. fetida (LC50 = 54.1 ml/cm2). E. fetida was unable to utilize oak/maple litter for growth, and attempts to use this species in microcosms were abandoned. In microcosm studies, reproduction of D. octaedra was affected at the expected environmental concentration (EEC), whereas growth and maturation rates did not decrease until 100x the EEC was used. Even at 100x EEC, a significant effect on survival of D. octaedra in microcosms was not demonstrated. The use of microcosm studies to provide insight into possible ecological effects of pesticides is discussed.

Attitudes about autopsy: implications for educational interventions.

Although the role of autopsy in confirming diagnoses and advancing research is well documented, family members are inadequately informed about the procedure. The present study examined attitudes about autopsy among older adults. Focus group interviews were conducted with members of three caregiver support groups and two senior centers. Predominant themes included: benefits, barriers, religious views, and concerns about procedures. Results suggest the need to design educational interventions to: (a) involve family members in advance planning; (b) provide counseling regarding the purpose, process, and procedures of autopsy; and (c) facilitate communication skills and awareness of local autopsy services and policies among physicians.

Increasing coordination of the dementia service delivery network: planning for the Community Outreach Education Program.

Dementia is an emerging public health concern because of its prevalence and the cost and extent of care typically needed for people with cognitive disorders. When family members seek assistance in providing care, they frequently encounter a fragmented service delivery network. To increase the coordination of services for people with dementia, the Community Outreach Education Program (COEP) has been designed to provide educational interventions to disseminate information about the diagnosis, assessment, management, and treatment of dementia to health care professionals, service providers, staff of volunteer and community organizations, and family members. This article describes plans for the COEP within the context of a community development perspective.

Effects of lethal and sublethal concentrations of the herbicide, triclopyr butoxyethyl ester, in the diet of zebra finches.

Lethal and sublethal effects of dietary triclopyr butoxyethyl ester (TBEE) on zebra finches (Poephila guttata Gould) were determined in laboratory experiments conducted between 8 January and 1 May 1991. The 8-day median lethal dietary concentration, LC50 (95% confidence interval), of TBEE to zebra finches was 1,923 (1,627 to 2,277) mg/kg. In the sublethal effects experiment, when birds were exposed to 500 mg/kg TBEE in the diet for 29 days, food consumption and body weight were significantly depressed (P < 0.05). Similar prolonged exposures to 50 and 150 mg/kg TBEE in the diet had no significant effect on food consumption or body weight (P > 0.05). Perch-hopping activity was depressed relative to controls in the 500 mg/kg group, and elevated in the 150 mg/kg group, but neither of these differences was significantly (P > 0.05). Disappearance of TBEE residues from treated seeds over the 29 day experimental period followed an exponential decay model, with half-lives in the order of 15 to 18 days. On the basis of our observation that TBEE had no significant adverse effects at a concentration greater than the maximum expected environmental concentration, we propose that forestry applications of triclopyr at registered dosage rates pose little risk to wild songbirds.