A case report of orbital haemorrhage associated with endoscopic sinus surgery and reversible sight loss: a multidisciplinary approach to management.

We report a case of intraoperative orbital haemorrhage as a complication of endoscopic sinus surgery performed under general anaesthesia. Initial unilateral complete visual loss occurred, but recovered due to accurate and early diagnosis combined with urgent surgical intervention. This patient's case is reported to illustrate the importance of early recognition of clinical signs and how a stepwise approach to management can result in a favourable visual outcome. Moreover, the mechanisms and pathophysiology of visual loss due to orbital haemorrhage following endoscopic sinus surgery are discussed.

Simplifying differential diagnoses of orofacial conditions - a guide to surgical sieves and red flags.

Formulation of a differential diagnosis with appropriate diagnostic tests is critical in day-to-day clinical practice. Many specialists or hospital-based practitioners in specialties such as oral medicine and oral surgery will be familiar with the use of surgical sieves and the term 'red flags' in their practice. However, it is the authors' experience that general dental practitioners may not be as familiar with such tools. Primary care practitioners are often the first port of call for patients with uncommon symptoms; therefore, it is essential that appropriate and timely referrals are made. The use of a surgical sieve and heightened awareness of red flags will assist practitioners significantly.

[Liver resection after downstaging with neoadjuvant chemotherapy for "unresectable" colorectal metastases]. / Resezione epatica dopo downstaging con chemioterapia neoadiuvante per metastasi colo-rettali "irresecabili".

Hepatic resection is the only treatment that offers a chance of long-term survival in patients with metastases from colorectal cancer. Nevertheless, a curative resection can be performed in only 10-20 per cent of patients: multiple bilobar metastases or "unresectable" disease are the greatest obstacles to surgical radicality. Techniques such as preoperative portal embolisation, preoperative portal ligation, two-stage hepatectomy, and neoadjuvant chemotherapy, have extended the possibility of liver surgery to patients with advanced metastatic colorectal cancer. The outcomes of two patients treated successfully with neoadjuvant chemotherapy (one case with FOL-F-OX, and one with FOL-F-IRI) followed by liver resection were analyzed. In both patients neoadjuvant chemotherapy enabled a curative liver resection to be performed without significant complications. In some patients, neoadjuvant chemotherapy permits the "downsizing" of metastatic disease to such an extent that a surgical approach proves feasible. This advance can dramatically improve the prognosis of patients with multiple or unresectable liver metastases from colorectal cancer.

Bilateral temporomandibular joint dislocation in a 29-year-old man: a case report.

INTRODUCTION: A dislocation of the temporomandibular joint represents three percent of all reported dislocated joints.The treatment entails reduction of the deformity and this can often be achieved in a ward setting. CASE PRESENTATION: We present the case of a 29-year-old Caucasian man with a non-traumatic bilateral anterior temporomandibular joint dislocation. Following several unsuccessful attempts, due to both inadequate patient analgesia and sedation, joint reduction had to be performed in theatre with the patient under general anesthesia. CONCLUSION: This case highlights the importance of providing the patient with adequate analgesia and sedation when attempting the reduction of temporomandibular joint dislocations.

Modeling the effect of snow and ice on the global environmental fate and long-range transport potential of semivolatile organic compounds.

Snow and ice have been implemented in a global multimedia box model to investigate the influence of these media on the environmental fate and long-range transport (LRT) of semivolatile organic compounds (SOCs). Investigated compounds include HCB, PCB28, PCB180, PBDE47, PBDE209, alpha-HCH, and dacthal. In low latitudes, snow acts as a transfer medium taking up chemicals from air and releasing them to water or soil during snowmelt. In high latitudes, snow and ice shield water, soil, and vegetation from chemical deposition. In the model version including snow and ice (scenario 2), the mass of chemicals in soil in high latitudes is between 27% (HCB) and 97% (alpha-HCH) of the mass calculated with the model version without snow and ice (scenario 1). Amounts in Arctic seawater in scenario 2 are 8% (alpha-HCH) to 21% (dacthal) of the amounts obtained in scenario 1. For all investigated chemicals except alpha-HCH, presence of snow and ice in the model increases the concentration in air by a factor of 2 (HCB)to 10 (PBDE209). Because of reduced net deposition to snow-covered surfaces in high latitudes, LRT to the Arctic is reduced for most chemicals whereas transport to the south is more pronounced than in scenario 1 ("southward shift"). The presence of snow and ice thus considerably changes the environmental fate of SOCs.

Development of a set of simple bacterial biosensors for quantitative and rapid measurements of arsenite and arsenate in potable water.

Testing for arsenic pollution is commonly performed with chemical test kits of unsatisfying accuracy. Bacterial biosensors are an interesting alternative as they are easily produced, simple, and highly accurate devices. Here, we describe the development of a set of bacterial biosensors based on a nonpathogenic laboratory strain of Escherichia coli, the natural resistance mechanism of E. coli against arsenite and arsenate, and three reporter proteins: bacterial luciferase, beta-galactosidase and Green Fluorescent Protein (GFP). The biosensors were genetically optimized to reduce background expression in the absence of arsenic. In calibration experiments with the biosensors and arsenite-amended potable water, arsenite concentrations at 4 microg of As/L (0.05 microM) were routinely and accurately measured. The currently most quantitative system expressed the bacterial luciferase as reporter protein, responding proportional with a concentration range between 8 and 80 microg of As/L. Sensor cells could be stored as frozen batches, resuspended in plain media, and exposed to the aqueous test sample, and light emission was measured after 30-min incubation. Field testing for arsenite was achieved with a system that contained beta-galactosidase, producing a visible blue color at arsenite concentrations above 8 microg/L. For this sensor, a protocol was developed in which the sensor cells were dried on a paper strip and placed in the aqueous test solution for 30 min after which time color development was allowed to take place. The GFP sensor showed good potential for continuous rather than end point measurements. In all cases, growth of the biosensors and production of the strip test was achieved by very simple means with common growth media, and quality control of the sensors was performed by isolating the respective plasmids with the genetic constructs according to simple standard genetic technologies. Therefore, the biosensor cells and protocols may offer a realistic alternative for measuring arsenic contamination in potable water.