Patching retinal breaks with Seprafilm for treating retinal detachments in humans: 9 years of follow-up.

PurposeTo describe the long-term surgical outcomes of four patients treated for retinal detachment using Seprafilm as a novel technique.MethodsRetinal breaks in four eyes were covered with Seprafilm using a transvitreal approach after cataract surgery, pars plana vitrectomy, fluid-air exchange, and laser photocoagulation. Neither long-standing gas nor silicone oil was used. The patients were not instructed to maintain a specific head positioning postoperatively.ResultsSuccessful retinal reattachment was achieved with a single surgery in all four eyes, and none developed proliferative vitreoretinopathy. The mean best-corrected visual acuity preoperatively and 9 years postoperatively were 20/97 and 20/33, respectively. The intraocular pressure increased several days postoperatively that lasted no longer than 2 weeks. Visual field defects either in the inferonasal or inferotemporal quadrant were detected postoperatively. The mean electroretinogram a- and b-wave amplitude ratios of the operated eyes to the fellow eyes were 0.68 and 0.64 preoperatively and 0.87 and 0.92 postoperatively, respectively. The mean corneal endothelial cell density was 2365 cells/mm2 preoperatively and 2592 cells/mm2 postoperatively.ConclusionCovering retinal breaks with Seprafilm may promote retinal reattachment without gas tamponade and postoperative head positioning. The visual outcomes 9 years postoperatively showed no apparent adverse effects of intraocular application of Seprafilm.

Analysis of photo-initiators in visible-light-cured dental composite resins.

Seven commercial visible-light-cured (VL) dental composite resins were analytically studied for identification of the photo-initiator consisting of photo-sensitizer and reducing agent. Gas-liquid chromatography (GC) was used for the determination of the dilute components extracted from the composite resin. Mass spectroscopy (GC-MS) was used for confirmation of the qualitative data obtained by GC. The results showed that all composite resins examined included camphorquinone (CQ) as a photo-sensitizer. The concentration of CQ in the resin phase, however, ranged from 0.17 to 1.03% w/w. The composite resin with hybrid-sized filler tended to have a higher concentration of CQ than did the micro-filled composite resin. As for the reducing agent, two out of seven brands contained dimethylaminoethyl methacrylate (DMAEMA), and one included dimethyl-p-toluidine (DMPTI). The mixing ratio between CQ and the amine in these three composite resins also varied. Another four brands did not contain either DMAEMA or DMPTI, and would utilize different reducing agents.

Frontal analysis of protein adsorption on a membrane adsorber.

The adsorption behaviour of two kinds of proteins, myoglobin and ovalbumin, with a membrane adsorber, DEAE MemSep 1000 (Millipore), was studied in comparison with a bead-based packed-bed adsorber, DEAE Sephacel (Pharmacia-LKB), by means of frontal analysis. Adsorption isotherms were obtained by integrating the breakthrough curves for various feed concentrations. Adsorption isotherms were expressed by the Langmuir equation and the adsorption capacity for the membrane adsorber was smaller than that for the packed-bed adsorber. The breakthrough curves of myoglobin for the membrane adsorber were independent of the flow-rate, but those of ovalbumin were affected by the flow-rate. Abnormal behaviour was observed for the adsorption of ovalbumin on a membrane adsorber. With the packed-bed adsorber, the breakthrough curves for both proteins were significantly affected by the flow-rate. A mathematical model for the membrane adsorber involving axial dispersion and adsorption kinetics was derived. The model simulated the breakthrough curves for myoglobin well. Axial dispersion was dominant for the membrane adsorber whereas intraparticle diffusion was dominant for the packed-bed adsorber.

Localized silicon distribution in supragingival calculus from Japanese monkeys (Macaca fuscata).

Using an electron-probe microanalyser, the distribution of silicon and other elements in supragingival dental calculus in domestic Japanese monkeys (Macaca fuscata) was studied. In two out of four monkeys kept in animals centres, a localized silicon distribution was found in both fracture and oral surfaces of the calculi. The silicon-rich area consisting of silicon alone resembled opal, but the areas containing silicon and other metal ions such as magnesium, aluminium, potassium and iron resembled clay minerals. In eight domestic monkeys, including the four animals described above, abundant calculus deposits were found. However, in four captured wild monkeys and in one which had been kept for less than a year at an animal centre, no dental calculus was found. There was almost no dental plaque accumulation in captured wild monkeys. It is suggested that calculus formation in Japanese monkeys is dependent on length of exposure to a commercial diet.

A simple technique for closure of a palatal fistula using a conchal cartilage graft.

A simple technique for closure of a palatal fistula using a conchal cartilage graft as a substitute for nasal lining flaps is reported. This graft simplifies the repair of the palatal fistula and protects the suture line of the oral covering flaps from recurrence.

Repair of scalp defects using a tissue expander and Marlex mesh.

A simple technique using Marlex mesh and a tissue expander to cover scalp defects is described and two patients are presented. This technique is suitable for medium-sized defects that cannot be closed primarily. Marlex mesh is sutured to the wound edges in lieu of a temporary skin graft and to prevent enlargement of the defect during tissue expansion. The tissue expander is placed under adjacent normal scalp in a subgaleal pocket developed through the scalp defect. The scalp defect is closed secondarily using the expanded scalp flap. This technique was performed in two patients with satisfactory results. Marlex mesh obviates the need for a temporary skin graft to cover the scalp defect.

Repair of cleft lip with nonsurgical correction of nasal deformity in the early neonatal period.

Auricular cartilage is soft and plastic at birth, so that congenital auricular deformities can easily be corrected nonsurgically in the early neonatal period. However, as the infant grows older, the flexibility of the auricle decreases. Alar cartilage exhibits the same elasticity as auricular cartilage in the early neonate. When a cleft lip is repaired, typically when the infant is about 3 months of age, it becomes difficult to correct the nasal deformity without surgical intervention. However, based on our experience, there is a fair possibility of correcting the cleft lip nasal deformity with a nonsurgical procedure in the early neonatal period. We performed cleft lip repair accompanied by nonsurgical correction of the nasal deformity in 44 neonates aged 2 to 7 days. A special retainer was placed in the affected nostril for 3 months. Following observation of 31 infants for 12 months or longer, their nasal shapes and symmetry were considered superior to those conventionally operated on at about 3 months of age. Except for one nasal infection, there were no complications.

[Therapeutic study on biofilm of the urinary tract using a severely complicated bladder model (biofilm model of the urinary tract)--experimental study using an automatic simulator of urinary antimicrobial agent concentration, and clinical study].

For the purpose of conducting a therapeutic study on biofilm of the urinary tract, we devised a computer-controlled severely complicated bladder model (biofilm model of the urinary tract) enabling us to simulate the time-course of the concentration of antimicrobial agents in the urine. Using this model, we investigated clarithromycin (CAM), which has been reported to have anti-biofilm action, at concentrations close to its urinary levels at the time of clinical use in order to predict its effect on biofilm of the urinary tract. On the basis of those experimental results, we also conducted a clinical examination. The following results were obtained. 1. The action of ciprofloxacin (CPFX, MIC: 8 micrograms/ml) alone, which shows anti-P. aeruginosa activity, caused apparent elimination of P. aeruginosa from the model. However, regrowth of the microbes occurred when CPFX was removed from the bladder model. Moreover, the biofilm was not eliminated by the antimicrobial action of CPFX, and this was surmised to be the cause of the regrowth. 2. CAM (MIC: above 128 micrograms/ml), which has no anti-P. aeruginosa activity, was similarly tested as anti-biofilm agent when added alone to the biofilm model. The P. aeruginosa recovered to its initial concentration within 48 hours, but the biofilm disappeared due to the action of CAM. 3. The combined action of CPFX and CAM caused microbial elimination from the bladder model without microbial regrowth, even after these antimicrobial agents were removed from the bladder model. After the action of CPFX and CAM, the biofilm disappeared, and no microbial adherence was noted. 4. Measurement of time-course of the alginate content, which is the main component of P. aeruginosa biofilm, in the presence of CAM found that the alginate content decreased below the limit of detection after day 5. 5. The clinical study of complicated urinary tract infection revealed the microbial elimination rate and the efficacy rate to be higher in the combined CPFX-CAM administration group than in the CPFX-only administration group. 6. Based on the above results, we surmise that the combined use of an antimicrobial agent which is active against the causative microbe and anti-biofilm agent such as CAM will show some degree of efficacy in eliminating biofilm of the urinary tract.

Patching retinal breaks with Seprafilm in experimental rhegmatogenous retinal detachment of rabbit eyes.

PURPOSE: To examine the short-term effect of Seprafilm for patching retinal breaks in experimental rhegmatogenous retinal detachment of rabbit eyes. METHODS: Experimental retinal detachment with a break was made and repaired by fluid-gas exchange during vitreous surgery in 10 rabbit eyes. In seven eyes, Seprafilm was applied to cover iatrogenic retinal breaks entirely (study group) and in other three eyes operations were finished without Seprafilm application (control group). Funduscopic examination was carried out in both groups and in study group optical coherence tomography (OCT) was performed to observe Seprafilm on the retinal break. Eyes of study group were enucleated on 7th and 14th postoperative day for histological evaluation. RESULTS: The funduscopic examination showed that the retina was reattached in all eyes of study group. Meanwhile all three eyes of control group resulted in proliferative vitreoretinopathy. OCT showed that Seprafilm adhered to the retina tightly. Funduscopic examination and OCT showed Seprafilm dissolved within 14 days. Histological examination revealed that Seprafilm adhered tightly to the retina and there was no inflammatory change at the Seprafilm application sites. CONCLUSIONS: In our small number of this study, Seprafilm was found to be beneficial to patch small and posteriorly located retinal breaks in vitreous surgery for rhegmatogenous retinal detachment.

[Morphological changes of vascular network of the midpalatal suture and palate mucosa after rapid maxillary expansion].

Rapid maxillary expansion has been utilized for years in the treatment of transverse maxillomandibular discrepancies. It is important to understand the changes of the vascular network in midpalatal suture following rapid maxillary expansion. The reason is because it is critical to maintain the blood supply and circulation for the osteogenesis and bone remodeling after the expansion. The purpose of this study was to examine the morphological changes in the vascular network of the palate regions following rapid maxillary expansion. A total of 30 dogs were divided into 6 groups of 5 dogs each, of which one group was used as a control. A skeleton type rapid maxillary expansion appliance was utilized in the 5 experimental groups. Transverse expansion was accomplished by activating the appliances 0.4 mm each day for 10 days, achieving a total of 4.0 mm of width increase. The animals were sacrificed and injected with acrylic resin through the maxillary artery at 3, 7, 14, 21 and 28 days. The thin sections were examined with a light microscope and fine vascular corrosion specimens were examined with a scanning electron microscope. The results were as follows: 1. Vascular network in the midpalatal suture. 1) The suture appeared as an interdigitating bony processes separated by a relatively narrow gap. The blood vessels were running in the direction from the posterior to anterior in the control. 2) 3 days after the expansion, the suture had separated. The hemorrhage which accompanied the expansion was not observed, though hyperemia and enlargement of the blood vessels were observed. The stretched blood vessels from the bone walls observed along the stretched fiber bundles were remarkable. A few new blood vessels were observed in various places in the bone walls. 3) 7 and 14 days after the expansion, the number of new blood vessels increased significantly and anastomosed. The tube-shaped new bone formation was observed in parts of the bone walls along the stretched fiber bundles and surrounding the blood vessels. 4) 21 days after the expansion, the sutural area was filled by new bone and the new blood vessels were embedded in the bone and the number of those had decreased. The new bone had thickened and joined in various ways. 5) 28 days after the expansion, the number of blood vessels decreased further and the bone formation was more progressed than the 21 day group. Those new bones had matured respectively. 2. Vascular network in the palate mucosa.(ABSTRACT TRUNCATED AT 400 WORDS)

[Correlations between masticatory performance in chewing gum method and occlusion as well as dento-facial morphology].

In order to examine the characteristics of the chewing gum masticatory test, the amount of sugar elution, the chewing time and the amount of sugar elution per second were measured in 109 young adults (93 males and 16 females), after 70 strokes of mastication. Their sex differences, differences among various occlusions, correlations with occlusal areas of the buccal teeth and correlations with roentgen cephalometrics were analyzed. 1. There was no sex difference in the amount of sugar elution. However, chewing time was shorter and the amount of sugar elution per second was higher in males than in females. 2. Compared with the normal occlusion group, the amount of sugar elution was significantly lower in the crowding and anterior cross bite groups (Inoue's classification), and in the Class III malocclusion group (Angle's classification) in males. The amount of sugar elution per second was also significantly lower in the crowding and anterior cross bite groups. However, significant differences could not be found for chewing time. 3. The amount of sugar elution per second was significantly correlated with occlusal areas in males and total samples. 4. The amount of sugar elution was significantly correlated with less than ANB and less than L 1 to MP in males, with less than L 1 to MP in total samples. The chewing time was significantly correlated with S-N, N-Me, N-ANS, S'-Ptm' in females. The amount of sugar elution per second was significantly correlated with less than SNA and less than L 1 to MP in males, and with A'-Ptm', Cd-Go, Go-Pog', Cd-Gn, less than SNA, less than L 1 to MP, less than MP-SN and gonial angle in total samples. 5. It is concluded that the chewing gum masticatory test is highly correlated with occlusion and dento-facial morphology. In particular, amount of sugar elution per second was thought to be a useful measure for masticatory performance in clinical orthodontics.

Failed tracheal intubation using a laryngoscope and intubating laryngeal mask.

PURPOSE: To report unexpected failed tracheal intubation using a laryngoscope and an intubating laryngeal mask, and difficult ventilation via a facemask, laryngeal mask and intubating laryngeal mask, in a patient with an unrecognized lingual tonsillar hypertrophy. CLINICAL FEATURES: A 63-yr-old woman, who had undergone clipping of an aneurysm seven weeks previously, was scheduled for ventriculo-peritoneal shunt. At the previous surgery, there had been no difficulty in ventilation or in tracheal intubation. Her trachea remained intubated nasally for 11 days after surgery. Preoperatively, her consciousness was impaired. There were no restrictions in head and neck movements or mouth opening. The thyromental distance was 7 cm. After induction of anesthesia, manual ventilation via a facemask with a Guedel airway was suboptimal and the chest expanded insufficiently. At laryngoscopy using a Macintosh or McCoy device, only the tip of the epiglottis, but not the glottis, could be seen, and tracheal intubation failed. There was a partial obstruction during manual ventilation through either the intubating laryngeal mask or conventional laryngeal mask; intubation through each device failed. Digital examination of the pharynx, after removal of the laryngeal mask, indicated a mass occupying the vallecula. Lingual tonsillar hypertrophy (1 x 1 x 2 cm) was found to be the cause of the failure. Awake fibrescope-aided tracheal intubation was accomplished. CONCLUSIONS: Unexpected lingual tonsillar hypertrophy can cause both ventilation and tracheal intubation difficult, and neither the laryngeal mask nor intubating laryngeal mask may be helpful in the circumstances.

Cyanoacrylate glue in the repair of retinal detachment associated with posterior retinal breaks in infants and children.

PURPOSE: To share the authors' experience with cyanoacrylate glue in posterior retinal breaks associated with retinal detachments in infants and children. METHODS: A retrospective study was performed of four consecutive pediatric patients who underwent vitreoretinal surgery for retinal detachment associated with posterior retinal breaks, for which cyanoacrylate glue was used. RESULTS: In three of the four patients, successful retinal reattachment with visual function was achieved by vitreoretinal surgery and cyanoacrylate placed on the apposed edges of posterior retinal breaks or used to plug a break (postoperative follow-up was 1.5-2 years). In two successful cases, the glue was applied onto the break while the retina was detached, which resulted in closure of the retinal breaks and reattachment of the retina in both cases. CONCLUSIONS: Cyanoacrylate creates a permanent closure of retinal breaks and may be useful in select cases of infant retinal detachment with posterior retinal breaks in which current available treatment failed or would fail.

Physical-chemistry characteristics and biodistribution of poly(ethylene glycol)-coated liposomes using poly(oxyethylene) cholesteryl ether.

Poly(ethylene glycol)-coated liposomes were prepared with poly(oxyethylene) cholesteryl ethers (mPEG-Chol). PEG unit numbers tested were 50, 100 and 200, of which the average molecular weights (m) of PEG were 2200, 4400 and 8800, respectively. Properties of both PEG-coated liposomes and PEG-Chol molecules were investigated. These liposomes exhibited a long circulation time in the blood after i.v. injection in rats, estimated by both the lipid membrane marker, L-alpha-dipalmitoylphosphatidylcholine [2-palmitoyl-9,10-3H](3H-DPPC), and an internal aqueous marker, 3H-inulin. Accumulation in the liver and spleen at 8h-post-injection was significantly reduced compared with conventional liposomes. The percentage of PEG-Chol incorporation in liposomal membranes was also investigated. Liposomes composed of egg yolk phosphatidylcholine (EPC)/PEG-Chol at various molar ratios were separated from free PEG-Chol molecules, which are not incorporated in liposomal membranes by chromatography over Sepharose CL-4B columns, PEG-Chol incorporation reached approx. 14 and 18 mol% of the total lipids with 25% PEG-Chol unit numbers of 200 and 50, respectively. The occupied area per molecule of PEG-Chol was larger than that of Chol, and the fluorescence anisotropy (r) of the initial 25 mol% (8800)PEG-Chol liposomes was smaller than that observed for 12.5 mol% Chol liposomes. PEG-coated liposomes containing calcein were incubated at 37 degrees C in heat-inactivated fetal bovine serum (FBS). In the presence of FBS, calcein leakage was increased with PEG-Chol percentage incorporation and an increase in FBS concentration. The amount released from PEG-coated liposomes represented 60% at maximum and was larger than that of the control liposomes. PEG-Chol molecules are interesting compounds since they can be easily synthesized in a large amount on an industrial scale. The basic physical-chemistry characteristics investigated in this article are critical to assess the pharmacological application of PEG-Chol liposomes as drug delivery systems.

Nuclear magnetic resonance studies of sugar metabolism in the human infant lens.

We investigated sugar metabolism in lenses isolated from infants with stage-5 retinopathy of prematurity (ROP). The lenses were incubated in 13C-labeled glucose (35.5 mM) or galactose (30 mM) for 24 h at 37.5 degrees C. Six to 8 lenses were pooled for each experiment. 13C-nuclear magnetic resonance spectroscopy was then performed on perchloric acid extracts of these lenses. Active aldose metabolism was indicated by the production of lactate. However, neither sorbitol nor dulcitol was detected. On the other hand, an experimental aldose reductase inhibitor, sorbinil, caused a decrease in the hexose monophosphate shunt activity suggesting an active polyol pathway. Both polyols therefore appeared to have been metabolized further. In addition, galactose metabolism was unique in that it not only involved a galactose-->glucose epimerization, but also a direct galactose-->ribose conversion, and a production of galactose-3-phosphate. Although it is possible that the ROP lenses have adapted to oxidative stress during the postnatal high-oxygen incubation for premature infants, we believe the observed sugar metabolism is representative of the developing human lens.

Surgical-orthodontic approach to skeletal class III malocclusion. Analysis of 45 cases with evaluation of curved oblique osteotomy and sliding osteotomy.

A curved oblique osteotomy in which the ascending ramus was cut obliquely on a curved line from its anterior border to the angle was used for the treatment of 29 patients with skeletal Class III malocclusion, and 16 other patients were corrected by either an ordinary body ostectomy or a sliding osteotomy in the first premolar region. Both curved oblique osteotomy and sliding osteotomy could easily be performed with a Stryker's reciprocating saw, and osseous healing at the sites of surgery was rapid as a large area of intimate bony contact between the segments was obtained. The resulting profile and skeletal changes studied by cephalograms were excellent, with no significant relapse, and recovery of a stable occlusion was attained. The combined approach with orthodontists which included thorough analysis of each patient, preoperative alignment of the dental arches and postoperative care was essential for obtaining the best results.

Surgical-orthodontic approach to skeletal class III malocclusion.

Twenty-nine adult patients with skeletal Class III malocclusion were treated by combined surgical-orthodontic management. A thorough analysis enabled us to point out the exact location and degree of the deformity and was of great help in determining the appropriate types of treatment. Corrections were made in 12 patients by the mandibular body ostectomy in the premolar region; the curved oblique osteotomy, in which the ascending ramus was cut obliquely on a curved line from the anterior border of the ramus to the angle, was used for the treatment of the remaining 17 patients. The resulting profile and occlusal improvements were satisfactory, Preoperative orthodontic treatment such as leveling of the dental arches, expansion of the upper dental arch to accommodate the maxilla to the mandible, correction of the upper and lower incisal inclinations, extraction of the premolars to decrease horizontal discrepancy or alignment of malpositioned teeth, and postoperative adjustment were effective in providing definite changes in profile and a stable occlusion-an important factor in the prevention of postoperative relapse.

[A morphological study on the mandibular symphysis of cleft lip and palate, anterior crossbite and Angle Class I malocclusions].

Morphological characteristics of the mandibular symphysis among the cleft lip and palate, anterior crossbite and Angle Class I malocclusions were analyzed cephalometrically. 1. In the symphyseal thickness at pogonion, the significant differences among the three groups were not found. In the cleft group, the symphyseal thickness at point B was significantly narrower than that of the Class I group. 2. In the symphyseal height, the cleft group was larger than that of the crossbite group, while the crossbite group was the middle of the two groups. 3. In the symphyseal inclination, the cleft group was significantly large, compared to that of the crossbite and Class I groups. The symphyseal inclination of the cleft group was mostly the alveolar part of mandibular symphysis. 4. The chin formation was the absorption of the around of point B. The chin formation was appeared between the ages of A and B groups.