A prospective randomized comparison of neoprene vs thermoplast hand-based thumb spica splinting for trapeziometacarpal arthrosis.

OBJECTIVE: In patients with trapeziometacarpal arthrosis, we tested the hypothesis that there is no difference in arm-specific disability 5-15 weeks after prescription of a pre-fabricated neoprene or a custom-made thermoplast hand-based thumb spica splint with the metacarpophalangeal joint included and the first interphalangeal joint free. METHOD: One hundred nineteen patients with a diagnosis of trapeziometacarpal arthrosis were prospectively randomized to wear either a neoprene or a thermoplast hand-based thumb spica splint. At enrollment, patients completed a set of validated questionnaires. An average of 9 weeks later, patients returned for a second visit. Bivariable analyses assessed factors associated with disability, pain and satisfaction. Analysis was by intention-to-treat. RESULTS: Sixty-two patients (32 with a neoprene and 30 with a thermoplast splint) completed the study, 51 patients (43%) did not return for the second visit, and six did not complete the protocol for other reasons. Non-completers were significantly younger than completers (P < 0.00044). On average completers rated the neoprene splint as more comfortable (P = 0.048), but there were no detectable differences in Disabilities of the Arm, Shoulder and Hand (DASH), change in DASH, pain, satisfaction, pinch or grip strength between the two splint types in our sample. CONCLUSION: When compared to custom-made thermoplast splints, pre-fabricated neoprene hand-based thumb spica splints are, on average, more comfortable, less expensive, and as effective in treating trapeziometacarpal arthrosis. This trial was registered at Clinicaltrials.gov (NCT00438763).

Assessment of different screw augmentation techniques and screw designs in osteoporotic spines.

This is an experimental study on human cadaver spines. The objective of this study is to compare the pullout forces between three screw augmentation methods and two different screw designs. Surgical interventions of patients with osteoporosis increase following the epidemiological development. Biomechanically the pedicle provides the strongest screw fixation in healthy bone, whereas in osteoporosis all areas of the vertebra are affected by the disease. This explains the high screw failure rates in those patients. Therefore PMMA augmentation of screws is often mandatory. This study involved investigation of the pullout forces of augmented transpedicular screws in five human lumbar spines (L1-L4). Each spine was treated with four different methods: non-augmented unperforated (solid) screw, perforated screw with vertebroplasty augmentation, solid screw with vertebroplasty augmentation and solid screw with balloon kyphoplasty augmentation. Screws were augmented with Polymethylmethacrylate (PMMA). The pullout forces were measured for each treatment with an Instron testing device. The bone mineral density was measured for each vertebra with Micro-CT. The statistical analysis was performed with a two-sided independent student t test. Forty screws (10 per group and level) were inserted. The vertebroplasty-augmented screws showed a significant higher pullout force (mean 918.5 N, P = 0.001) than control (mean 51 N), the balloon kyphoplasty group did not improve the pullout force significantly (mean 781 N, P > 0.05). However, leakage occurred in some cases treated with perforated screws. All spines showed osteoporosis on Micro-CT. Vertebroplasty-augmented screws, augmentation of perforated screws and balloon kyphoplasty augmented screws show higher pullout resistance than non-augmented screws. Significant higher pullout forces were only reached in the vertebroplasty augmented vertebra. The perforated screw design led to epidural leakage due to the position of the perforation in the screw. The position of the most proximal perforation is critical, depending on screw design and proper insertion depth. Nevertheless, using a properly designed perforated screw will facilitate augmentation and instrumentation in osteoporotic spines.

A congenital teratoma with a cleft palate: report of a case.

Teratomas are benign tumors containing cells from ectodermal, mesodermal and endodermal layers. They occur in about 1 in every 4000 births and most commonly in the sacrococcygeal region, followed by the ovaries. Congenital epignathus teratomas are rare embryological neoplasms localised in the region of head and neck. An epignathus is found in approximately 1:35,000 to 1:200,000 live births. This accounts for 2-9% of all teratomas. Size and location of the neoplasm in the oronasopharynx is variable. Teratomas are partly undiagnosed at the time of birth. They may exist with an intracranial extension or as small polyps. Large epignathi can lead to difficult management during and after birth. The case of a newborn girl with a combination of an epignathus and a cleft palate is described. The epignathus presented as a huge mass extending out of the mouth of the infant girl. On the day of birth debulking of the extraoral portion of the tumor, followed by intraoral exstirpation, was performed. The results of the histologic examination indicated a congenital epignathus. Six months later a recurrence was found.

Cement leakage into the posterior spinal canal during balloon kyphoplasty: a case report.

We report a case of cement leakage into the posterior spinal canal due to inadvertent pedicle perforation during balloon kyphoplasty. The leakage was corrected immediately without any sequelae. Features seen on radiography and the minimally invasive procedure used for removal are described. The postoperative radiographs of 100 consecutive patients treated with balloon kyphoplasty were subsequently reviewed. Only one patient had a similar leakage but had no neurological complications.

Clinical parameters and adrenocortical activity to assess stress responses of alpacas using different methods of restraint either alone or with shearing.

Shearing of alpacas is stressful and is undertaken by restraint in the standing position, cast on the floor or on a tilt table. The objectives of the study were to evaluate and compare the stress responses between different methods. The study consisted of two parts. In part one, 15 animals were restrained applying all three methods but without shearing. In part two, 45 animals in three groups of 15 were shorn using one of the three procedures. Body temperature, heart rate, respiratory rate, salivary cortisol and faecal cortisol metabolites (FCM) were measured. Part 1: restraint in a standing position was less stressful than other procedures. Part 2: the classic clinical parameters changed significantly over time but without significant differences between the methods. The number of injuries did not differ. Saliva cortisol and FCM concentrations varied in wide ranges between animals. An increase in FCM concentrations occurred in all groups but saliva cortisol concentration increased only after shearing on the ground. The recommendations of the study are to shear calm alpacas in the standing position but animals showing severe defence reactions should be shorn either cast on the ground or on a table to decrease the risk of injuries.

Tricalcium phosphate-based biocomposites for mandibular bone regeneration--A histological study in sheep.

The present study investigated the suitability of three different absorbable biocomposites for the repair of critical sized bone defects created at the mandibular angle of adult sheep. Each biocomposite was composed of a three-dimensional individualized polylactide scaffold, containing a tricalcium phosphate biomaterial (chronOS). Either autologous bone marrow (chOS/BoneMarrow) or coagulation factor XIII (chOS/FactorXIII) was added to the biomaterial for osteopromotion. Venous whole blood (chOS/Blood) added to the biomaterial served as a control. A total of 18 adult sheep were used for implantation studies, subdivided into three groups of six animals each. After 12 weeks of observation, the animals were sacrificed and the mandibles were retrieved for qualitative and quantitative histologic assessment within three regions of interest (transitional zone, center, and periphery) throughout the biocomposites. Successful bone regeneration was defined by the absence of scaffold deformation and the presence of new bone formation within the biocomposites. In histomorphometry, only chOS/BoneMarrow showed elevated area fractions of newly formed bone in all regions of interest (transitional zone 50.7 ± 7.5, center 31.9 ± 9.3, periphery 23.1 ± 13.5). This led to preservation of the macroscopic scaffold structure in all specimens. Zero hurdle regression confirmed this by validating the factor biocomposite as significant (p < 0.001) for regeneration success. In our experiment, chOS/BoneMarrow was the only biocomposite passing the hurdle of regeneration in all three regions of interest. In contrast, bone formation was less pronounced and uniform in chOS/FactorXIII and chOS/blood-containing specimens. In these groups, scaffolds showed obvious to significant deformation. Overall, autologous bone marrow showed the most promising results in our experimental setting. As opposed to reports in the literature, we could not confirm the suitability of coagulation factor XIII to promote bone formation, since bone formation rates were comparable only to those of the control venous blood.

The comparative leakage behavior of reverse filling materials.

This study compares the in vitro apical seal achieved with thermoplasticized gutta-percha used with and without a sealer cement and that achieved with dental amalgam and a varnish liner following an apicoectomy and a Class I preparation of single root teeth. The teeth were immersed in methylene blue dye for 10 days, were sectioned longitudinally, and the amount of leakage was determined. No difference in leakage was found between the apical seals achieved with thermoplasticized gutta-percha used with a sealer cement and that obtained with dental amalgam with varnish. The leakage found with thermoplasticized gutta-percha used without a sealer cement was significantly greater.

Ameloblast cycling patterns as measured by fluorochrome infiltration of rat incisor enamel.

Rapid modulation of maturation ameloblasts between smooth-ended and ruffle-ended forms may play an important part in the development of normal dental enamel. Previous studies of modulation rates relied upon measurements of stained or fluorescing bands on the enamel surface of whole incisors along with separate histological sections for cell-band dimensions. The present study utilized direct measurement of maturation-ameloblast bands and fluorescing regions of underlying enamel in the same histological sections, which increased the accuracy and ease with which modulation rates could be determined. Rats were injected with calcein at various times before killing and preparation of survey midsagittal sections of the lower incisors. The lengths of bands of smooth-ended ameloblasts and underlying fluorescing regions of enamel were measured throughout the maturation zone. Modulation rates were found to range from 238 microns/h (early maturation) to 91 microns/h (late maturation). Calcein diffused into enamel to varying degrees depending upon the location within the maturation stage. This new approach of direct measurement greatly facilitates the investigation of ameloblast modulation and provides additional insights into progressive structural changes in enamel during maturation.

Surveying smokeless tobacco use, oral lesions and cessation among high school boys.

We surveyed 821 Iowa teenage boys to establish patterns of smokeless tobacco use, occurrence of oral lesions and the effect of lesions on attitudes about quitting, current use and plans for future use. Results suggest that young ST users who currently have a lesion or have experienced lesions may be particularly receptive to discussion of quitting options and other information about ST health effects. Dentists and other oral health professionals should initiate ST intervention when establishing a lesion history or on discovering a lesion at examination.

Assessment of the combined orthodontic-surgical treatment from the patients' point of view. A longitudinal study.

In a longitudinal study, 40 patients who underwent a combined orthodontic-surgical treatment, were interviewed 4 weeks before operation and 1 week and/or half a year after surgery in order to evaluate patients' expectations and appraisal of the operation and their psycho-social situation. The comparisons between the patients' pre- and postoperative statements yielded the following picture: the patients showed a high degree of satisfaction with the result of the operation. They judged their postoperative facial appearance, with the help of a "semantic differential', to be significantly more attractive. Satisfaction also was expressed in a higher degree of psychological well-being and thus an increase in self-confidence and motivation. Postoperatively, the "Giessen test' showed also a distinctly positive change of the patients' mood and improved experiences with social interaction. Before the operation almost half of the patients feared sensitivity loss or disturbance. One out of 5 patients did in fact suffer from this problem--but not from pain--half a year after the operation. Some patients felt they had received insufficient prior information about the procedure and the risk of the operation. In spite of all burdens for the patients, the assessment of the result of the operation is (generally) positive, not only from the medical point of view.

SU-E-T-548: Case Study of HDR Vs IMRT in Pediatric Sarcomas.

PURPOSE: To compare the dose to critical structures using HDR brachytherapy versus IMRT in pediatric tumors. METHOD: Two sarcoma cases, for which both HDR and IMRT could be options, were selected for this case study. Case 1 targeted a volume on the posterior neck/upper back with an HDR prescription of 600cGy × 5 fractions, 3000cGy total. The IMRT prescription used was 180cGy × 25 fractions, 4500cGy total with a boost of 180cGy × 6 fractions, 1080cGy. The IMRT PTV used was a 0.5cmexpansion of the HDR PTV; the boost PTV was identical to the HDR treatment plan. Case 2 targeted a volume on the palette of the mouth with an HDR prescription of 300cGy × 12 fractions, 3600cGy total. The IMRT prescription used was 180cGy × 28 fractions, 5040cGy total. A 0.5cm expansion of the HDR PTV was used for the IMRT PTV. In both cases, for both HDR and IMRT, at least 95% of the PTV received 100% prescription dose, following Children's Oncology Group protocols. RESULTS: Case 1 : the mean doses to the body, brachial plexus, esophagus, spinal cord and thyroid were higher using IMRT than HDR. Integral dose was 6.6 times higher using IMRT than HDR. Case 2: the mean doses to the body, mandible, and parotids were higher using IMRT than HDR. Integral dose was 2.9 times higher using IMRT than HDR. CONCLUSION: This study shows the potential benefit of treating with HDR compared to IMRT in select pediatric cases. These results suggest that HDR can be superior to IMRT in the sparing of critical structures and in delivering less integral dose to the patient while still achieving adequate target coverage. However, lower mean doses to critical structures must also be weighed against the possibility of complications from HDR's very high hotspots.

Endocultivation: the influence of delayed vs. simultaneous application of BMP-2 onto individually formed hydroxyapatite matrices for heterotopic bone induction.

When bone morphogenetic protein (BMP) is delivered to matrices in vivo may affect tissue engineered bone constructs for jaw reconstruction after cancer surgery. This study compared the effects of BMP application at different times after matrix implantation for heterotopic bone induction in a rat model. Hydroxyapatite blocks were implanted unilaterally onto the surface of the latissimus dorsi muscle. A second block was implanted onto the contralateral muscle after 1, 2 or 4 weeks and 200 µg rhBMP-2 was injected into the blocks on both sides. Bone formation and density inside the blocks was analysed by CT and histology. 8 weeks after BMP application increases in bone density within the scaffolds were most pronounced in the simultaneous application group (179 HU). Less pronounced increases were observed for the 1 (65 HU), 2 (58 HU) and 4 (31 HU; p<0.0001) week delay group. Homogeneous bone induction started from the central channel of the blocks. Capillaries and larger vessels were seen in all constructs, samples receiving delayed BMP treatment demonstrated significantly greater neovascularization. Delayed application of BMP was less effective for heterotopic bone formation than simultaneous application. A central channel allows homogeneous bone induction directly from the centre of the blocks.

[Coping behavior and supplying medical information--a study of mothers having delivered a child with a lip-jaw-palate cleft]. / Bewältigungsverhalten und ärztliche Informationsvermittlung--eine Studie an Müttern, die ein Kind mit einer Lippen-Kiefer-Gaumen-Spalte geboren haben.

To be delivered of a child with cleft lip and palate is an extreme psychic stress factor for the mother. In coping with this, she is left to the support of the caring medical staff. Therefore, the aim of the present study was 1. to ascertain, to what extent mothers of children with cleft lip and palate are given information on the malformation, and receive emotional support by the medical staff; and 2. to determine the effect such experiences have on their ability to cope. For this purpose we developed a special questionnaire, which was completed by 154 mothers of such children. Retrospectively, a relevant part of them criticised not only the communication and the contents of information, but also the emotional support as deficient. A correlation between these determinants and largely insufficient coping was statistically confirmed. Our results should be taken into account in respect of the practical requirements when caring for mothers of children with a cleft lip and palate.

Characterization of periplasmic Escherichia coli protein expression at high cell densities.

We have used two-dimensional electrophoresis (2-DE) to analyze changes in protein expression profiles during a microbial cultivation process on an industrial scale. An Escherichia coli strain W31 10 containing the gene for recombinant human growth hormone production was used. Samples were taken at time intervals ranging from fast to slow growth rate (late growth phase at high cell density/starvation) and 2-DE analysis combined with image analysis using the PDQuest software showed significant alterations in expression levels of a number of proteins. Twenty-four protein spots were identified using a combination of matching with SWISS-2DPAGE E. coli map, N-terminal sequence analysis and mass spectrometry matrix-assisted laser desorption/ionization (MALDI). Two of the most abundant proteins expressed at late growth phase (pI 5.4/28 kDa and pI 5.5/28 kDa) were subjected to N-terminal sequence analysis after electrotransfer of the proteins from a preparative 2-DE gel to polyvinylidene difluoride (PVDF) membrane. Sequence tags of five amino acids in combination with approximate pI and Mr identified both proteins as deoxyribose phosphate aldolase (gene name deoC). In addition, both spots were subjected to tryptic in-gel digestion and analyzed using MALDI. Peptide mass fingerprints from both spots showed similar MALDI spectra and 10 of 10 tryptic fragments confirmed the identity as deoC. The identification of the acidic variant of deoC on 2-DE gels and the observation of this variant as induced during late growth phase is novel.

[Tumor oxygenation in combined whole body hyperthermia and polychemotherapy. Studies exemplified by recurrent carcinoma of the mouth cavity]. / Tumoroxygenierung unter kombinierter Ganzkörperhyperthermie und Polychemotherapie. Untersuchungen am Beispiel eines Rezidivkarzinoms der Mundhöhle.

BACKGROUND AND OBJECTIVE: Previous studies have reported synergistic effects of combined hyperthermia and chemotherapy and/or irradiation. The response to irradiation and chemotherapy of well-oxygenated and vascularized tumors generally is better than that of hypoxic tumors. Therefore, tumor oxygenation is recognized as an important predictive factor in the therapy of malignant tumors. In practice, the head and neck area remains outside of the hyperthermia chamber during whole-body hyperthermia. It was the aim of this study to evaluate if the head and neck region receives sufficient warmth and, if so, if tumor oxygenation increases accordingly. PATIENTS/METHODS: Whole-body hyperthermia, as heat radiation (Enthermics Medical Systems RHS-7500), was applied to the narcotised 60-year-old male patient with a local recurrence tumor pT3 pN2b M0 squamous cell carcinoma of the oral cavity. Tumor oxygenation and temperature were measured by LICOX catheters via one-point measurement during the entire hyperthermia treatment (3.5 h). Parallelly, chemotherapy (ifosfamide/Carboplatin) was given in four cycles (one cycle/month). RESULTS: With a latency of 10 min the increase of intratumoral temperature was comparable to temperatures achieved in the esophagus. The maximum intratumoral temperature was 41.8 degrees C. The average increase in tumor oxygenation was more than 100%. The clinical outcome in the case presented was a partial tumor remission (PR). CONCLUSIONS: During combined whole-body hyperthermia and polychemotherapy, tumor oxygenation is also significantly improved in the head and neck area, despite the fact that the head and neck area remained outside the hyperthermia chamber. The intratumoral temperature was comparable to esophageal and rectal temperatures.