Mid-term results of alumina ceramic unlinked total elbow arthroplasty with cement fixation for patients with rheumatoid arthritis.

Aims: The aim of this study was to report the mid-term clinical outcome of cemented unlinked J-alumina ceramic elbow (JACE) arthroplasties when used in patients with rheumatoid arthritis (RA). Patients and Methods: We retrospectively reviewed 87 elbows, in 75 patients with RA, which was replaced using a cemented JACE total elbow arthroplasty (TEA) between August 2003 and December 2012, with a follow-up of 96%. There were 72 women and three men, with a mean age of 62 years (35 to 79). The mean follow-up was nine years (2 to 14). The clinical condition of each elbow before and after surgery was assessed using the Mayo Elbow Performance Index (MEPI, 0 to 100 points). Radiographic loosening was defined as a progressive radiolucent line of >1 mm that was completely circumferential around the prosthesis. Results: The mean MEPI scores significantly improved from 40 (10 to 75) points preoperatively to 95 (30 to 100) points at final follow-up (p < 0.0001). Complications were noted in ten elbows (ten patients; 11%). Two had an intraoperative humeral fracture which was treated by fixation and united. One had a postoperative fracture of the olecranon which united with conservative treatment and one had a radial neuropathy which resolved. Further surgery was required for one with a dislocation, three with an ulnar neuropathy and one with a postoperative humeral fracture. Revision with removal of the components was performed in one elbow due to deep infection. There was no radiographic evidence of loosening around the components. With any revision surgery or revision with implant removal as the endpoint, the rates of survival up to 14 years were 93% (95% confidence interval (CI), 83.9 to 96.6) and 99% (95% CI 91.9 to 99.8), respectively, as determined by Kaplan-Meier analysis. Conclusion: With the appropriate indications, the mid-term clinical performance of the cemented JACE TEA is reliable and comparable to other established TEAs in the management of the elbow in patients with RA. Cite this article: Bone Joint J 2018;100-B:1066-73.

Carcinoma-specific Ulex europaeus agglutinin-I binding glycoproteins of human colorectal carcinoma and its relation to carcinoembryonic antigen.

Glycoproteins binding to Ulex europaeus agglutinin-I (UEA-I) lectin, which recognizes the terminal alpha-L-fucose residue, were analyzed in 18 cases of human colorectal carcinoma by sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by the Western blotting method. In the distal large bowel (descending and sigmoid colon and rectum), high-molecular-weight glycoproteins binding to UEA-I existed in carcinoma tissue but not in normal mucosa. In the proximal large bowel (ascending and transverse colon), high-molecular-weight glycoproteins binding to UEA-I were found both in normal mucosa and in carcinoma tissue, whereas those from the carcinoma tissue had an apparently lower molecular weight as compared to the weight of those from the normal mucosa. Thus there is a biochemical difference in UEA-I binding glycoproteins between the normal mucosa and the carcinoma tissue, although in our previous histochemical study no difference was observed in UEA-I binding glycoproteins of the proximal large bowel between the carcinoma tissue and the normal mucosa. Furthermore, carcinoembryonic antigen from the carcinoma tissue was found to have the same electrophoretical mobility as the UEA-I binding glycoproteins.

A fixative suitable for in situ hybridization histochemistry.

We compared the morphology and stability of hybridization signals between paraffin sections of rat retina fixed with commonly used 4% paraformaldehyde/PBS and those fixed with a fixative containing glutaraldehyde in in situ hybridization histochemistry, using a digoxigenin-labeled RNA probe complementary for beta-galactoside alpha 2,6-sialyltransferase mRNA. Retinal detachment was frequently observed in the sections fixed with 4% paraformaldehyde-PBS, whereas the morphology was satisfactorily preserved in those fixed with either 0.5% glutaraldehyde, 4% paraformaldehyde-PBS, or 2.5% glutaraldehyde-PBS. Without glutaraldehyde, it was difficult to determine the most appropriate length of proteinase K digestion of tissue sections for facilitating probe penetration, since the optimal time for definite hybridization was variable among the retinal cells in heterogeneous layers. By addition of glutaraldehyde to paraformaldehyde or with glutaraldehyde alone, it was easy to establish the appropriate time for the unmasking procedure, since intense mRNA signals were constant throughout the retina by proteinase K digestion for more than 30-40 min. Using a fixative that causes stronger cross-linking (e.g., glutaraldehyde) is recommended to improve not only the morphology but also the stability of hybridization signals in in situ hybridization histochemistry with paraffin embedding and digoxigenin-labeled RNA probes.

Effects of storage of jaws in saline and of velocity of loading on the force required to extract the rat mandibular first molar.

Storage of jaws in cold saline for up to 32 h did not cause significant changes in the ultimate loads required to extract the rat mandibular first molar. The mean ultimate loads were 33.05, 34.91 and 36.38 newtons at the extension rates 1, 5 and 25 mm/min respectively, though the differences were not significant between groups. The force required to extract the tooth would be fairly constant even after the storage of the dissected jaws in cold saline for longer periods of time. Changes in the force required were not detectable within the range of the velocities of loading employed.

Influence of antimucin antibody in kidney transplantation.

A protein in saliva that is resistant to boiling and has a molecular weight greater than 400,000 daltons was found. Antibody against this antigen occurred naturally in about 20% of 92 normal and 334 dialysis patients. This antibody was associated with an early graft failure in studies of 201 first and 133 multiple graft patients. The effect was strong in male patients and absent in female patients. This antimucin antibody may explain some early graft failure in negative crossmatches.

A suggested method for mixing direct filling restorative gallium alloy.

Good wettability is one of the desirable physical properties of mercury-free gallium-based alloys (Gallium Alloy GF). However, wettability, while providing good adhesion to the cavity wall, has the adverse effect of causing stickiness to the inside of the capsule during mixing, and also to the metal hand instruments used for packing. To control this stickiness the alloy mixture was treated with a small amount of alcohol using two different methods. In both groups (alcohol-added and alcohol-treated groups), 5, 10, or 15 microliters of alcohol was added. However, for the alcohol-treated group, the alcohol was shaken from the mixture. In both groups, remarkable improvement was seen in their handling properties, for the alloy mixture did not adhere to the inside of the capsule and was easily taken out as one mass. Compressive strength, tensile strength, and creep were tested in the alcohol-added/-treated groups, and compared with those of a control (conventionally mixed gallium alloy) and a high-copper amalgam (Spherical-D). All tests were done according to ISO 1559 (International Organization for Standardization, 1986), and the results were analyzed using one-way ANOVA (Duncan, P < 0.05). Surface microhardness (KHN) and dimensional change during hardening were evaluated according to ISO 1559 and compared to the control results. In mixing Gallium Alloy GF, an addition of less than 5 microliters of alcohol had the effect of preventing the alloy mixture from sticking to the inside of the capsule and remarkably enhanced the handling properties. This suggested mixing technique did not alter either the mechanical properties tested for this material or the desirable dimensional expansion that occurs during hardening.

Experimental impression tray fabricated with a NiTi shape memory alloy plate.

A small experimental impression tray was fabricated with a NiTi shape memory alloy plate. After recovery of the shape memory effect, the upper rims of the tray holding the impression were opened to some extent, the resistance during removal of the model from the impression was significantly decreased compared to a commercially available tray and the tray before recovery of the shape memory effect. The pull-out force of the model from the impression was 23.5(0.2)N for the commercially available tray, 23.5(3.9)N for the experimental tray before recovery of the shape memory effect and 14.7(4.0)N after recovery of the shape memory effect (heated for 15 min at 70 degrees C). Therefore the tray should be useful in teeth fracture free modeling.

[Psychological aspects of dental students in the course of clinical prosthetics].

Cornell Medical Index (CMI), Manifest Anxiety Scale (MAS) and Yatabe-Guilford Character test (Y-G test) were carried out on 165 dental students in the course of clinical prosthetics to understand the psychological changes after study in this course. According to the Y-G profile patterns, in male students, the ratio of A, B, C, D, E and F types were 12.6, 6.7, 14.8, 63.0, 2.2 and 0.007%, and in female students, 6.9, 34.5, 17.2, 34.5 and 6.9% respectively. From the results of CMI, most of the students were stable after study in this course. Psychosomatic profile patterns of CMI before study were similar to those after in both sexes. All items of CMI were decreased in males, but some items were not decreased in females. Anxiety measured by MAS was decreased in many students but was increased in some students after study in this course. These results indicate that it is necessary to be concerned with the mental as well as physical well-being in unstable students.

[Clinical study on the correlation between occlusion raising and free-way space].

This paper presents three cases in which CSC telescope dentures were inserted following occlusion raising. Post-operative course remained uneventful in all three cases. Follow-up observations suggested that the use of CSC telescope denture, is helpful in prosthetic treatment which includes occlusion raising. In Case 1, occlusion was raised to a level above the free-way space. However, a new free-way space appeared after occlusion raising and it existed for a long time. A free-way space, which conformed to a space calculated from the free-way space before occlusion raising and the amount of occlusion raising, appeared in Case 2. In Case 3, however, the free-way space after occlusion raising was narrower compared to a space calculated from free-way space before occlusion raising and amount of occlusion raising.

The preparation of cell fusion-inducing proteoliposomes from purified glycoproteins of HVJ (Sendai virus) and chemically defined lipids.

Cell fusion-inducing (fusogenic) proteoliposomes of defined chemical composition were reconstituted from purified glycoproteins of hemagglutinating virus of Japan (Sendai virus) either with lipids extracted from the virus particles or with a chemically defined lipid mixture. Cell fusion reactions induced by the reconstituted system have several important characteristics similar to the virus-induced fusion reaction: fusogenic activity of the proteoliposomes depends on the presence of active fusion protein in the vesicles and, in the case of Ehrlich tumor cells, the fusion is almost completely inhibited by adding cytochalasin D to a final concentration of 4 microgram/ml. The only known difference between the original and reconstituted systems is that a greater amount of the latter is necessary for the same degree of fusogenic activity. Thus, the reconstituted system can be used as a model for the Sendai virus-induced fusion reaction. A lipid mixture (phosphatidylcholine:phosphatidylethanolamine:phosphatidylserine:sphingomyelin = 1:2:1:1, by weight, and cholesterol equimolar to the total phospholipids) similar to that of the virion was active for reconstitution, whereas a mixture containing the same composition of phospholipids but no cholesterol, and ones containing cholesterol with only a single species of phospholipid were not reconstitutively active.

[Clinical observation of bruxism-induced wear facets and the influence of wear facets on masticatory function].

The wear facets produced 10 years ago were compared with the present ones in a 35-year old patient with bruxism. The electromyographic data of 10 years ago were also compared with the current data. Current mandibular kinesiograph data were also measured. The total area of the present wear facets was increased approximately 2.3 times those of 10 years ago in the upper teeth, and approximately 2 times in the lower teeth. However, the number of current wear facets of the upper and lower teeth was reduced, compared to that of 10 years ago. The Gothic arch tracing revealed a difference of about 1 mm between the centric occlusion and the centric relation. The patient had a unilateral balanced occlusion and a grinder-type chewing pattern. The free-way space, was in a normal range, approximately 2 mm. The raw electromyographs during sponge chewing 10 years ago differed from the present findings, although the chewing rhythm was the same.

A clinicoradiological study of maxillary osteomyelitis.

Eleven cases of maxillary osteomyelitis were studied clinically and radiologically. Clinically, the molar area was most affected. The average age of the patients was 47 years and there was no sex difference. Radiologically, the spotty type of osteolytic change was the most frequent, and osteosclerosis was rare. Sequestrum was not a clear feature radiologically. The features of maxillary and mandibular osteomyelitis were compared and the findings discussed.

[Radiographic findings of the so-called globulomaxillary cyst].

In definite diagnosis of this cyst, it is deemed that a comprehensive diagnosis is required including operative findings upon its extraction and the pathohistological findings of the extracted matter in addition to the radiographic and clinical findings, such as one that the region of development is between the maxillary lateral incisor and the cuspid, one that the adjacent teeth are vital ones, etc. Thus, we examined 10 cases that we had defined as the subjects of so-called Globulomaxillary cyst by clinical and pathohistological findings in terms of the developmental region, size, border, etc. As a result, the following things turned out: 1. The median positions of cystic development existed 8 cases in left side and 2 cases in right side out of 10 cases. And this median positions could be divided into those between the central incisor and the lateral incisor (5 cases) and those between the lateral incisor and the cuspid (5 cases). 2. The pathohistological findings led to the following classification; 2 cases with no inflammation, 5 cases with inflammation, and 3 cases with present inflammation in the past. The border line of cyst on radiographic findings tended to be relatively unclear in the cases with inflammation in the past.

Impingement after total knee arthroplasty caused by cement extrusion and proximal tibiofibular instability.

A 57-year-old patient with rheumatoid arthritis showed posterolateral impingement after total knee arthroplasty. The radiographs showed bone cement extrusion posterolateral to the tibial tray. Arthrotomy through a posterolateral approach revealed that the impingement was caused not only by cement extrusion against the fibular head but also by proximal tibiofibular joint instability. It was speculated that rheumatoid arthritis had caused proximal tibiofibular instability, active knee motion had caused fibular head shift by tension of biceps femoris and the fibular head had been impinged on the extruded cement. In cementing the tibial tray, especially in a rheumatoid patient, it is of paramount importance to take caution against posterolateral cement extrusion in order to minimize the risk of fibular head impingement during total knee arthroplasty.

Differential diagnosis between cyst and tumor. Dentigerous cyst and ameloblastoma containing teeth.

A study was conducted on 21 cases of ameloblastoma (a type of tumor containing an embedded tooth) and 87 cases of dentigerous cyst. The former cases were selected from among those which had been diagnosed histopathologically. Using radiographs of these lesions, the following parameters were measured: 1) the distance between the cement-enamel junction of the embedded tooth and its attachment to the cystic wall; 2) the area of the radiolucent image (similar to the area with a cystic appearance). From measurements of the former parameter, it appeared that the embedded tooth extends more toward the root apex in ameloblastoma than in dentigerous cyst, whereas the latter parameter indicated that the radiolucent area varies in size slightly in ameloblastoma, but tends to be smaller in dentigerous cyst. Moreover, with regard to clustering between ameloblastoma and dentigerous cyst, no definite tendency was detected on distance, whereas only ameloblastoma without dentigerous cyst was seen above 20 cm2 of area.

Immunohistochemical studies with a monoclonal antibody on the distribution of phosphophoryn in predentin and dentin.

A monoclonal antibody was raised against phosphophoryn, a unique noncollagenous phosphoprotein in dentin. Mouse myeloma NS-I cells were fused with spleen cells obtained from BALB/c mice immunized with phosphophoryn from fetal calf tooth germs. Mice inoculated with the hybridoma produced ascites fluid containing the antibody and this reacted only with a band of phosphophoryn transblotted from polyacrylamide gel. Immunohistochemical studies with the antibody showed that phosphophoryn was present in odontoblasts, odontoblastic processes and dentin, but not in the matrix of predentin, and that the phosphophoryn content of the dentin layer was high at and around the predentin-dentin junction and gradually decreased toward the enamel layer. The area corresponding to mantle dentin was not stained with the antibody.

Cystic lesions of the maxillomandibular region: MR imaging distinction of odontogenic keratocysts and ameloblastomas from other cysts.

OBJECTIVE: Differentiating odontogenic keratocysts and ameloblastomas from other cystic lesions in the maxillomandibular region is important because of their high recurrence rates. Conventional radiography, CT, and fine-needle aspiration biopsy are limited for differential diagnosis. The purpose of this study was to review the MR findings in patients with odontogenic keratocysts, ameloblastomas, and other maxillomandibular cysts to determine the value of MR imaging in the differential diagnosis of these lesions. SUBJECTS AND METHODS: MR images were obtained in 38 patients with 43 cystic lesions of the maxillomandibular region. All the lesions (19 odontogenic keratocysts, 11 ameloblastomas, five primordial cysts, five radicular cysts, and three cysts of other types) were pathologically confirmed by surgery or biopsy. Contrast-enhanced MR studies were performed in 34 patients. Images were reviewed to determine various imaging parameters: locularity, solid or cystic pattern, thickness and contrast enhancement of the walls, and homogeneity and signal intensities of the fluids. T2 relaxation times of cystic components were calculated in 31 lesions. RESULTS: MR images of odontogenic keratocysts showed that the cyst were unilocular in 10 lesions and multilocular in nine. In 10 lesions the cysts wall was uniformly thin and had poor contrast enhancement. Seven cysts had thick walls and two had no definite walls. In 17 lesions, the cystic contents showed heterogeneous signal intensity on T1-weighted images, T2-weighted images, or both. Eight cysts had predominantly intermediate or high T1-weighted signal intensity, and six cysts had predominantly intermediate T2-weighted signal intensity. MR findings in ameloblastomas were different from those in odontogenic keratocysts: a mixed solid and cystic pattern (11 lesions), irregularly thick walls (11 lesions), papillary projections (seven lesions), and strong enhancement of solid components (nine lesions). T2 relaxation times of cystic components were significantly shorter in odontogenic keratocysts than in ameloblastomas, with no overlap. All other cysts showed a unilocular, purely cystic pattern, with homogeneous fluids, although the T2 relaxation times of four lesions overlapped those of odontogenic keratocysts. CONCLUSION: From the MR findings of the walls, solid components, and the fluid contents, odontogenic keratocysts could be differentiated from ameloblastomas in all cases, although some other cysts showed MR findings similar to those of odontogenic keratocysts.

Clinical assessment of the pumping technique in treating TMJ arthrosis with closed lock.

The treatment of closed jaw locking due to temporomandibular joint (TMJ) arthrosis is described. Conventional mandibular manipulation of the lower and/or upper joint compartments was performed using hydraulic pressure from an imaging X-ray medium. The procedure was used in 40 patients with closed locking (5 acute and 35 chronic). The results of the treatment are evaluated and factors affecting the results are examined. In four of the five patients with acute closed locking, the lock was successfully released after use of the pumping technique on the lower joint compartment. In patients with chronic locking, an average improvement of 6.6 mm in the degree of interincisal opening was observed within 3-4 days of treatment with the pumping technique. In 13 of these patients, satisfactory opening (at least 40 mm) was achieved immediately. All the patients underwent further forward and contralateral manipulation to assist mouth opening, and after a period of 2-3 months 16 patients showed a further average improvement of 5.4 mm in interincisal opening.

Ameloblastoma in the maxillomandibular region: MR imaging.

Nine patients suspected of having primary ameloblastoma of the mandible or maxilla and five patients with clinical and/or radiologic indications of postoperative recurrence of ameloblastoma were examined with magnetic resonance (MR) imaging. In the former, results were compared with those of conventional radiography, computed tomography (CT), and pathologic analysis. Seven tumors were multilocular; two were unilocular. MR imaging showed a mixed pattern of solid and cystic components (n = 9), irregularly thick walls (n = 9), and papillary projections (n = 6). MR imaging was superior to conventional radiography and CT in demonstrating these findings. However, shell-like bulgings of the bone cortex were demonstrated more effectively with conventional radiography and/or CT in six cases, and soft-tissue invasion was overestimated with MR imaging in four cases. All tumors except one showed strong enhancement of solid components including papillary projections, walls, and septa at enhanced MR imaging. In the latter group of patients, MR imaging correctly demonstrated recurrence in two and no recurrence in three.