[Retrieval of a migrated plastic stent in a 51-year-old man]. / Bergung eines migrierten Doppel-Pigtail-Stents bei einem 51-jährigen Patienten.

BACKGROUND: Endosonographically guided transgastric drainage is the first-line interventional therapy of walled-off necrosis and symptomatic pancreatic pseudocysts in necrotizing pancreatitis. Plastic stents or lumen apposing metal stents are commonly used. A possible complication of endoscopic therapy is stent migration. CASE REPORT: We report upon a 51-year-old man who presented with acute necrotizing pancreatitis. Transgastric necrosectomy was performed and 5 transmural double-pigtail stents (DPS) were left in situ to drain the residual retroperitoneal cavity. The patient recovered and 4 stents were endoscopically removed 5 weeks later on an outpatient basis, whereas the fifth stent was suspected to have passed spontaneously via the natural route. The asymptomatic patient presented 3 months later for follow-up computed tomography. The necrosis had healed but one DPS was seen beyond the gastric wall near the kidney. Transmural access to the stent could be achieved by an endosonographically guided puncture toward the proximal portion of the stent followed by placement of a hydrophilic guidewire alongside the stent. A new gastrostomy was created by using a 6F cystotome followed by wire-guided dilation with a 12 mm balloon. The stent could then be grasped with transmurally inserted rat-tooth forceps and repositioned across the gastrostomy site. The patient was given prophylactic antibiotics. After removal of the stent, the patient could be discharged. CONCLUSION: Herein, we present the successful endosonographically guided transmural removal of a retroperitoneally migrated plastic stent. Of note, in our patient we had to rely completely on endosonography and radiography for localization and targeting of the stent, since the former necrotic cavity had meanwhile completely healed.

Mechanobehaviour in dolichofacial and brachyfacial adolescents.

OBJECTIVES: To test whether mechanobehaviour (temporomandibular joint (TMJ) loads, jaw muscle use) was different between facial types and correlated with ramus height (Condylion-Gonion, mm). SETTING AND SAMPLE POPULATION: University of Missouri-Kansas City (UMKC) Orthodontic Clinic. Ten dolichofacial and ten brachyfacial adolescents (Sella-Nasion-Gonion-Gnathion (SN-GoGn) angles ≥37° and ≤27°, respectively) consented to participate. MATERIALS AND METHODS: Numerical models calculated TMJ loads for a range of static biting based on subjects' three-dimensional anatomy. Subjects were trained to record jaw muscle electromyography (EMG) over 2 days and 2 nights in their natural environments. Laboratory EMG/bite-force calibrations determined subject-specific EMG for 20 N bite-force (T20Nave ). Jaw muscle use via duty factors (DF=muscle activity duration/total recording time, %) was determined from day and night recordings for muscle-specific thresholds from ≥5% to ≥80%T20Nave . ANOVA and Tukey's HSD post hoc tests assessed for group differences in mechanobehaviour (TMJ loads, DFs). Regression modelling correlated subjects' normalized TMJ loads, DFs and ramus height. RESULTS: Dolichofacial compared to brachyfacial subjects produced significantly higher (P<.05) TMJ loads, where ipsilateral loads were ≥20% larger for some biting angles, but had significantly less (all P<.05) masseter (day, night) and temporalis (night) DFs. Regression analysis showed a significant relationship amongst normalized TMJ loads, masseter DF and ramus height (R2 =.49). CONCLUSIONS: Mechanobehaviour showed significant differences between facial types and was correlated with ramus height.

Effect of length post and remaining root tissue on fracture resistance of fibre posts relined with resin composite.

To investigate the influence of post length and amount of remaining root tissue on the fracture resistance of roots restored with fibre posts relined with resin composite. Ninety upper canine teeth were divided into nine groups (n = 10). The post spaces were prepared resulting in different lengths, as follows: group 2/3, preparations with lengths of 10 mm; group 1/2, preparations with lengths of 7·5 mm; and group 1/3, preparations with lengths of 5 mm. Each group was divided into 3 subgroups according to amount of remaining root tooth tissue (2, 1 mm or 0·5 mm of thick root). Fibre posts relined with resin composite were cemented, and all teeth were restored with metal crowns. The samples were submitted to the fracture resistance test in a universal testing machine, at an angle of 135° and speed of 0·5 mm min(-1) . Failure modes were observed and the data of fracture resistance were submitted to the anova and Tukey's (α = 0·05). No statistically significant difference in fracture resistance was found among different post lengths (P > 0·05). Remaining dentin thickness of 2 and 1 mm did not differ statistically in fracture resistance (P > 0·05), which was higher than of 0·5 mm dentin thickness (P < 0·05). A prevalence of repairable failure was observed in all groups. It can be concluded that the length of fibre post relined with resin composite did not influence fracture resistance, but thickness was an important factor for the restoration of endodontically treated teeth.

The randomized shortened dental arch study: tooth loss over five years.

OBJECTIVES: The study was designed to provide clinical outcome data for two treatments of the shortened dental arch (SDA). MATERIAL AND METHODS: In a multicenter randomized controlled clinical trial, patients with complete molar loss in one jaw were provided with either a partial removable dental prosthesis (PRDP) retained with precision attachments or treated according to the SDA concept preserving or restoring a premolar occlusion. No implants were placed. The primary outcome was tooth loss. RESULTS: Of 152 treated patients, 132 patients reached the 5-year examination. Over 5 years, 38 patients experienced tooth loss. For the primary outcome tooth loss, the Kaplan-Meier survival rates at 5 years were 0.74 (95% CI 0.64, 0.84) in the PRDP group and 0.74 (95% CI 0.63, 0.85) in the SDA group. For tooth loss in the study jaw, the survival rates at 5 years were 0.88 (95% CI 0.80, 0.95) in the PRDP group and 0.84 (95% CI 0.74, 0.93) in the SDA group. The differences were not significant. No Cox regression models of appropriate fit explaining tooth loss on the patient level could be found. CONCLUSIONS: The overall treatment goals of a sustainable oral rehabilitation and the avoidance of further tooth loss over longer periods were not reliably achievable. The influence of the type of prosthetic treatment on tooth loss might have been overestimated. CLINICAL RELEVANCE: Regarding our results, the patient's view will gain even more importance in the clinical decision between removable and fixed restorations in SDAs.

In vitro comparisons of casting retention on implant abutments among commercially available and experimental castor oil-containing dental luting agents.

STATEMENT OF PROBLEM: Although cement-retained implant prostheses are widely used, the quantification of optimal retention remains controversial, and new dental luting agents should be evaluated. PURPOSE: The purpose of this study was to compare, in vitro, the casting retention on implant abutments after cementation with 3 commercially available luting agents and an experimental luting agent (castor oil polyurethane, COP) with variable weight percentages (wt%) of calcium carbonate (CaCO3). MATERIAL AND METHODS: Seventy-two palladium-silver cast copings were fabricated and divided into 6 groups: Temp Bond interim cement (TB); zinc phosphate cement (ZP); Rely X ARC resin cement (RX); pure COP (COP); COP + 10% wt% CaCO3 filler (COP 10); and COP + 50% wt% CaCO3 filler (COP 50). After cementation, the specimens were stored in distilled water at 37°C for 24 hours and subjected to removal force tests in a universal testing machine (5 kN; 0.5 mm/min). Statistical analyses were performed with the Kruskal-Wallis and Student-Newman-Keuls tests (α=.05). RESULTS: The median values of casting retention (N) were as follows: TB=57.20 ±10.4; ZP=343.56 ±50.3; RX=40.07 ±9.7; COP=258.98 ±41.4; COP 10=466.57 ±79.3; and COP 50=209.63 ±31.4. The Kruskal-Wallis test showed significant differences among the groups (P<.01). TB and RX had the lowest mean retention values; COP, COP 10, and COP 50 were equal to ZP, and COP 10 had the highest retention. CONCLUSIONS: The casting retention on implant-abutments provided by COP was similar to that of copings cemented with zinc phosphate and may be influenced by the addition of calcium carbonate.

Tropomodulin caps the pointed ends of actin filaments.

Many proteins have been shown to cap the fast growing (barbed) ends of actin filaments, but none have been shown to block elongation and depolymerization at the slow growing (pointed) filament ends. Tropomodulin is a tropomyosin-binding protein originally isolated from red blood cells that has been localized by immunofluorescence staining to a site at or near the pointed ends of skeletal muscle thin filaments (Fowler, V. M., M. A., Sussman, P. G. Miller, B. E. Flucher, and M. P. Daniels. 1993. J. Cell Biol. 120: 411-420). Our experiments demonstrate that tropomodulin in conjunction with tropomyosin is a pointed end capping protein: it completely blocks both elongation and depolymerization at the pointed ends of tropomyosin-containing actin filaments in concentrations stoichiometric to the concentration of filament ends (Kd < or = 1 nM). In the absence of tropomyosin, tropomodulin acts as a "leaky" cap, partially inhibiting elongation and depolymerization at the pointed filament ends (Kd for inhibition of elongation = 0.1-0.4 microM). Thus, tropomodulin can bind directly to actin at the pointed filament end. Tropomodulin also doubles the critical concentration at the pointed ends of pure actin filaments without affecting either the rate of extent of polymerization at the barbed filament ends, indicating that tropomodulin does not sequester actin monomers. Our experiments provide direct biochemical evidence that tropomodulin binds to both the terminal tropomyosin and actin molecules at the pointed filament end, and is the long sought-after pointed end capping protein. We propose that tropomodulin plays a role in maintaining the narrow length distributions of the stable, tropomyosin-containing actin filaments in striated muscle and in red blood cells.

The BIOSAFEPAPER project for in vitro toxicity assessments: preparation, detailed chemical characterisation and testing of extracts from paper and board samples.

Nineteen food contact papers and boards and one non-food contact board were extracted following test protocols developed within European Union funded project BIOSAFEPAPER. The extraction media were either hot or cold water, 95% ethanol or Tenax, according to the end use of the sample. The extractable dry matter content of the samples varied from 1200 to 11,800 mg/kg (0.8-35.5 mg/dm2). According to GC-MS the main substances extracted into water were pulp-derived natural products such as fatty acids, resin acids, natural wood sterols and alkanols. Substances extracted into ethanol particularly, were diisopropylnaphthalenes, alkanes and phthalic acid esters. The non-food contact board showed the greatest number and highest concentrations of GC-MS detectable compounds. The extracts were subjected to a battery of in vitro toxicity tests measuring both acute and sublethal cytotoxicity and genotoxic effects. None of the water or Tenax extracts was positive in cytotoxicity or genotoxicity assays. The ethanol extract of the non-food contact board gave a positive response in the genotoxicity assays, and all four ethanol extracts gave positive response(s) in the cytotoxicity assays to some extent. These responses could not be pinpointed to any specific compound, although there appeared a correlation between the total amount of extractables and toxicity.

Changes in biting forces with implant-supported overdenture in the lower jaw: A comparison between conventional and mini implants in a pilot study.

The biting ability of patients improves noticeably after receiving implant-supported overdentures in comparison to conventional complete dentures. However, the change of biting with such treatment concepts has been quantitatively investigated in only a limited number of studies. The aim of the present study has been to measure the biting forces of edentulous patients with complete dentures and after receiving implant-supported overdentures. A total of 26 edentulous patients were included. Ten patients received two to four conventional implants (control group, Ø3.3-3.7mm, L11-13mm) and 16 patients received four to five mini implants (study group, Ø1.8-2.4mm, L13-15mm) inserted in the mandibular interforaminal region. All patients received a lower overdenture with ball/rubber ring attachments and a complete denture for the maxilla. The biting forces were measured using Prescale pressure sheets type low before the insertion of implants and after receiving implant-supported overdenture. The measured sheets were later scanned and analysed using FPD-8010E software. The range of biting forces before the insertion of implants was 80N-122N for the control group and 66-88N for the study group. After the insertion of implants, the range of biting forces increased to 167N-235N for the control group and to 81N-138N for the study group. However, the increase in biting forces after the insertion of implants was not significant for either group. No significant difference was obtained between the two implant systems. The biting forces improved after insertion of implants regardless of which implant system was used. However, the degree of improvement is noticeably related to the original bone quality of the mandible at the insertion regions of implants.

Complete sequencing shows a role for MSX1 in non-syndromic cleft lip and palate.

MSX1 has been proposed as a gene in which mutations may contribute to non-syndromic forms of cleft lip and/or cleft palate. Support for this comes from human linkage and linkage disequilibrium studies, chromosomal deletions resulting in haploinsufficiency, a large family with a stop codon mutation that includes clefting as a phenotype, and the Msx1 phenotype in a knockout mouse. This report describes a population based scan for mutations encompassing the sense and antisense transcribed sequence of MSX1 (two exons, one intron). We compare the completed genomic sequence of MSX1 to the mouse Msx1 sequence to identify non-coding homology regions, and sequence highly conserved elements. The samples studied were drawn from a panethnic collection including people of European, Asian, and native South American ancestry. The gene was sequenced in 917 people and potentially aetiological mutations were identified in 16. These included missense mutations in conserved amino acids and point mutations in conserved regions not identified in any of 500 controls sequenced. Five different missense mutations in seven unrelated subjects with clefting are described. Evolutionary sequence comparisons of all known Msx1 orthologues placed the amino acid substitutions in context. Four rare mutations were found in non-coding regions that are highly conserved and disrupt probable regulatory regions. In addition, a panel of 18 population specific polymorphic variants were identified that will be useful in future haplotype analyses of MSX1. MSX1 mutations are found in 2% of cases of clefting and should be considered for genetic counselling implications, particularly in those families in which autosomal dominant inheritance patterns or dental anomalies appear to be cosegregating with the clefting phenotype.

Cholesterol enhances platelet-derived growth factor-BB-induced [Ca2+]i and DNA synthesis in rat aortic smooth muscle cells.

In the present study, we describe possible mechanisms by which hypercholesterolemia may contribute to the development of cardiovascular diseases. Treatment of rat aortic smooth muscle cells for 20 hours with cholesterol-rich liposomes (500 micrograms/mL cholesterol, 100 micrograms/mL low-density lipoprotein) resulted in a 76 +/- 12% increase in total cholesterol content. The effects of cholesterol enrichment were examined by determination of changes in cell membrane fluidity. Fluidity of the cholesterol-enriched cell membranes was decreased at all temperatures between 15 degrees C and 40 degrees C. Changes in membrane fluidity in whole cell membranes represented changes in fluidity of microsomal membranes isolated by Percoll gradient ultracentrifugation. The basal [Ca2+]i and the maximal platelet-derived growth factor (PDGF)-BB-induced [Ca2+]i was elevated by 30% and 90% in cholesterol-enriched cells, respectively. In contrast, the resting pH, and the PDGF-BB-induced stimulation of the Na+/H+ exchange were not affected in cholesterol-enriched cells. The effect of PDGF-BB on [3H]thymidine incorporation in cholesterol-enriched cells was elevated by 40% in comparison with untreated cells. Our findings show that cellular cholesterol may be involved in the development of vascular diseases via modulation of the PDGF-induced increase in [Ca2+]i and DNA synthesis in vascular smooth muscle cells.

The role of mineralocorticoid receptors in the circadian activity of the human hypothalamus-pituitary-adrenal system: effect of age.

The purpose of this study was to test the role of the mineralocorticoid receptor (MR) in the circadian activity of the hypothalamus-pituitary-adrenal (HPA) system of elderly healthy subjects. Nine elderly subjects (age: 66.2 +/- 7.7 years) were treated for 8 days with both the MR antagonist spironolactone and a placebo in a randomized, single-blind cross-over order. After treatment, we studied the circadian profiles of ACTH, plasma cortisol and saliva cortisol. No significant change in ACTH concentrations emerged. However, there were significant increases in circadian minimal (52.4 +/- 26.7 versus 33.3 +/- 14.4 nmol/l), mean (166.2 +/- 24.9 versus 133.0 +/- 18.3 nmol/l), and maximal cortisol concentrations (389.7 +/- 57.7 versus 335.4 +/- 45.0 nmol/l). Also, in the diurnal trough, we found an increase in saliva cortisol concentrations. Compared to young healthy controls, spironolactone treatment had stronger effects in the elderly. We therefore conclude that: 1) MR is involved in the human HPA system regulation; 2) the MR participates in the regulation of circadian nadir and peak activity of the HPA system; and 3) the HPA system in the elderly is more vulnerable to dysregulation at the level of the MR.

High incidence of upper gastrointestinal tract involvement in children with Crohn disease.

This retrospective study of Crohn disease in 230 children and adolescents with a mean age of 12.5 years at the time of diagnosis and an average follow-up of 6.6 years showed that 30% had lesions of the esophagus, stomach, and duodenum. Three patients had Crohn disease isolated to the upper gastrointestinal tract. The 169 patients with both small and large bowel disease were at greater risk (33%, P less than .05) of having upper gastrointestinal lesions than the 37 with isolated small bowel disease and the 21 with disease limited to the colon and/or rectum. An aggregate of symptoms and signs more likely present in those with upper gastrointestinal involvement included: dysphagia, pain when eating, nausea and/or vomiting, and aphthous lesions of the mouth. Furthermore, weight loss was more severe and hypoalbuminemia more frequent. Because upper gastrointestinal series x-ray studies failed to detect upper gastrointestinal lesions in 13 patients of 69 of those with upper gastrointestinal disease, endoscopy should be considered in all children and adolescents in whom a diagnosis of Crohn disease is entertained. Endoscopy and biopsy of the upper gastrointestinal tract should be done in any patient with symptoms suggestive of proximal involvement. Finally, in view of the fact that endoscopy established the diagnosis of Crohn disease in five patients previously thought to have chronic ulcerative colitis, the procedure should routinely be performed in all patients with chronic ulcerative colitis or indeterminate colitis before surgery is performed.

Imaging of cysts and odontogenic tumors of the jaw. Definition and classification.

For the evaluation of jaw cysts and odontogenic tumors, the radiologic examinations include conventional films, computed tomographic (CT) scans, and magnetic resonance (MR) images. The indications for these radiologic methods are discussed along with the radiologic findings for the various cysts and tumors described. The differential diagnosis of these lesions is also included in the discussion.

Effects of bile acids on actin polymerization in vitro.

Bile acids are major determinants of canalicular bile secretion, and there are indications that choleretic bile acids increase bile canalicular contractions, in isolated rat hepatocytes. Therefore, we examined the influence of various bile acids on the rate of actin polymerization in vitro. The free forms of cholic acid, ursodeoxycholic acid, and chenodeoxycholic acid, as well as their taurine and glycine conjugates, were incubated with purified muscle actin, at a concentration of 100-300 nmoles/mg actin. The rate of actin polymerization was measured by viscometry and the fluorescence of the pyrene probe, linked to actin. Results showed that all bile acids slow the rate of polymerization, and that the effect was dose-dependent. However, the reduction by chenodeoxycholic acid was greater than that caused by the other bile acids. The results indicate that bile acids, particularly in high concentrations interact with actin, a finding that may be related to the increased bile canalicular contractility, and altered canalicular membrane morphology, induced by choleretic bile acids.

Skull base dumbbell tumor: surgical experience with two adolescents.

Pediatric skull base tumors are rare and until recently were considered unresectable. We present two patients with tumors of similar anatomic position with an extracranial component in the infratemporal fossa and parapharyngeal space, an isthmus at the foramen ovale, and a superior component in the middle cranial fossa in the region of the cavernous sinus. A 15-year-old girl experienced contiguous spread of a spindle cell sarcoma; an 18-year-old boy developed a chondrosarcoma. A middle fossa approach provided the advantage of surgical avoidance of structures such as the middle ear and mastoid, facial nerve, and mandible. Postoperative recovery was rapid. Our impression is that preoperative carotid artery occlusion and a middle fossa approach for tumor resection can be performed in a young patient with acceptable morbidity and at least short-term benefit. Surgery can, therefore, provide an additional therapeutic approach to complement irradiation and chemotherapy.

Primary intra-osseous carcinoma of the maxilla in a horse.

An 8-year-old Hannoverian horse developed a swelling of the maxilla caused by a tumour of the hard palate. On histological examination the tumour was diagnosed as a primary intra-osseous carcinoma of the maxilla, a rare odontogenic tumour not previously described in the horse.

The histological nature of epulides in dogs.

The histological characteristics of a series of 154 oral tumours with the clinical appearance of epulides in 129 dogs were reviewed. Diagnoses were based on current criteria in human oral pathology and compared with the original diagnoses. The histological findings suggested that the majority of epulides in the dog can be classified as focal fibrous hyperplasia (43.5 per cent), peripheral ameloblastoma (17.5 per cent), peripheral odontogenic fibroma (WHO type) (16.9 per cent) and pyogenic granuloma (1.95 per cent). In addition, a number of other odontogenic tumours (1.95 per cent) and non-odontogenic tumours (18.2 per cent) such as fibrosarcoma and squamous cell carcinoma, which are not traditionally associated with the clinical appearance of an epulis, were diagnosed. Of 74 lesions that were previously diagnosed as fibromatous and ossifying epulides, 50 (68 per cent) were reclassified as focal fibrous hyperplasia and 21 (28 per cent) as peripheral odontogenic fibroma (WHO type). The majority of lesions (76 per cent), which were originally classified as acanthomatous epulis, were found to be peripheral ameloblastoma. In addition, three squamous cell carcinomas, two rare odontogenic tumours and two cases of focal fibrous hyperplasia were diagnosed in this classification. It was concluded that, as in man, the term epulis is a clinically descriptive term and that the renal nature of these lesions should be determined histologically.

Tumors of the paranasal sinuses.

Benign and malignant tumors, including polyps, represent conditions that occur frequently enough to be considered in the differential diagnosis of sinus disease. The locations and extent of these lesions (especially malignant tumors) should be evaluated by CT and MRI. This is especially indicated when malignant lesions extend outside the confines of the paranasal sinuses into adjacent areas, such as the orbit, intracranial cavity, and parapharnygeal space.

Comparison of ciprofloxacin assays.

Two high pressure liquid chromatography methods developed independently and two different microbiological methods assayed samples containing ciprofloxacin derived from four volunteers: 46 sera, 19 saliva and 27 urine specimens. Each subject had received 500 mg of ciprofloxacin by mouth, with the samples collected in the ensuing six hours. Fifteen mock unknowns, prepared by adding known amounts of ciprofloxacin to normal human serum, were also assayed by the four procedures. The limits of sensitivity of the HPLC assays were less than 0.01 microgram/ml; the sensitivity limits of the bioassay were 0.02 microgram/ml (disc method) and 0.06 microgram/ml (well method). The inter-assay data was analyzed by linear regression. Ciprofloxacin concentrations in serum samples correlated well (R = 0.90) with all methods. Values obtained with urine samples also correlated well (R greater than or equal to 0.80). We conclude that either microbiological assay or quantitation by HPLC is satisfactory for quantitation of ciprofloxacin.

Evaluation of the stable fly (Stomoxys calcitrans) as a vector of enzootic bovine leukosis.

Experiments reported here were directed at 2 questions: (1) Can the stable fly (Stomoxys calcitrans) transmit enzootic bovine leukosis? (2) Could early viremia augment the probability of transmission by this insect? In one vector experiment, calves and bovine leukemia virus (BLV)-infected cows were housed with and without stable flies. The calves were monitored serologically during a 3-month postexposure period, using the agar gel immunodiffusion test. All fly-infested and fly-free calves remained BLV-seronegative. For a second vector experiment, donor calves, newly injected with blood from BLV-infected cows with high virus expression, were tethered alternately between uninoculated, weaned BLV-seronegative calves. These groups were housed with or without flies in 2 replicate trials. The inoculated calves from the first replicate seroconverted at 16 and 23 days after inoculation; the inoculated calves from the second replicate seroconverted at 11, 16, 16, and 37 days after inoculation. All uninoculated calves remained BLV-seronegative. In a manual transmission experiment, 50 unfed stable flies were allowed to complete a meal on each of 3 BLV-seronegative calves after feeding on a BLV-seropositive cow with high (42%) virus expression. One control calf was injected with blood from the cow. Seroconversion occurred in the control calf and 1 calf on which flies were given access. A scanning electron microscopic study was made of the everted and closed mouth parts of the stable fly. Given the lymphocyte count in blood from the cow used in the manual vector transmission experiment, it was calculated that 3,950 mouth part volumes would be necessary to transmit BLV.(ABSTRACT TRUNCATED AT 250 WORDS)