Evaluating Quality of Life After Facial Reanimation Using the Facial Clinimetric Evaluation Scale in a Series of Pediatric Patients.

BACKGROUND: Facial palsy can have significant functional and psychological impact. Dynamic facial reanimation methods have provided means of restoration of smile. There remains a dearth of quality of life data in children. The authors aim to assess patient reported outcomes in this underreported population. METHODS: A retrospective review was performed of pediatric patients with facial palsy who had dynamic facial reanimation from 2009 to 2017 at a single institution. Patients were sent a digital Facial Clinimetric Evaluation (FaCE) questionnaire, a validated tool to assess patient quality of life. FaCE statements are grouped into 6 categories: facial movement, facial comfort, oral function, eye comfort, lacrimal control, and social control. RESULTS: Twenty patients met inclusion criteria. Fourteen successfully completed the survey. With normal function being 100, our cohort scored: facial movement 38.7 ±â€Š14.3; facial comfort 67.3 ±â€Š23, oral function 75 ±â€Š22.7, eye comfort 68.75 ±â€Š18.2, lacrimal control 53.6 ±â€Š32.5, social function 64.3 ±â€Š25.6. The overall FaCE score was 61.07 ±â€Š10.85. The facial movement subscores were lower for brow raise 16.1 ±â€Š33.4 relative to smiling 53.6 ±â€Š29.2 and lip pucker, 46.4 ±â€Š23.7. No correlation was found between facial movement scores and total scores (R2 < 0.01). There was a strong negative correlation between total scores and time since procedure (Spearman's rho R =  -0.45). CONCLUSION: Our pediatric facial reanimation cohort demonstrated excellent social function, in contrast to a relatively lower facial movement score. The low facial movement score was mediated by low score for brow raise and was not correlated to overall FaCE score. Interestingly, overall FaCE score tended to decrease with time from procedure.

The Canadian healthy infant longitudinal development birth cohort study: biological samples and biobanking.

BACKGROUND: It is hypothesised that complex interactions between genetic and environmental factors give rise to allergy and asthma in childhood. The Canadian Healthy Infant Longitudinal Development (CHILD) study was designed to explore these factors. METHODS: CHILD is a longitudinal, general population birth cohort study following infants from mid-pregnancy to age 5 years. Over this time period, biological samples, questionnaires, clinical measures and environmental data are collected. RESULTS: A total of 3624 families have been recruited, and many thousands of samples and questionnaires have been collected, annotated, and archived. This report outlines the rationale and methodology for collecting and storing diverse biological samples from parents and children in this study, and the mechanisms for their release for analyses. CONCLUSIONS: The CHILD sample and data repository is a tremendous current and future resource and will provide a wealth of information not only informing studies of asthma and allergy, but also potentially in many other aspects of health relevant for Canadian infants and children.

The limited incision harvest of the rectus femoris flap for complex groin wound management.

BACKGROUND: Muscle flaps can be effective in the protocol of complex groin wound management, yet donor-site morbidity remains a continued concern. The purpose of this study was to present a minimally invasive approach to the harvest of the rectus femoris flap (RFF) for groin wound vascularized tissue coverage. PATIENTS AND METHODS: A retrospective study examined all patients undergoing RFF coverage and reconstruction of a complex groin wound between July 1, 2010, and December 31, 2011. During the study period, the senior author (S.K.K.) performed all RFF harvests through a minimally invasive approach, whereas all other surgeons performed the RFF harvest through a standard approach. Patients who underwent a minimally invasive RFF approach were compared with those who underwent the standard incision. RESULTS: Forty-three patients underwent RFF coverage procedures, 11 of which were carried out using the minimally invasive technique. The patients in the minimally invasive cohort were older (P = 0.03) but had similar rates of medical comorbidities. Minimally invasive RFF harvests were more commonly performed in the planned, salvage setting (P = 0.03). No difference was found in the vascular surgery procedure type (P = 0.13), presence of exposed prosthetic graft material (0.2), or rate of culture-positive wound (P = 0.67). Importantly, no differences in operative time (184.4 [45.5] minutes vs 169.3 [31.7] minutes, P = 0.45) or postoperative complications were observed, with no graft losses or major limb-related morbidity in either group. CONCLUSIONS: The RFF continues to be a workhorse flap for complex groin wounds, most often in the salvage setting. This study demonstrates that a minimally invasive approach can be used for flap harvest with equivalent results to that of the standard longitudinal incision.

Extraction of broken pedicle screws: technical note.

OBJECTIVE: To describe a simple technique for extraction of broken pedicle screw fragments using a high-speed drill and to discuss additional extraction techniques presented in the literature. TECHNIQUE: The broken pedicle screw is removed by drilling a pilot hole with a side-cutting bit next to and along the long axis of the fragment in the superior aspect of the pedicle. The bit is then wedged into the interface between the bone and the proximal screw threads. While the bit is pressed against the threads, the drill is activated in brief pulses. The clockwise rotation of the drill bit engages the threads and backs out the screw fragment RESULTS: This technique has been successfully used in at least two patients with fractured titanium screws allowing placement of larger diameter screws in the same holes. Standard equipment was used, and no complications were encountered. CONCLUSION: Broken titanium pedicle screws can be extracted without damaging the pedicle and without using specialized equipment.

Functional brain mapping using positron emission tomography scanning in preoperative neurosurgical planning for pediatric brain tumors.

OBJECT: The purpose of this report is to demonstrate the value of functional brain mapping using the positron emission tomography (PET) method for preoperative neurosurgical planning in children with brain tumors. Brain maps were used to characterize the relationship between potentially resectable tumors and functionally eloquent brain areas. METHODS: Five children, ranging in age from 3 to 13 years, with hemispheric brain tumors adjacent to eloquent cortex were studied. Magnetic resonance (MR) imaging was used to identify the brain tumors; PET imaging after injection of [18F] fluorodeoxyglucose (FDG), [11C]L-methionine (CMET), or a combination of the two was performed to grade the tumors; and a [15O] H2O uptake study was used to characterize the anatomical relationships of the tumors to functional cortex. The cortical activation maps were obtained during control periods and during behavioral tasks and were used to document motor, visual, and speech and language organizational areas. Wada tests were performed in two patients. Language and speech activation was concordant with the results of Wada testing. CONCLUSIONS: Functional brain mapping using PET scans and coregistered MR images provided the neurosurgeon with precise definitions of structural and functional cortical areas; this altered surgical management in some cases and/or was used to predict outcome. The combination of PET imaging with FDG and/or CMET and measurements of [15O] water uptake was useful in characterizing and grading tumors and instrumental in achieving effective neurosurgical planning. Postoperative results in the five cases suggest that preoperative functional brain mapping has the potential to improve outcome by defining a surgical plan to maximize resection and minimize the risk of neurological sequelae.

Cyclodextrin chiral stationary phases for liquid chromatographic separations of drug stereoisomers.

Many active drugs are racemic mixtures. Because the two enantiomers of a racemate often cause different pharmacological responses, the use of optically pure isomers is desirable and may be soon required. Cyclodextrin-bonded silica gel can be used as chiral stationary phase (CSP) in liquid chromatography. The enantiomers of 25 different racemic drugs were separated on such CSPs in the reversed-phase mode. The principal features of the cyclodextrin chiral recognition mechanism are recalled and some information on future trends for cyclodextrin CSPs is provided.

The use of a soft denture liner for chronic residual ridge soreness.

Chronic residual ridge soreness in patients with complete dentures can be caused by various factors. A differential diagnosis between physiologic or anatomic problems (or both) and functional deficiencies in the patient's present dentures must be made. The functional deficiencies can often be eliminated easily, whereas physiologic and anatomic problems may be more difficult to correct, especially in the geriatric patient. If the functional deficiencies in the patient's dentures have been corrected and surgical procedures are not a viable alternative, placement of a long-term resilient liner can often resolve the chronic residual ridge soreness that is present in denture patients. Properly placed and properly cared for silicone or silicone rubber resilient denture liners can provide comfort for over 70% of patients with chronic residual ridge soreness for 3 to 5 years and often longer.

Combining resin-bonded prostheses and removable partial dentures: report of case.

The resin-bonded prosthesis provides an alternative for tooth replacement in that the prosthesis can be combined with other dentures. The prosthesis was used conservatively in this case, with modified abutment teeth to improve the function of the removable partial denture. Decreased expense, shorter chair time, and the noninvasive nature of the procedure make the prosthesis an option for patients with special problems.

Familial renal disease in Norwegian Elkhound dogs: morphologic examinations.

Periglomerular and interstitial fibrosis were the earliest renal lesions in 21 Norwegian Elkhound (NE) dogs with familial renal disease. Histopathologic study did not reveal the cause of the disease, and light microscopy did not show renal lesions different from nonfamilial renal lesions commonly observed in dogs. Histopathologic evaluation was reliable for detecting disease in NE dogs prior to onset of isosthenuria and azotemia. Results of glomerular counts, determining kidney size, and dissection of the nephron indicated that nephron numbers and size were adequate early in the disease, but that numbers decreased as the disease progressed. Electron microscopic and immunofluorescent studies were not suggestive of an immune basis of the renal disease, nor did histopathologic or angiographic studies indicate primary vascular lesions. Nephron dissections revealed sacculations in distal tubules and collecting ducts of affected NE dogs. Renal disease did not develop in mongrel pups given injections of an homogenate or renal tissue from an affected NE dogs.

Benign fibrous histiocytoma: a rare endobronchial neoplasm.

Fibrous histiocytomas are rarely found within the lung and have presented as a mass within a major airway only twice previously. This is the third reported case of such a tumor visualized roentgenographically in an airway on the frontal chest film of a patient presenting with recurrent pneumonia.

Guided tissue healing for single-tooth implants.

The emergence profile of a single-tooth implant abutment has a significant effect on the esthetics of the final restoration. Most healing abutments are cylindrical, unlike the nonround contours of the natural teeth being replaced. The resulting peri-implant sulcus is round rather than having the correct anatomic cross-sectional shape. This disparity may compromise the ideal emergence profile of the final restoration. This article presents a technique in which a custom abutment and provisional crown or the definitive restoration can be placed at second-stage surgery to guide tissue healing to optimum form and esthetics.

The casting accuracy of nickel--chromium alloys for fixed prostheses.

The casting accuracy of four nickel--chromium alloys (Ultratek, Omega, Microbond N/P2, and Nobil-Ceram) was compared to that of a precious alloy, Jelenko "O". The experiment consisted of fabricating and fitting cast copings to a cobalt--chromium test preparation of a maxillary central incisor and measuring the marginal discrepancy in eight selected points. The experiment indicated that Jelenko "O" had the greatest casting accuracy, followed successively by Ultratek, Nobil-Ceram, Microbond N/P2, and Omega. Statistical analysis of the data revealed no significant difference between Jelenko "O" and Ultratek alloys in fit of five of eight test points, but Jelenko "O" was significantly better in fit than Nobil-Ceram, Microbond N/P2, and Omega alloys. The following conclusions may be drawn from this experiment: 1. The nickel--chromium alloys tested did not cast as consistently or as accurately as precious alloy Jelenko "O". 2. The casting accuracy may be related to the amount of casting shrinkage that occurs in each alloy type, and further research is necessary to determine if expansion compensation of the selected phosphate-bonded investment recommended by the alloy manufacturers is adequate for the casting shrinkage of the test alloys. 3. Alloy composition and technique parameters may also influence the accuracy of the casting, but further research is necessary to determine their singular effects.

A one-appointment mouthstick appliance.

Quadriplegics rely on mouthstick appliances to perform a variety of tasks to establish more self-sufficiency. Present techniques to fabricate a quality mouthstick applicance requires professional expertise, time, and laboratory expense. A technique for providing an inexpensive, durable mouthstick appliance in one appointment is described.

Properties of Kaurene Synthetase from Marah macrocarpus Endosperm: Evidence for the Participation of Separate but Interacting Enzymes.

Ent-kaurene is synthesized from geranylgeranyl pyrophosphate in a two step sequence catalyzed by kaurene synthetase; the first step (A activity) involves the conversion of geranylgeranyl pyrophosphate into the intermediate ent-trans labda-8(17), 13-dien-15-yl pyrophosphate (copalyl pyrophosphate) which is further cyclized to ent-kaurene in the second step (B activity). The resolution of enzyme fractions which catalyze each step independent of the other has been accomplished for the first time by means of QAE Sephadex A-50 chromatography and polyacrylamide gel electrophoresis of kaurene synthetase preparations from endosperm tissue of immature seed of Marah macrocarpus. Molecular weights for the A and B enzymes were each estimated as approximately 82,000 by means of gel filtration chromatography and sedimentation velocity determinations.Experiments in which [(14)C]geranylgeranyl pyrophosphate and [(3)H]copalyl pyrophosphate were incubated simultaneously with kaurene synthetase preparations demonstrated that copalyl pyrophosphate derived from [(14)C]geranylgeranyl pyrophosphate is more readily converted to kaurene than is exogenously added [(3)H]copalyl pyrophosphate. This implies that copalyl pyrophosphate derived from the catalytic site of the A enzyme is preferentially channelled to the B enzyme catalytic site for conversion to ent-kaurene, rather than freely equilibrating with a pool of copalyl pyrophosphate in the medium. Experiments in which the rates of the overall AB and independent B activities of kaurene synthetase preparations were measured as a function of total protein concentration further suggest that overall AB activity is catalyzed by an AB enzyme complex which is in equilibrium with free A and B enzymes. A model is proposed for M. macrocarpus kaurene synthetase in which separate but interacting A and B enzymes must associate for the efficient production of ent-kaurene from geranylgeranyl pyrophosphate.

Base shade determination of a new elastomer for maxillofacial prostheses.

A method for determining and fabricating base shades for MDX-4-4210 Clean Grade Elastomer has been described. Eight base shades are illustrated, and 12 base shade formulae are provided.

N-oxidation of phentermine to N-hydroxyphentermine by a reconstituted cytochrome P-450 oxidase system from rabbit liver.

Previous studies in our laboratory have indicated that the cytochrome P-450 system is involved in the oxidation of phentermine (2-methyl-1-phenyl-2-aminopropane) to N-hydroxyphentermine by liver microsomal preparations. In the present study, a reconstituted system which consisted of cytochrome P-450 and NADPH cytochrome P-450 reductase purified from liver microsomes of phenobarbital-induced rabbits was found to oxidize phentermine to N-hydroxyphentermine. The reaction was NADPH-dependent and required the presence of both the cytochrome P-450 and reductase preparations. N-Hydroxyphentermine was formed 3 times more rapidly in incubation mixtures which contained dilauroyl phosphatidylcholine than in those without added phospholipid. The reaction was inhibited several-fold by octylamine. It is concluded that the cytochrome P-450 system is able to catalyze the oxidation of phentermine to N-hydroxyphentermine.

Use of tissue-tinted porcelain to restore soft-tissue defects.

Anterior, partially edentulous residual ridges often have hard-tissue and soft-tissue defects that create esthetic and functional problems when conventional fixed prostheses are used to replace the missing teeth. However, tissue-tinted porcelain can be used in conjunction with fixed prostheses to solve many of these problems. Proper prosthesis design and shade matching are important considerations in the fabrication of fixed prostheses that incorporate tissue-tinted porcelain to restore hard-tissue and soft-tissue defects.

Evaluation of D-amino acid levels in human urine and in commercial L-amino acid samples.

Detectable levels of four free D-amino acids (phenylalanine, tyrosine, tryptophan and leucine) were found in human urine. This was accomplished using a liquid chromatographic coupled column (i.e., achiral-chiral) method that was developed for the rapid and sensitive analysis of these compounds. The technique was tested on a series of commercial L-amino acids. Care was taken to minimize racemization. Trace to percent levels of contaminating D-enantiomers were found in all commercial samples. In urine the D-amino acids ranged from several hundredths of a percent up to percent levels of the corresponding excreted natural L-amino acids. There were no apparent correlations between the amount of amino acids excreted and the relative amount of D-enantiomers present. Currently this study is being expanded to include additional amino acids and a variety of other physiological fluids.

Adding retentive features in the rebonding of cast metal resin-bonded prostheses.

Many methods have been used to improve retention in resin-retained fixed prostheses, such as electrolytic etching of the retainer, the labial wrap design, proximal grooves, cast pin retention, and the use of improved adhesive resins such as Panavia EX (Kuraray Co, Osaka, Japan). Insufficient retentive features often lead to debonding of resin-retained fixed prostheses. Debonded prostheses may occasionally be recemented and successfully retained by the addition of retentive features to the prosthesis and abutment teeth. When recementing a debonded prosthesis with questionable retention, additional retention may be added to the retentive wings of the prosthesis by using a Rochette retentive hole in combination with pin retention or enamel/dentinal slots in the abutment teeth.