Antioxidant activity of milk protein hydrolysate in alloxan-induced diabetic rats.

We investigated the effects of milk protein concentrate (MPC) and milk protein concentrate hydrolysate (MPCH) as antioxidant agents in rats. Six groups of healthy (non-diabetic) and type-II diabetic rats were used: (1) healthy rats (control), (2) alloxan-induced rats (diabetic control group), (3) healthy rats treated orally with MPC, (4) diabetic rats treated orally with MPC, (5) healthy rats treated orally with MPCH, and (6) diabetic rats treated orally with MPCH. We concluded that treatment with MPC or MPCH reduced the level of thiobarbituric acid reactive substances in healthy and diabetic rats. Treatment with MPC or MPCH improved activities of antioxidant enzymes (catalase, superoxide dismutase, reduced glutathione, glutathione-S-transferase, and glutathione peroxidase) in healthy and diabetic rats. From the present data, we concluded that both MPC and MPCH contain potent antioxidants and could improve the health of rats or other animals with diabetes mellitus.

Effect of the naked neck gene on carcase composition and immunocompetence in chicken.

1. An experiment was conducted to study the effect of naked neck gene (Na) on carcase measurements and some immunological responses of chickens. 2. The presence of naked neck gene in a single or double state increased body weight. 3. The naked neck genotypes (NaNa or Nana) exhibited higher relative weight of dressed carcase, drumstick and breast muscles compared to normally feathered individuals (nana). The proportion of abdominal fat was decreased in both naked neck genotypes compared with normally feathered ones. 4. A higher (non-specific) cell-mediated immune response was evoked in Na gene bearing birds. 5. Higher concentrations of antibodies occurred after injection of sheep red blood cells into naked neck birds, particularly at 14 d post-secondary injection. 6. The NaNa birds had a higher heterophil/lymphocyte ratio than Nana and nana siblings.

Occurrence of Shiga toxin-producing Escherichia coli O157 in selected dairy and meat products marketed in the city of Rabat, Morocco.

Samples of meat and dairy products taken from the city of Rabat, Morocco, were examined for the presence of Escherichia coli O157 by the selective enrichment procedure followed by plating on cefixime-tellurite-sorbitol MacConkey agar and a latex agglutination test. The ability of isolates to produce Shiga toxins (ST1 or ST2) was also tested by an agglutination test using sensitized latex. Dairy samples (n = 44) included different products commonly consumed in the country. Meat samples (n = 36) were taken from traditional butchers because these products are generally marketed in this way. Random samples were taken from each product during the period of January through May. Of the 80 samples tested, 8 (10%) harbored E. coli O157. Four dairy and four meat samples were contaminated (9.1 and 11.1%, respectively). Of 10 E. coli O157 isolates from contaminated samples demonstrating true antigen-antibody agglutination, 5 (50%) produced either ST2 alone or ST2 plus ST1. Four of the five strains (80%) were meat isolates and produced ST2 with or without ST1, and the fifth was a dairy isolate producing ST2.

A comparison of imaging techniques with surgical experience in orbital injuries. A prospective study.

The aim of the study is to compare the effectiveness of computerised tomography (CT) and magnetic resonance (MR) imaging in diagnosing herniation and entrapment of orbital soft tissues in orbital fractures. 15 consecutive patients with clinical signs and symptoms of medial orbital wall injury were examined with CT and MR. The data were subsequently compared with the findings of the surgical exploration with regard to the extent of the wall fractures, the presence of soft tissue herniation and its entrapment. CT and MR were equally accurate in demonstrating or excluding orbital wall fractures but both modalities slightly underestimated their incidence. CT and MR underestimated the actual incidence of soft tissue herniation and entrapment when compared with the surgical findings but the extent of soft tissue herniation and entrapment were demonstrated more clearly by MR than by CT scanning. MR imaging when available should therefore be used as the initial imaging modality and CT held in reserve for confirmation as positioning in the MR unit is easier and more comfortable for recently injured patients who may well have other injuries.

Intramedullary plasma cell tumours.

The intramedullary solitary plasma cell tumour is an invasive tumour of plasma cells. Three cases of solitary intramedullary plasmacytoma and one case of follicular lymphoma with marked plasma cell component are described. The diagnostic and therapeutic difficulties are discussed.

Osteomyelitis of the mandible in children--clinical presentations and review of management.

Four cases of osteomyelitis of the mandible in children are reported to illustrate the spectrum of presentation. A proliferative rather than a lytic bony response is usually seen due to attenuation of the causative organisms and the improved immunological status of children in Britain. The importance of penicillin-resistant organisms and anaerobes, early diagnosis by scintigraphy and the use of hyperbaric oxygen therapy are highlighted.

Cardiac dysrhythmias during oral surgery: effect of combined local and general anaesthesia.

In two groups, each of 50 patients undergoing oral surgery, effects of combining lidocaine nerve block with halothane general anaesthesia were studied. Local blockade of surgical stimuli reduced markedly the incidence of cardiac dysrhythmias occurred during halothane anaesthesia. Recovery was faster and post-operative analgesia was enhanced.

The use of biodegradable fixation in sagittal split and vertical subsigmoid osteotomy of the mandible: a preliminary report.

OBJECTIVE: An absorbable pin made from poly-p-dioxanone (Orthosorb, Johnson and Johnson, UK) was used to internally fix osteotomies of the mandibular ramus. We present our initial series of 10 patients. DESIGN: Open study. SETTING: Regional unit, teaching hospital, UK. SUBJECTS AND INTERVENTIONS: 10 patients who required a bilateral sagittal split osteotomy (BSS, n = 3) or a vertical subsigmoid osteotomy (BVSS, n = 6), or both (n = 1). MAIN OUTCOME MEASURE: Jaw functioning and ability to open mouth. RESULTS: 9/10 followed up for 1 year, 1/10 lost to follow up at one month, 1/10 lost to follow up at one year. 7/9 reported the same degree of mouth opening as preoperatively, 2/9 slightly less. 3/10 developed slight anterior open bite problems; 1/10 required no treatment, 1/10 improved with selective grinding, and 1/10 was lost to follow up. No patient complained of discharge from the site of the implant or of any change in sensation of the lip. CONCLUSION: Small absorbable implants undoubtedly have a place in selected maxillofacial operations, but there are still some problems with their use, including complications during the learning curve.

Cross-match requirements in orthognathic surgery: an audit.

A retrospective audit was undertaken of the value of routine cross-matching of blood for patients undergoing orthognathic surgery at Canniesburn Hospital, Glasgow. Overall, routine cross-matching of blood was wasteful of resources for all but the more major types of osteotomy procedure: Le Fort III, Le Fort II, malar osteotomies requiring a bicoronal flap and bimaxillary osteotomies. The study has financial implications regarding the proper use of cross-matching in selected patients undergoing elective orthognathic surgery. A blood ordering tariff has been suggested for the various procedures studied.

A comparison of the use of external pin and transnasal Kirschner wire fixation for the unstable tripod malar fracture: a prospective trial.

A prospective study involving 54 patients was undertaken to compare external pin and transnasal Kirschner wire (K-wire) fixation of the unstable, non-comminuted, tripod malar fracture. The features assessed were: (1) The aesthetic result. (2) The ease and speed of both procedures. (3) Per-operative complications. (4) Post-operative complications. (5) Patient tolerance of the procedure.

Randomized prospective study of the influence of steroids on postoperative eye-opening after exploration of the orbital floor.

OBJECTIVE: To find out if giving steroids reduces postoperative swelling in orbital surgery. DESIGN: Prospective, randomized, double-blind trial. SETTING: Regional unit, teaching hospital, UK. SUBJECTS AND INTERVENTIONS: 20 patients who require orbital floor exploration after injuries. Patients were given methylprednisolone 250 mg (or placebo identically packaged) at induction of anaesthesia, with a further three doses at 6-hourly intervals postoperatively. MAIN OUTCOME MEASURE: Differences in interpalpebral width before and after operation. RESULTS: Those given steroids (n=11) had a significantly increased interpalpebral width compared with placebo (n=9) postoperatively (P < 0.01, 95% confidence intervals of the difference = 1 mm-6 mm). CONCLUSION: Short courses of steroids therapy should be considered in orbital surgery for appropriate patients. There is an advantage in being able to assess the globe postoperatively.

The characteristics of midfacial fractures and the association with ocular injury: a prospective study.

Ocular injuries commonly occur in patients with facial fractures. This prospective study was set up to determine the incidence of ocular injuries, as assessed by an ophthalmologist, in patients who had sustained midfacial fractures. Over a 2-year period, a study of 363 patients who had sustained midfacial trauma sufficient to lead to a facial bone fracture (438 fractures) was undertaken and patients received a comprehensive examination by an ophthalmologist and an orthoptist within 1 week of injury. The characteristics of the eye injuries sustained were related to the aetiology of the fracture, the type of fracture, and the sex and age of each patient. Ninety percent of patients sustained ocular injuries of various severities. Sixty three percent of patients sustained only minor or transient ocular injuries, 16% suffered moderately severe ocular injury and 12% experienced severe eye injuries. Road traffic accident was associated with the highest incidence of severe ocular disorder (9/45 = 20%) whilst assaults had the second highest incidence at 11% (20/181). One third of all patients with comminuted malar fracture suffered a severe ocular disorder (9/27) whilst blow-out fracture came second at 16.7% (6/36). Fifty six patients (15.4%) had a decrease in their visual acuity and 9 patients (2.5%) had significant traumatic optic neuropathy. Decrease in visual acuity was the main clinical finding accompanying the majority of significant eye injuries. When ocular injuries were related to aetiology, it was apparent that road traffic accidents and assaults associated with alcohol abuse showed the highest incidence of major ocular dysfunction. It is suggested that all patients sustaining midfacial fracture associated with a significant decrease in visual acuity either pre- or postoperatively should have an early ophthalmological review.

Diplopia following midfacial fractures.

Over a period of 2 years, 363 patients who had sustained a total of 438 midfacial fractures due to blunt trauma received a full ophthalmological examination within 1 week of injury. Of these, 72 patients (19.8%) developed diplopia. Diplopia was most common following road traffic accidents (31%) and least common with simple falls (10%). Blow-out fractures of the orbit led to double vision in 58% of cases. Eighty two percent of patients recovered from diplopia within 6 months of injury; only 1 patient required squint surgery for double vision. The principal risk factors for diplopia comprise road traffic accidents, blow-out fractures and comminuted malar fractures. Early surgical reconstruction of midfacial fractures with conservative management of concomitant motility disorders has, in our series, resulted in very few patients having diplopia in the long term.

Midfacial fractures and the eye: the development of a system for detecting patients at risk of eye injury.

Maxillofacial trauma is often complicated by injury to the eye. Such injuries may be difficult to detect and may therefore be missed. Detailed ophthalmic examinations were carried out prospectively on 363 patients who had sustained midfacial fractures. Fifty four parameters comprising maxillofacial, radiological and ophthalmic data were recorded and coded for each patient. All encoded data were divided into predictors (the data potentially available to the maxillofacial surgeon) and outcome (the data potentially available to the ophthalmologist). Statistical methods of regression, and the analysis of contingency tables, led to the identification of the principal predictors indicative of underlying ophthalmic injury and thence to a scoring system which predicts the severity of such injuries. Impaired visual acuity is the principal predictor and when employed alone gives a sensitivity value of 80%. Pure blow-out fracture or comminuted facial fracture, double vision and amnesia emerged as additional factors which yielded an efficient scoring system with a sensitivity of 89% and specificity of 90% for the population upon which it was based. A score sheet is provided in the paper. These predictors can be remembered from the acronym Blow-out fracture, Acuity, Diplopia, Amnesia, Comminuted Trauma. As many such injuries result from a BAD ACT, it is easily remembered. This scoring system requires to be tested upon a new population of individuals in order to determine its efficacy.

Midfacial fractures and the eye: the development of a system for detecting patients at risk of eye injury--a prospective evaluation.

Midfacial trauma is often complicated by ocular disorder. A scoring system has been devised to help the maxillofacial surgeon identify patients who warrant referral to an ophthalmologist. A prospective pilot study was carried out on 100 patients with midfacial fractures to evaluate the effectiveness of this system in clinical practice. The sensitivity value was 94.4% and the specificity value was 89%. Only 1 patient, who clinically warranted referral to an ophthalmologist, was missed by the system whilst 9 others were incorrectly classified as warranting referral. The results of this evaluation demonstrate the competence of the system.

Public knowledge of dental registration and management of common dental problems.

The government has recently changed its policy on dental registration. There is now a requirement to attend a dentist within 15 months of the previous appointment or dental registration will lapse. The authors of this article undertook a survey of the patients attending for dental treatment at the accident and emergency department of their hospital to ascertain whether inappropriate attendance was due to ignorance about general dental services. Of the 501 respondents 14% had not seen their general dental practitioner within the last 15 months and were therefore no longer registered--only 21% realized that they had to keep regular appointments or dental registration would lapse. A proportion (30%) had tried to contact the dentist outside normal working hours; 27% of these were unhappy with the outcome. Telephone calls were unanswered in 38% of those expressing dissatisfaction and 45% subsequently attended hospital for treatment.

Modified sampling connection for sidestream end tidal CO2 monitoring during pediatric anesthesia.

A modification to the sampling connection of Ohmeda 5200 CO2 monitor was done to abolish the increase in apparatus dead space induced by the patient circuit adapter. The modified and the original sampling connections [MSC & OSC] were compared regarding their effects on end tidal CO2 (PECO2), during surgery in 12 anesthetized spontaneously breathing infants and children. The MSC maintained normal PECO2, while it was significantly higher using the OSC.

Closed circuit coasting from high flow isoflurane anesthesia.

Closed circuit coasting after high flow isoflurane-N2O anesthesia was used in 30 patients undergoing operations expected to last more than one hour. Near the end of the operation, the circuit was closed by shutting off anesthetics and reducing oxygen flow to that necessary to maintain constant end-tidal circuit volume throughout the duration of coasting (Tc). End-tidal isoflurane concentration of 0.5% was a safe target for coasting. Good correlation was found between Tc and anesthetic delivery duration (TAD). An adequate TC for the first hour of TAD was 15 minutes followed by 11 minutes more for each subsequent hour of TAD. The technique is safe, simple, economic, predictable and practical.

Modified interface between pediatric ventilator and Ayre's T-piece for use in neonates.

The lowest tidal volume delivered by most of the pediatric anesthesia ventilators could be large for neonates, and may generate unacceptably high peak airway pressures. The effective tidal volume can however be reduced by connection of a small rubber bag between the ventilator and the expiratory limb of the Ayre's T-piece circuit to divide the delivered gas mixture between the added bag and the neonate's lungs. The delivered tidal volume by the ventilator can then be manipulated to achieve the desired peak inspiratory pressure; 18-20 cm H2O in neonates with normal lung compliance. The modification was found to be simple, safe and convenient.

Dysrhythmias during oral surgery--effect of combined local and general anesthesia.

In two groups, each of 50 patients undergoing pulpectomy or multiple extractions, effects of combining xylocaine nerve block with halothane general anesthesia were studied. Local blockade of surgical stimuli reduced markedly the incidence of dysrhythmias occurring during halothane anesthesia. Recovery was faster and postoperative analgesia was enhanced.