Ectopic mandibular third molar: report of two cases by intraoral and extraoral access.

Ectopic third molar displacement is a rare event in the population. The etiology of this infrequent condition has not been completely clarified. Optimal management is still unclear. In symptomatic patients surgical removal, after a careful preoperative planning, is the recommended treatment. Several surgical approaches, both extraoral and intraoral, have been described, depending on the ectopic molar position. This paper reports two cases of ectopic third molar, one located in the coronoid process and the other one in the lower edge of the mandibular body. Both teeth were removed successfully by an intraoral and extraoral approach respectively.

An improved time-of-flight method for cluster deposition and ion-scattering experiments.

A molecular beam apparatus has been developed for deposition and scattering experiments of size-selected clusters. The new setup combines a bimetallic laser ablation cluster source with a collinear time-of-flight mass spectrometer. Mass selection is achieved with a pulsed electrostatic mirror. A significantly improved transmission in combination with a reduction of the kinetic energy distribution of the mass selected clusters has been obtained. Without further modification of the apparatus, surface-induced dissociation of mass selected tin clusters has been investigated, demonstrating the possibility to combine cluster beam deposition and scattering experiments.

Diagnosis of acute Q fever by PCR on sera during a recent outbreak in rural south Australia.

Diagnosis of Q fever has largely been dependent upon serology, which may lead to delayed diagnosis as seroconversion can take weeks to develop. During a recent Q fever outbreak (27 patients) in rural South Australia, we compared the diagnostic rate of serology with two separate real-time PCRs, the 27kDa outer membrane protein and the insertion sequence. PCR was positive (on either or both PCR assays) in sera of 67% of the patients. Median time required for making serological diagnosis was 17 days, compared with 4 days by PCR. Q fever PCR is an effective tool in the diagnosis of acute Q fever infection.

Long-term persistence of Coxiella burnetii after acute primary Q fever.

BACKGROUND: Long-term persistence of C. burnetii in infected animals was established in the 1950s and 60s, but the implications for human Q fever are not fully explored. AIM: To compare the prevalence of markers of infection in a cohort of Q fever patients in Australia (up to 5 years after infection) with those in the 1989 Birmingham cohort (12 years after infection). DESIGN: Case follow-up study. METHODS: C. burnetii was tested for by: (i) antibodies to Phase 1 and 2 antigens in the three immunoglobulin classes; (ii) detection of DNA in bone marrow and peripheral blood mononuclear cells by PCR assays directed against several different targets in the genome; and (iii) attempts to isolate coxiellas in cell culture or mice from PCR-positive samples. Amplicon specificity was verified by fluorometric probing and by sequencing. Cross-contamination was excluded by extensive use of non-template controls, and in particular by the use of certain IS1111a target sequences. RESULTS: Irrespective of clinical state, both groups remained seropositive, principally exhibiting medium levels of IgG antibody against C. burnetii Phase 2 antigen. C. burnetii genomic DNA was detected by PCR in 65% of bone marrow aspirates from Australian patients and approximately 88% of Birmingham patients. No coxiella were isolated from PCR positive samples. DISCUSSION: We propose a provisional model for persistence. In Q fever without sequelae, the process is largely confined to the bone marrow. In Q fever fatigue syndrome (QFS), it is modulated by the patient's immunogenetic background to give higher levels of coxiella genomes in bone marrow and increased shedding into the peripheral blood. In Q fever endocarditis, late pregnancy, or during iatrogenic or other immunosuppression, the multiplication cycle is prolonged, and a potential source of live organisms.

Long-term persistence after acute Q fever of non-infective Coxiella burnetii cell components, including antigens.

BACKGROUND: Previous studies of inciting factors for a prolonged post-infection fatigue syndrome after Q fever (variously termed QFS or Q fever associated CFS/ME in the literature) showed that after the acute infection a high proportion of asymptomatic and QFS patients had Q fever antibody and also low levels in PBMC and bone marrow of Coxiella burnetii (C.b.) DNA with PCR assays directed against three different target sequences in different parts of the coxiella genome. Attempts to isolate a strain of C.b. in A/J mice, and cell culture from PCR positive PBMC and bone marrow were consistently negative. The detailed composition of the persisting coxiella residues remains to be defined. AIM: To retest and provide detailed results on selected PCR positive samples from the Birmingham Q fever outbreak patients tested by a highly sensitive method to detect viable organisms and to determine the nature of the residual coxiella cell components. DESIGN: Laboratory case study. METHODS: NOD/SCID mice were inoculated with samples from the 1989 Q fever outbreak in Birmingham and followed for evidence of infection and the presence of coxiella DNA and specific antigens in spleen and liver macrophages. A significant, unexpected finding of specific antigen was followed by assessment of its ability to provoke production of inflammatory and non-inflammatory cytokines in mice, in THP-1 human macrophage cell cultures and to induce inflammatory lesions in the skin of guinea pigs hyperimmunized against Q fever vaccine. RESULTS: Culture of samples from 10 Birmingham Q fever patients in NOD/SCID mice, 12 years from infection did not yield viable Coxiella burnetii, as shown earlier. However complexes of material with coxiella antigens were found in mouse spleens in all cases but in significantly greater amounts in samples from those with post Q fever fatigue syndrome. The antigenic complexes [now designated 'immunomodulatory complexes' (IMC)] were shown to stimulate cytokine release in the mice and in the THP-1 macrophages and to provoke an inflammatory reaction on intradermal injection into the skin of Q fever hyperimmunized guinea pigs. CONCLUSION: The study identifies a non-infective complex of C.b. antigens able to survive in the host and provoke aberrant humoral and cell medicated immunity responses - a possible pathogenic link between initial infection and a subsequent long-term post Q fever fatigue syndrome.

Q fever: persistence of antigenic non-viable cell residues of Coxiella burnetii in the host--implications for post Q fever infection fatigue syndrome and other chronic sequelae.

BACKGROUND: Our previous studies of persistence of Coxiella burnetii in humans after an initial acute Q fever infection revealed raised, maintained antibody levels and low levels of coxiella genomic DNA at the age of 5 years from onset in Australian patients and at 12 years in patients in the 1989 Birmingham UK Q fever outbreak. Attempts to isolate the coxiella in standard cell culture and susceptible mice by serial passage of PCR positive PBMC and bone marrow were negative. AIM: To retest PCR positive patient samples by more sensitive methods for viable coxiellas and for the coxiella cell components of antigen and specific lipopolysaccharide (LPS). To re-interpret the previous results in the light of the new information. To review the pertinent literature for a concept of an immuno-modulatory complex generated by the current studies. DESIGN: Laboratory case study. METHODS: Stored patient samples were inoculated into SCID mice that were followed for 60 days. Mouse spleen and liver samples were then examined by PCR assay for targets in the COM1 and IS1111a sequences and for antigens by IFA with a polyclonal rabbit antiserum to C. burnetii Phase 1 and a monoclonal antiserum to Phase 1 LPS (details; O. Sukocheva et al., unpublished data). RESULTS: All specimens, including a recently excised heart valve from a Birmingham patient with late developing endocarditis, were infection negative in SCID mice. Dilutions of SCID mouse spleen and liver homogenates titrated in PCR assays were negative at dilutions attained by control mice inoculated with an endpoint dilution of a viable prototype strain of C. burnetii. Sections of the spleens from all specimens showed a complex of coxiella antigen-LPS by IFA. DISCUSSION/REVIEW: We advance a concept of long-term persistence of a non-infective, non-biodegraded complex of coxiella cell components with its antigens and specific LPS [so called Immunomodulatory complex (IMC)] associated with traces of genomic DNA that signalled its presence in our earlier studies. The IMC's survival in patients for at least 12 years, and in one patient for 70 years implies a capacity for serial passage in macrophages with effective down-regulation of their biodegrading functions. The review assesses the compatibility of the IMC concept in relation to cogent literature on C. burnetii interactions with macrophage and cell-mediated immunity. Some remaining gaps in our knowledge of the organ sites and duration of carriage of viable coxiellas after initial infection are also identified.

Country watch. Brazil.

PIP: Persons who are infected with human immunodeficiency virus (HIV) or who suffer from acquired immunodeficiency syndrome (AIDS) often have their civil rights violated in Brazil. To remedy this, the Candido Mendes College in Rio de Janeiro introduced a voluntary course, "AIDS - Legal Approaches", into its law curriculum. Incentive was provided by the college's Model Law Office (MLO), where students learn to defend the rights of people in need. Class size is about 25; law professors use recent magazine and newspaper articles, and documentation on lawsuits concerning persons with HIV to teach the class. Course topics include relevant civil law (suits against blood banks), contract law (suits against private health insurance companies which refuse to cover treatment expenses related to HIV or AIDS), family law, inheritance law, labor law (unjust dismissal of persons with HIV), criminal law (intentional transmission of AIDS), violations of basic human rights, and comparative jurisprudence and constitutional law (a comparison of Brazilian law in this area to the laws of other countries). Students, during their field practice periods at the MLO, provide legal assistance to persons with HIV. Approximately 150 cases have been handled, often with positive outcomes, to date. Clients hear about the program via television, radio, and newspapers. Materials and information about lawsuits handled by the MLO are available to other colleges and universities with the hope of stimulating the formation of similar programs elsewhere.^ieng

[Hemiballism as a result of a focal hemorrhagic lesion of the subthalamic nucleus documented by CT]. / Emiballismo dovuto a lesione emorragica focale del nucleo subtalamico documentata dalla TC.

The authors relate a case of hemiballism with favourable evolution, suddenly arisen in an hypertensive subject, in whom the CT (Computer Tomography) pointed out a small hemorrhage at the level of the subthalamic nucleus (body of Luys), controlateral to hypercinesias. The authors underline the extreme rareness of such clinico-radiologic association since more than 10 years after the introduction of CT only another analogous observation has been related in literature. Cases of hemichorea and/or hemiballism, secondary to ischemic, hemorrhagic or angiomatous lesions, variously situated at the level of basal nuclei have been more often documented through CT.