Factors impeding enzymatic wheat gluten hydrolysis at high solid concentrations.

Enzymatic wheat gluten hydrolysis at high solid concentrations is advantageous from an environmental and economic point of view. However, increased wheat gluten concentrations result in a concentration effect with a decreased hydrolysis rate at constant enzyme-to-substrate ratios and a decreased maximum attainable degree of hydrolysis (DH%). We here identified the underlying factors causing the concentration effect. Wheat gluten was hydrolyzed at solid concentrations from 4.4% to 70%. The decreased hydrolysis rate was present at all solid concentrations and at any time of the reaction. Mass transfer limitations, enzyme inhibition and water activity were shown to not cause this hydrolysis rate limitation up to 50% solids. However, the hydrolysis rate limitation can be, at least partly, explained by a second-order enzyme inactivation process. Furthermore, mass transfer impeded the hydrolysis above 60% solids. Addition of enzyme after 24 h at high solid concentrations scarcely increased the DH%, suggesting that the maximum attainable DH% decreases at high solid concentrations. Reduced enzyme activities caused by low water activities can explain this DH% limitation. Finally, a possible influence of the plastein reaction on the DH% limitation is discussed.

Non-HIV-associated Kaposi's sarcoma of the tongue. Case report and review of the literature.

Kaposi's sarcoma is a frequently seen AIDS-related malignant neoplasm in the head and neck region, especially in the oral cavity, but is rarely described in the HIV-negative and non-immunosuppressed individual. The case of a 76-year-old HIV-negative, non-immunocompromised woman with a solitary Kaposi's sarcoma of the tongue is reported. The tumour was locally excised with subsequent local radiotherapy. Diagnosis and therapy are discussed and compared with a review of the contemporary literature.

Osteosclerotic bone dysplasia (melorheostosis) of the mandible.

Melorheostosis is a linear bone dysplasia of unknown origin that may be associated with soft-tissue alterations. Although any part of the skeleton can be affected, this condition is rarely observed in the craniofacial region. Only seven cases of melorheostosis with craniofacial involvement have been reported and cranial manifestation only is even rarer. To the authors' knowledge, manifestation in the mandible only has not yet been documented. A patient with isolated melorheostosis of the mandible with characteristic symptomatic bone pain is presented. The clinical, radiological and histological findings are described and possible therapeutic options are discussed.

[Long-term results following reconstruction of maxillary sinus wall defects with titanium micro-mesh: a CT-based study]. / CT-kontrollierte Spätergebnisse nach Defektdeckung im Kieferhöhlenbereich mit dem Mikrotitangitter.

BACKGROUND: Extensive bony defects of maxillary sinus walls have to be reconstructed to prevent long-term complications. Different autogenous, allogeneic, and alloplastic materials, e.g., titanium mesh, are used for reconstruction. MATERIAL AND METHODS: In 26 patients large defects of the facial and laterodorsal walls of the maxillary sinus were reconstructed using titanium micro-mesh. The mean follow-up period was 49 months (5 months-10 years). All patients were examined with computed tomography applying multiplanar reconstruction techniques and three-dimensional volume rendering. RESULTS: In the CT scans stable scars of 3-6 mm thickness could be found on the antral surfaces of all titanium meshes bridging the defects. In 70% of the patients the volume of the reconstructed maxillary sinus reached 80-100% of the contralateral side. Volume losses were not due to poor adaptation of the titanium mesh but were caused by thickening of maxillary sinus walls or traumatic malpositions. In 77% of the patients ventilation of the maxillary sinus was undisturbed. After mesh removal neither facial contour disturbances nor changes of sinus volume were noted. Soft tissue invasion into the sinus was prevented by a stable scar which had formed underneath the mesh. Three-dimensional reconstruction confirmed symmetrical facial contours in all patients. CONCLUSIONS: The titanium micro-mesh offers a simple and effective alternative to autogenous tissue with stable long-term results for reconstruction of large maxillary sinus wall defects.

[Juvenile ossifying fibroma. Case report with diagnostic and therapeutic considerations]. / Juveniles ossifizierendes Fibrom. Fallbericht mit diagnostischen und therapeutischen Uberlegungen.

BACKGROUND: Fibro-osseous lesions of the jaws, including juvenile ossifying fibroma, pose diagnostic and therapeutic difficulties due to their clinical, radiological and histological variability. CASE REPORT: The case of an 8-year-old girl with a juvenile ossifying fibroma of the mandible is presented. Extirpation of the tumor and filling of the defect with cancellous bone was performed. After 9 months, a recurrence occurred which made a second extirpation of the tumor necessary. This was done without osteoplasty. After a 2-year follow-up the patient is free of tumor. DISCUSSION: Different classifications for fibro-osseous lesions of the jaws can be found in the literature. This makes a correct diagnosis and standardized treatment difficult. Based on the case presented here, the histological features of juvenile ossifying fibroma and the differentiation from osteosarcoma are discussed. At present, conservative surgical treatment seems to be adequate for these tumors.

Long-term results following miniplate eminoplasty for the treatment of recurrent dislocation and habitual luxation of the temporomandibular joint.

Twenty patients with recurrent mandibular dislocation or habitual luxation of the temporomandibular joint who underwent miniplate eminoplasty between 1994 and 1999 are presented. The follow-up period ranged from 2 to 7 years. Clinical examination showed no evidence of recurrent dislocation. No significant reduction of normal mouth opening was found one year postoperatively. The pain level, self-estimated by the patients on a scale from 0 to 10, decreased significantly from 4.1 preoperatively to 1.2 one year postoperatively. In seven patients fractures of the miniplates occurred 3 to 7 years after eminioplasty (two bilateral fractures, five unilateral fractures). Due to the high incidence of plate fractures miniplate eminoplasty cannot be recommended as the surgical treatment of choice for recurrent dislocation or habitual luxation of the mandible, although the recurrence rate is low and pain is reduced considerably.

Dynamic simulation of chemical industry wastewater treatment plants.

High variability, stringent effluent permits, and often extreme operating conditions define the practice of wastewater treatment in the chemical industry. This paper reviews the benefits and challenges of applying dynamic simulation to chemical-industry wastewater treatment plants by describing case studies at full-scale wastewater treatment plants (WWTP). The applications range from process troubleshooting to optimization and control. The applications have been valuable and useful in developing a deeper understanding of the plants as integrated systems. However there still remains substantial work to implement the dynamic simulations for daily real-time use by plant engineers and operators. This opportunity to improve plant operations is still largely untapped and will remain so until dynamic state estimation and data reconciliation are incorporated into simulation packages for use in developing the on-line simulations.

Periradicular surgery of molars: a prospective clinical study with a one-year follow-up.

AIM: The purpose of this prospective clinical study was to evaluate the outcome of periradicular surgery of molars after one year. METHODOLOGY: The material consisted of 25 molars with 39 roots demonstrating periradicular lesions of endodontic origin. Surgical treatment included root-end resection, root-end preparation with sonic microtips, and root-end filling with Super-EBA cement. At the one-year follow-up examination, healing was evaluated clinically and radiographically. Healing was assigned to three categories: (i) success (ii) improvement, and (iii) failure using well defined criteria. RESULTS: Eighty-eight per cent of the surgically treated molars showed successful healing. In 8%, the healing was rated as improved and only 4% were failures. CONCLUSIONS: The outcome of the present study and data of recently published studies show that periradicular surgery may result in a predictable treatment outcome in molars with persistent periradicular lesions.

Aggressive uterine sarcoma with rhabdoid features: diagnosis by peritoneal fluid cytology and absence of INI1 gene mutation.

We report a primary uterine sarcoma with classic histologic, immunohistochemical, and ultrastructural features of a malignant extrarenal rhabdoid tumor (MERT). It arose in a 71-year-old woman who presented with postmenopausal bleeding, ascites, and a right pelvic mass. Malignant cells with rhabdoid morphology were identified by cytologic examination of the peritoneal fluid. Exploratory laparotomy revealed a 10-cm right adnexal mass and disseminated peritoneal tumor. Pathologic study showed diffuse expansion of the endometrial stroma by rhabdoid-like cells with transmural infiltration of the myometrium and extensive involvement of uterine serosa and right ovary by tumor. Neoplastic cells were immunoreactive for vimentin, cytokeratin, and epithelial membrane antigen, and cytoplasmic whorls of intermediate filaments were observed by electron microscopy. Fluorescence in situ hybridization (FISH) studies with chromosome 22-specific probes showed no loss of the INI1 gene, and no coding sequence mutation was identified.

Long-term results following reconstruction of craniofacial defects with titanium micro-mesh systems.

INTRODUCTION: Reconstruction of craniofacial defects can be carried out with autogenous tissue (calvarium, rib, iliac crest), allogeneic implants (AAA-bone, lyophilized cartilage) or alloplastic material (methacrylate, hydroxyapatite, titanium implants and mesh systems). Selection of the implant material used for reconstruction is still controversial. MATERIAL AND METHODS: At the Department of Oral and Maxillofacial Surgery, Kantonsspital Luzern, 20 patients with defects in the craniofacial and/or orbito-ethmoidal region have been treated using titanium micro-mesh between 1991 and 1998. Two different mesh systems, micro-titanium augmentation mesh and dynamic mesh, have been used for bony reconstruction in non load-bearing areas. The defects were caused by acute trauma, osteomyelitis of the frontal bone and previous operations. The titanium micro-mesh was used with the following indications: (1) immediate reconstruction in the primary treatment of comminuted fractures with bone loss in non load-bearing areas, (2) treatment of contour irregularities (possibly in combination with bone or cartilage grafts). All patients were followed up clinically and radiographically at quarterly intervals for a year. RESULTS: No wound infections, exposures or loss of the mesh have been observed. Long-term stability of the reconstructions was excellent. When walls of the paranasal sinuses were reconstructed complete repneumatisation took place. CONCLUSIONS: Advantages of this reconstructive technique are: (1) universal applicability (craniofacial, orbital, sinus defects, comminuted fractures); (2) stable 3-D reconstruction of complex anatomic structures were easily performed; (3) immediate availability with no donor site morbidity as bone or cartilage grafts were not necessary; (4) combination with bone or cartilage grafts is possible; and (5) very low susceptibility to infection.

Benign cellular changes in Pap smears. Causes and significance.

OBJECTIVE: We reviewed consecutive cases classified as benign cellular changes (BCC) over a four-month period. STUDY DESIGN: Cases classified as BCC were retrieved from the cytology files. A search was carried out to identify the previous Pap smears and concomitant cervical biopsies. RESULTS: One thousand one hundred three cases (23% of our gynecologic smears) were classified as BCC. Ninety-two patients (8.3%) underwent concurrent cervical biopsies. Specific infections accounted for 8% of BCC cases; reactive changes accounted for 92%. Of the biopsy specimens, 8.3% had no significant pathologic change. The most common biopsy diagnoses were cervicitis (31.5%), immature squamous metaplasia (16.3%) and reserve cell hyperplasia (10.8%). Miscellaneous benign diagnoses accounted for 21.7%. Cervical intraepithelial neoplasia (CIN) 1/human papillomavirus (HPV) was present in 14% of cases. All patients with biopsy diagnoses of CIN 1 had at least two previous abnormal Pap smears. Previous biopsy reports were available for review in 127 (12%) of the 1,103 patients. Of these 127 cases, 53.5% had a previous diagnosis of CIN/HPV; 9.4% had invasive carcinoma. A benign diagnosis was reported in 36.5%. CONCLUSION: The majority of BCC cases are due to reactive and inflammatory processes. In patients with a previous history of CIN, BCC may be of some significance. In patients with no significant prior cervical abnormalities, a Pap smear classified as BCC represents a reactive process.

Financial impact of tertiary care in an academic medical center.

OBJECTIVE: To analyze the financial impact of three complex vascular surgical procedures to both an academic hospital and a department of surgery and to examine the potential impact of decreased reimbursements. SUMMARY BACKGROUND DATA: The cost of providing tertiary care has been implicated as one potential cause of the financial difficulties affecting academic medical centers. METHODS: Patients undergoing revascularization for chronic mesenteric ischemia, elective thoracoabdominal aortic aneurysm repair, and treatment of infected aortic grafts at the University of Florida were compared with those undergoing elective infrarenal aortic reconstruction and carotid endarterectomy. Hospital costs and profit summaries were obtained from the Clinical Resource Management Office. Departmental costs and profit summary were estimated based on the procedural relative value units (RVUs), the average clinical cost per RVU ($33.12), surgeon charges, and the collection rate for the vascular surgery division (30.2%) obtained from the Faculty Group Practice. Surgeon work effort was analyzed using the procedural work RVUs and the estimated total care time. The analyses were performed for all payors and the subset of Medicare patients, and the potential impact of a 15% reduction in hospital and physician reimbursement was analyzed. RESULTS: Net hospital income was positive for all but one of the tertiary care procedures, but net losses were sustained by the hospital for the mesenteric ischemia and infected aortic graft groups among the Medicare patients. In contrast, the estimated reimbursement to the department of surgery for all payors was insufficient to offset the clinical cost of providing the RVUs for all procedures, and the estimated losses were greater for the Medicare patients alone. The surgeon work effort was dramatically higher for the tertiary care procedures, whereas the reimbursement per work effort was lower. A 15% reduction in reimbursement would result in an estimated net loss to the hospital for each of the tertiary care procedures and would exacerbate the estimated losses to the department. CONCLUSIONS: Caring for complex surgical problems is currently profitable to an academic hospital but is associated with marginal losses for a department of surgery. Economic forces resulting from further decreases in hospital and physician reimbursement may limit access to academic medical centers and surgeons for patients with complex surgical problems and may compromise the overall academic mission.

Do qualifiers of ASCUS distinguish between low- and high-risk patients?

OBJECTIVE: To evaluate the qualification of a Pap smear classified as atypical squamous cells of undetermined significance (ASCUS) favor reactive or neoplasia as recommended by the Bethesda System. STUDY DESIGN: The smears from 105 concurrent patients with a cytologic diagnosis of ASCUS not otherwise qualified were reviewed and subclassified as ASCUS favor reactive, low grade squamous intraepithelial lesion (LSIL) or high grade squamous intraepithelial lesion (HSIL) based on the Bethesda System criteria. The cervical biopsy diagnoses were correlated. RESULTS: Of the 105 cases classified as ASCUS, 37 were subclassified as favor reactive, 51 as favor LSIL and 17 as favor HSIL on cytologic review. In the ASCUS favor reactive group, 19 (51%) had reactive changes on biopsy, 17 (46%) had cervical intraepithelial neoplasia (CIN) 1, and 1 (2%) had CIN 3. A total of 48% patients had CIN. In the favor LSIL group, there was CIN 1 in 28 cases (55%), CIN 2 or 3 in 12 (23%) and benign changes in 11 (22%) on biopsy. Seventy-eight percent had CIN. In the 17 cases classified as ASCUS favor HSIL group, all had CIN. CONCLUSION: Of the total 105 cases of ASCUS, 71% had CIN, 29% had reactive changes on follow-up biopsies, and 48% of patients in the ASCUS favor reactive group had CIN. Qualifiers of ASCUS have questionable utility in patient management.

Preliminary results and analysis of a new set of sonic instruments for root-end cavity preparation.

The introduction of microinstruments for root-end cavity preparation has clearly improved the surgical technique in periradicular surgery with apicectomy. The new generation of sonic and ultrasonic root-end preparation devices, usually termed 'retrotips', has simplified the preparation of a sufficiently deep cavity that follows the original path of the root canal. The present paper describes the use of a new set of diamond-surfaced retrotips driven by a sonic handpiece. For clinical evaluation a prospective study was carried out, with assessment of pre-, intra- and postoperative data in 50 teeth (43 patients). This paper analyses: (i) the applicability of the new retrotips; (ii) the quality of the root-end filling assessed radiographically; (iii) the immediate postoperative course. Access with the retrotips to the resected root-end was found to be excellent in 80% of the treated teeth. The postoperative radiographs showed a root-end filling of at least 3 mm in 70% of the resected teeth. Healing was uneventful in all cases and most patients presented without any symptoms after 5 days and 10 days. The long-term treatment outcome will be reported in a future paper.

[Results of transcranial and subcranial management of fractures of the naso-ethmoid-orbital system in complex midfacial fractures]. / Ergebnisse der transkranialen und subkranialen Versorgung von Frakturen des nasoethmoidoorbitalen Systems bei komplexen Mittelgesichtsfrakturen.

Injuries of the nasoethmoid-orbital (NEO) region are associated with midfacial fractures or fractures of the frontobase in over 90% of all cases. In up to 70% fractures of the skull base run through the roof of the ethmoidal bone or the lamina cribrosa. There are different surgical approaches for the treatment of these complex fractures. Between 1990 and 1997 50 patients with midfacial fractures in association with NEO fractures were treated in the Klinik für Mund-, Kiefer- und Gesichtschirurgie, Kantonsspital Luzern, Switzerland. Of these, 25 had suffered midfacial fractures combined with fractures of the nasoethmoid-orbital and frontobasal region and were treated via a transcranial approach. The other 25 patients with midfacial and NEO fractures without involvement of the frontobasis were managed by subcranial incisions. A total of 47 patients were followed up for up to 4 years. The results were reevaluated retrospectively. There was no case of secondary liquorrhea, intracranial or ethmoidal infection. Our therapeutic concept of transcranial and subcranial management of NEO fractures in combination with frontobasal and midfacial fractures is demonstrated.

Localized ridge augmentation using a micro titanium mesh: a report on 27 implants followed from 1 to 3 years after functional loading.

The present paper describes the clinical and radiographic healing results of 27 implants followed from 1 to 3 years after functional implant loading. Prior to implant placement, alveolar ridges with insufficient bone volume were augmented using autogenous bone grafts and a micro titanium mesh for graft stabilization. After a mean interval of 5.2 months implants were installed. Following an osseointegration period of on average 7.2 months, implants were supplied with suprastructures. The mean loading period for the 27 implants was 21 months. All implants exhibited ankylotic stability and healthy peri-implant soft tissues. The detailed analysis of clinical parameters (probing depth, level of mucosal margin, attachment level, modified plaque and sulcus bleeding indices) and radiographic measurements (crestal bone level), revealed findings similar to those at implants placed into non-augmented bone. Peri-implant bone resorption was calculated to be 1.0 mm for the 1st year after implant loading and 0.1 mm for the following year. Pain, suppuration or semilunar bone defects were absent at all implants. It was concluded that loaded dental implants which have been inserted into an augmented alveolar ridge using autogenous bone grafts and a micro titanium mesh for graft stabilization, demonstrate clinical and radiographic findings similar to those of implants placed into a pristine ridge.