Lyssavirus distribution in naturally infected bats from Germany.

In Germany, to date three different lyssavirus species are responsible for bat rabies in indigenous bats: the European Bat Lyssaviruses type 1 and 2 (EBLV-1, EBLV-2) and the Bokeloh Bat Lyssavirus (BBLV) for which Eptesicus serotinus, Myotis daubentonii and Myotis nattereri, respectively, are primary hosts. Lyssavirus maintenance, evolution, and epidemiology are still insufficiently explored. Moreover, the small number of bats infected, the nocturnal habits of bats and the limited experimental data still hamper attempts to understand the distribution, prevalence, and in particular transmission of the virus. In an experimental study in E. serotinus a heterogeneous dissemination of EBLV-1 in tissues was detected. However, it is not clear whether the EBLV-1 distribution is similar in naturally infected animals. In an attempt to further analyze virus dissemination and viral loads within naturally infected hosts we investigated tissues of 57 EBLV-1 positive individuals of E. serotinus from Germany by RT-qPCR and compared the results with those obtained experimentally. Additionally, tissue samples were investigated with immunohistochemistry to detect lyssavirus antigen in defined structures. While in individual animals virus RNA was present only in the brain, in the majority of E. serotinus viral RNA was found in various tissues with highest relative viral loads detected in the brain. Interestingly, viral antigen was confirmed in various tissues in the tongue including deep intralingual glands, nerves, muscle cells and lingual papillae. So, the tongue appears to be a prominent site for virus replication and possibly shedding.

Giant naevus, giant excision, eleg(i)ant closure? Reconstructive surgery with Integra Artificial Skin to treat giant congenital melanocytic naevi in children.

BACKGROUND: The optimal surgical treatment of giant congenital melanocytic naevi remains a considerable challenge in reconstructive surgery. None of the currently available techniques is universally applicable. The goal of this pilot study was to test Integra Artificial Skin (Integra) in the surgical treatment of giant congenital melanocytic naevi. METHODS: Between May 2000 and March 2004, Integra was used in 12 children (n=12; aged seven months to 11 years, mean 3.8 years). Giant congenital melanocytic naevi covered 1-12% of the total body surface area (mean 4.2%) located over the trunk in 50%, and over face and extremities in 25% each. RESULTS: In eight children, Integra implantation was primarily successful; in four patients a partial or complete removal and re-implantation was necessary due to complications. The final take rate of Integra ranged from 95-100%, except for one patient with a take rate of 30% (mean 93%). Second stage split-thickness skin grafting yielded take rates from 95-100% (mean 98%). Functional and cosmetic outcome was rated excellent in 58%, good in 25% and fair in 17% (follow-up six months to four years, mean 2.2 years). CONCLUSIONS: These results suggest that Integra is a new and valid method to successfully treat giant congenital melanocytic naevi in early childhood in a definitive manner and with high-quality results.

Amniotic fluid brain-specific proteins are biomarkers for spinal cord injury in experimental myelomeningocele.

Myelomeningocele (MMC), the most severe form of spina bifida (SB), causes neurological deficit. Injury to the spinal cord is thought to begin in utero. We investigated whether brain-specific proteins (BSPs) would enable us to monitor the development of MMC-related tissue damage during pregnancy in an animal model with naturally occurring SB (curly tail/loop tail mouse; n = 256). Amniotic fluid levels of neurofilament heavy chain (NfH), glial acidic fibrillary protein (GFAP) and S100B were measured by standard ELISA techniques. The amniotic fluid levels of all BSPs were similar in SB and control mice on embryonic day (E) 12.5 and 14.5, whereas a significant increase was observed for GFAP in SB mice on E16.5. Levels of all BSPs were significantly increased in SB mice on E18.5. The rapid increase in GFAP, paralleled by a moderate increase in NfH and S100B, suggests that spinal cord damage starts to accelerate around E16.5. The macroscopic size of the MMC was related to NfH level on E16.5 and E18.5, suggesting that axonal degeneration is most severe in large MMC. Amniotic fluid BSP measurements may provide important information for balancing the risks and benefits to mother and child of in utero surgery for MMC.

Fractures of the neck of the radius in children. Early experience with intramedullary pinning.

The treatment of fractures of the neck of the radius in children is difficult, particularly if the angulation of the fracture exceeds 60 degrees. Since 1994 we have used closed reduction and stabilisation with an intramedullary Kirschner wire in patients with grade-IV fractures according to the classification of Judet et al. In a retrospective analysis of a two-year period (1994 to 1996), 324 children with fractures of the elbow were treated in our department. Of these, 29 (9%) had a fracture of the neck of the radius; six were grade-IV injuries (1.9%). Five of the latter had an excellent postoperative result with normal movement of the elbow and forearm. One patient with a poor result had a concomitant dislocation of the elbow. Our results suggest that closed reduction and intramedullary pinning of grade-IV fractures allows adequate stabilisation while healing occurs.

Pitfalls in therapy of upside-down stomach.

The upside-down stomach (UDS) is a special form of gastric organoaxial volvulus in a supradiaphragmatic hernial sac. The authors report five cases treated between 1979 and 1998, and seek to point out possible problems and pitfalls in the surgical management of this uncommon anomaly. Retrospective analysis of these cases shows that brachyesophagus as described is not a problem in UDS, as the esophagus is of normal length. The hiatus, on the other hand, is always very large and needs proper narrowing, which may be achieved through a transabdominal approach more easily than through a transthoracic access. A common esophago-aortal hiatus is often present. In conclusion, the authors recommend a hiatal repair and gastropexy, i.e. fundophrenopexy and corpoventropexy along the esophageal axis to prevent recurrent gastric herniation or torsion. Transabdominal access should be chosen since brachyesophagus is not expected. Beware of a common hiatus when preparing the hiatal crura. An antireflux procedure is not necessary as gastro-esophageal reflux usually resolves spontaneously after hiatal repair and gastropexy.

Posttraumatic dural sinus thrombosis in children.

Posttraumatic dural sinus thrombosis (DST) in children has rarely been described in the literature. Over a period of two years (1994-1996) we treated 131 children (n=131) with minor or severe head injury requiring a cranial computed tomography (CT) scan. DST was found in eight patients (6.1%), five with mild and three with severe cranial trauma. Diagnosis was suspected either because of a skull fracture crossing over a dural sinus or because of a hyperdensity at a dural sinus in the noncontrast CT scan. Enhanced CT scan was used to confirm DST. No specific symptoms related to DST were observed. DST was managed conservatively in all patients and recovery was uneventful. Recanalization of the sinus was documented to occur within three weeks to six months in six children. One patient showed a residual clot after five months and another did not have a follow-up CT scan. Based on our data we conclude that neither surgical nor medical intervention is indicated in traumatic DST in children.

Characteristics of dental emergency clinic patients with and without disabilities.

This study compared oral health and demographic characteristics of patients with and without disabilities at a dental school emergency clinic. Of 407 consecutive patients surveyed, 20.4% reported disabilities. Two groups matched by age and gender, those with disabilities (DIS, n = 79) and those without disabilities (ND, n = 177), were compared on questionnaire responses; two subgroups, DIS (n = 38) and ND (n = 44), were assessed clinically. The mean ages of the DIS and ND groups were 44.0 years (SD +/- 11.6) and 43.0 years (SD +/- 12.3), respectively. By chi-squared analysis, DIS vs. ND subjects had significantly lower levels of education, employment, income, and dental insurance, and greater dependence on Government funding. In the DIS group, 79.5% were not working, while 6.4% did work regularly. In the ND group, the corresponding values were 30.9% and 46.9%, respectively. In the DIS group, 51.9% identified Medicaid acceptance as the reason they sought care at the clinic, while 62.7% of the subjects in the ND group identified the lower fee structure as the reason for clinic selection. More DIS than ND subjects reported dentists' unavailability and inability to manage the disability, lack of transportation, effect of dental problems on health, and referral by a health professional. DIS vs. ND subjects had significantly fewer sound teeth and more missing teeth. The results suggest that one in five dental school emergency clinic patients has disabilities.

Acute appendicitis in neonates: complication or morbus sui generis?

Neonatal appendicitis (NA) is very rare and is associated with a very high perforation rate. Three cases treated at our hospital since 1969 are presented. All of them had a perforated appendix; two represented a complication of an underlying disease, i.e., Hirschsprung's disease and cystic fibrosis, respectively. These diseases should always be ruled out actively in cases of NA. If an underlying disease is not found, NA might be an isolated form of necrotizing enterocolitis limited to the appendix. Histology cannot distinguish between a simple appendicitis and a localized form of NEC, so NA must be regarded as a complication of an underlying disease as well as a morbus sui generis.

Fractures at the base of the skull in gunshots to the head.

The distribution of fractures at the base of the skull was investigated in 147 victims with lethal head shot wounds caused by handguns or small calibre low-velocity rifles. In individuals without an impact of the projectile at the base of the skull, bullets lodged in the head were found up to a calibre of 7.65 mm (pistol) or .38 special (revolver), respectively. In cases with a trajectory through the cranial fossae positive results were obtained up to 9 mm (pistol) or even .45 (revolver). Fractures in anterior parts of the base of the skull were a rather frequent finding (82% of the cases) and could also be observed in victims shot by low energy guns. Fracture lines in particular in all cranial fossae, however, indicate a comparatively high energy missile and were found in victims without a direct impact of the bullet at the base of the skull after the use of guns with a calibre of at least 7.65 mm. Severe fractures leading to a hinge-like mobility of the base of the skull point also to projectiles of rather high energy. On the other hand, such fractures were also found in a victim with a contact shot by a .22 rifle. Therefore, it must be emphasized that individual factors such as the constitution of the base of the skull, the path of the bullet, technical parameters of the gun and ammunition used are of great importance if conclusions are to be drawn on an unknown gun by evaluation of fractures at the base of the skull.

[Intestinal foreign body with sigmoid perforation in an area of carcinomatous stenosis: incidental finding or etiology?]. / Intestinaler Fremdkörper mit Sigmaperforation in karzinomatösem Stenosebereich: Zufallsbefund oder Ursache?

Ingestion of a foreign body is a common incident. In most cases it rarely produces symptoms, but sometimes may cause severe complications such as abscess formation, obstruction or perforation. A definite diagnosis can be difficult to obtain for the following reasons: 1. the past history doesn't give any clue; 2. the symptoms are veiled by another intestinal disease; 3. radio opaquity of the foreign body is absent; 4. complications can mimic different symptoms inspite of their unique etiology. The following case reports a patient with an intestinal perforation, where a foreign body and a stenosis, caused by a sigma neoplasm, were simultaneously present. Histological findings showed that the foreign body, not the neoplasm, was causing the perforation, whereas for the underlying disease it only was an incidental finding.

Comparison of incoming dental school patients with and without disabilities.

A survey of incoming dental school patients compared 64 adult patients (DECOD) and 73 patients without disability (ND), regarding past dental experience, current needs, and basis for selecting the school's clinics. The responses indicated that, for DECOD patients, clinic selection was based largely on Medicaid acceptance, staff experience, and inability of other dentists to manage their disability; for ND patients, selection was based on lower fee structure. Both groups expressed high treatment need, but the rate was lower for DECOD than for ND patients. More DECOD patients reported severe dental anxiety and adverse effects of dental problems on general health. Chart records revealed that clinical findings exceeded perceived need for both DECOD and ND patients. While both groups had high periodontal disease rates (91%), DECOD patients had significantly poorer oral hygiene and less restorative need than ND patients. The findings suggest differences between persons with disabilities and other patient groups in difficulty of access to dental services in the community, reasons for entering the dental school system, and in presenting treatment need and/or treatment planning.

Cranial fractures and direction of fire in low velocity gunshots.

A total of 59 penetrating contact shot wounds to the head caused by handguns was investigated and a comparison was made between the magnitude and the number of fracture lines at the entrance and exist site of the vault and at the base of the skull. It was noted that in approximately 50% of the cases the extent of fractures at the entrance site exceeded those at the exit wound while in the remaining individuals no relevant differences or even greater exit fractures were found. Furthermore, no close correlation between the fracture patterns of the vault and at the base of the skull occurred indicating that differences in the magnitude and the number of entrance or exit fracture lines cannot provide reliable information on direction of fire. Additionally, no further conclusions on the gun used can be drawn from differences in the entrance and exit fracture patterns. It can only be assumed that the absence of fractures in the cranial fossae points to the use of small calibre handguns (< or = 7.65 mm) while a fragmentation of the skull can as a rule be expected after shots from guns with larger calibres (> 7.65 mm).

Frequency of blood spatters on the shooting hand and of conjunctival petechiae following suicidal gunshots wounds to the head.

A total of 103 suicidal and 29 homicidal gunshot fatalities were evaluated. In 42% of the suicides, characteristic findings like blood spatters and/or powder soilings, could be found on the shooting hand by naked-eye inspection indicating the importance of an accurate examination of the deceased's hands at autopsy for a preliminary diagnosis. Petechial hemorrhages of the conjunctivae due to the gas pressure after discharge of the weapon were observed in 22% of those cases with contact shot wounds to the head/neck, but not in cases of distant shot injuries following the use of non-high velocity ammunition. Therefore, conjunctival petechiae can be regarded as an additional but optional sign of contact head shots in cases without alterations possibly influencing the development of conjunctival pin-point bleedings. The evidence of such findings can be of practical importance if the entrance shot wound cannot be examined for whatever reason.

Chlorhexidine swabbing applications under various conditions of use in preventive oral care for persons with disabilities.

A sample of 44 adults with severe disabilities completed a randomized single-blind cross-over study testing chlorhexidine swabbing under various conditions: with/without prior dental prophylaxis, reduced frequency of application (2 vs. 5 times per week), and prolonged use (42 weeks). All subjects received therapeutic doses of 10 mL 0.12% chlorhexidine gluconate (Peridex, Procter & Gamble) and 10 mL 0.05% NaF applied with a Toothette (Sage Products). Clinical effectiveness of chlorhexidine swabbing compared with placebo was previously reported. In the present study, while initial benefits were observed to be independent of dental prophylaxis, significant reductions in periodontal scores were sustained by a combination of dental prophylaxis and swabbing protocol, at reduced frequency of application and over prolonged time. High levels of acceptance and compliance by subjects/caregivers were maintained. Subjects/caregivers reported improvements in dental health as well as in attitude, quality of life, and smile. Chlorhexidine swabbing at maintenance frequency, combined with periodic dental prophylaxis, may offer an effective and pragmatic long-term preventive regimen for persons with disabilities.

A comparison of oral health in spinal cord injury and other disability groups.

A controlled pilot study determined oral health in persons with quadriplegia due to spinal cord injury, and compared dental disease rates in spinal cord injury and other disability groups. Seventeen adults with spinal cord injury and 17 controls were assessed for dental/medical/social history; manual function; head, neck, and oral lesions; salivary flow; DMFS; and gingivitis, periodontal pockets, plaque, and calculus. Findings were compared with those from prior studies according to the same protocol, for groups of similar age with mental retardation, cerebral palsy, traumatic brain injury, and chronic mental illness. No significant differences between spinal cord injury and control subjects were noted, except that fewer spinal cord injury subjects brushed daily or flossed (p < 0.05); dependent subjects tended to have more plaque and gingivitis than those brushing independently. Subjects with spinal cord injury and mental illness had less gingivitis than those with mental retardation and cerebral palsy (p < 0.001); on calculus, subjects with spinal cord injury ranked lower than subjects with mental illness (p < 0.05). On DFS, mentally ill subjects and those with traumatic brain injury ranked higher than mentally retarded and cerebral palsy groups, with spinal cord injury subjects intermediate. Mentally retarded and traumatic-brain-injured subjects had fewer teeth than other groups (p < 0.05). The findings suggest differences in oral health status and oral care for various disabled populations.

Efficacy of chlorhexidine swabbing in oral health care for people with severe disabilities.

Chlorhexidine is effective when used as an oral rinse, but many disabled people cannot use such a protocol. A double-blind cross-over study tested the efficacy of applying chlorhexidine with a sponge-swab, in a sample of 76 severely disabled adults, drawn from diverse rehabilitation settings. Two randomly assigned groups applied 10 mL 0.12% chlorhexidine gluconate (Peridex, Procter & Gamble) or 10 mL placebo, using a "Toothette" (Halbrand) once daily, 5 times per week for 10 weeks. All subjects received 10 mL 0.05% NaF, applied similarly but separately from the test/placebo agent. Pre- and post-trial measures included perceived level of function and oral status, that is, DMFS, plaque, calculus, pocket depth, and tooth stain. The protocol received high levels of compliance and acceptance. Compared with placebo, swabbing with chlorhexidine resulted in consistent, and, in part, significant improvements in plaque, gingivitis, and periodontal pocket depth. Side effects of chlorhexidine, that is, tooth stain and calculus, were relatively minor. Perceived improvements in dental health were associated with improved physical health, appearance, and mouth odor. The results indicate that chlorhexidine swabbing is a useful oral disease preventive protocol for persons with disability.

A comparison of the oral health of persons with and without chronic mental illness in community settings.

Severe dental disease has been reported for patients receiving psychiatric treatment. This study compared the oral status of noninstitutionalized adults with chronic mental illness with a similar group without such history, and evaluated relative risk factors, for example, xerostomia, diet, hygiene, and poverty. A sample of 37 subjects with chronic mental illness (CMI) and 29 control subjects without mental illness were assessed for dental, medical and social history; head, neck, and oral soft tissue pathology; salivary flow; DMFS, gingivitis, loss of periodontal attachment, plaque, and calculus. The groups were equivalent in socio-economic level, education, dental history, and home care. All subjects with CMI received psychotropic medications (mean of 3.8 drugs for 10.3 years). The CMI group had significantly higher incidence in the following variables: self-reported dry mouth; consumption of carbonated beverages (P less than .001); mucosal, lip, and tongue lesions (P less than .01); coronal smooth surface caries (P less than .001); severity of plaque (P less than .001) and calculus (P less than .01); and salivary flow (P less than .05). No significant differences were evident in the M and F components of DMFS, in gingivitis or loss of attachment. The results indicate significant increases in risk factors and increased oral pathosis in persons with mental illness who live in community settings compared with a control group that showed dental neglect.

[Short-stop ammunition]. / Short-stop-munition.

Now and again ammunition is offered emphasizing its "less deadly" or "not at all deadly" effects. On application, however, these types of ammunition contrary to the manufacturer's allegations turn out to be a real threat. On the one hand results can be rather harmful while on the other side at court a remonstration on the grounds of not knowing such outcome beforehand may be successful. Under these aspects construction and effects of a special small shot ammunition for revolvers (Speer 38/357 Shot Shells, manufactured by CCI), of the cartridge "Short-Stop", manufactured by MB Associates in San Ramon (California) and, in connexion with own casework, a "shock-defense" sort of ammunition, manufactured by Rauchalles (Offenburg, West Germany) are compared and discussed with respect to their construction and effects.