Baby boy blue and mommy too! A rare case of methaemoglobinaemia presenting simultaneously in a mother-neonate pair.

Methaemoglobinaemia occurs when there is >1% methaemoglobin in erythrocytes. In an infant, they can present either congenitally or in an acquired form. We present a rare case of methaemoglobinaemia presenting simultaneously in a mother and infant pair. The mother and infant were discharged well on Day-4 post-delivery with both mother and baby recording oxygen saturation levels of 100%. On Day-7, during a routine clinic visit, they were incidentally found to be centrally cyanosed. There were no other abnormalities. On investigation, the methaemoglobin levels were elevated in the infant (23.9%) and mother (14.3%). Treatment with ascorbic acid normalised mother's methaemoglobin levels; but baby's levels remained high until the administration of oral methylene blue. Both baby and mother remained well and pink at last follow-up at 2 years 8 months of age. This case illustrates difficulties in ascertaining the cause of methaemoglobinaemia. Postdelivery, the mother-neonate pair were pink, and their haemoglobin electrophoresis were normal, hence it was unlikely to be congenital methaemoglobinaemia. The team could not identify any triggering factors for acquired methaemoglobinaemia. There was also the uncertainty of the necessity to treat the baby. This is because treatment is not without harmful effects and despite the high methaemoglobin levels, the infant was otherwise well. Only a single published paper recommended that high methaemoglobin levels must be treated, and the recommendation was not supported by evidence. Lessons learnt from our case are that neonates with methaemoglobinaemia can be safely treated with oral methylene blue, but more research is needed on the benefitrisk profile of treatment.

Chondroitin sulfate in palatal wound healing.

Chondroitin sulfate is up-regulated in granulation tissue during wound healing. To investigate the role of chondroitin sulfate in the wound-healing process after surgical repair of cleft palate, we isolated and cultured rabbit palatal fibroblasts. Treatment with chondroitin-6-sulfate resulted in a dose-dependent increase in cell adhesion and cell proliferation, whereas the reverse effects were seen after chondroitinase degradation of chondroitin sulfate. The biological actions of chondroitin sulfate appeared to be dependent on the presence and position of sulfate groups. Inhibition of glycosaminoglycan sulfation by chlorate treatment led to reduced cell adhesion and cell proliferation and a slower rate of wound closure in vitro. Furthermore, exposure to chondroitin-4-sulfate resulted in a dose-dependent reduction in cell adhesion. Together, these results show that chondroitin sulfate is involved in palatal wound healing.

Fabrication of a new composite orthodontic archwire and validation by a bridging micromechanics model.

A new technique based on tube shrinkage is proposed for the fabrication of composite archwires. Compared with a traditional pultrusion method, this new technique can avoid any fiber damage during the fabrication and can provide the archwire with a required curvature in its final clinical usage. The present paper focuses on the technique development and mechanical design and validation in terms of constituent materials by using a micromechanics bridging model. Prototype archwire has been fabricated using fiberglass and an epoxy matrix, with a wire diameter of 0.5mm and a 45% fiber volume fraction. Tensile and three-point bending tests have shown that the mechanical performance of the prototype composite archwire is comparable to that of a clinical Ni-Ti archwire. Another purpose of the present paper is to provide an efficient procedure for a critical design of composite archwires. For this to be possible, the ultimate load especially flexural load carrying ability of the composite archwire must be assessed from the knowledge of its constituent properties. However, difficulty exists in doing this, which comes from the fact that the failure of the utmost filament of the composite archwire subjected to initially the maximum bending stress does not imply its ultimate failure. Additional higher loads can still be applied and a progressive failure process is generated. In this paper, the circular archwire was discretized into a number of parallel laminae along its axis direction, and the bridging micromechanics model combined with the classical lamination theory has been applied to understand the progressive failure process with reasonable accuracy. Only the constituent fiber and matrix properties are required for this understanding. Nevertheless, the ultimate bending strength cannot be obtained only based on a stress failure criterion. This is because neither the first-ply nor the last-ply failure corresponds to the ultimate failure. An additional critical deflection (curvature) condition must be employed also. By using both the stress failure and the critical deflection conditions, the predicted load-deflection up to the ultimate failure agrees well with the measured data. Thereafter, different mechanical performances of composite archwires can be tailored before fabrication by choosing suitable constituent materials, their contents, and the archwire diameters. Several design examples have been shown in the paper.

Corrosion and cytotoxicity evaluation of thermafil endodontic obturator carriers.

The purpose of this study was to evaluate the in vitro cytotoxicity of two metallic and two plastic Thermafil carrier materials, and to separately evaluate the in vitro corrosion behavior of the two metallic carriers. Stainless-steel, Ti-6AI-4V, Polysulfone, and Vectra carriers were evaluated for cytotoxicity using the ISO-recommended agar overlay test. The two metallic carriers were additionally corrosion tested in 0.9% NaCl solution for 174 wk, at 37 degrees C. Elemental analyses of the corrosion solutions were periodically conducted using inductively coupled plasma-mass spectroscopy. Agar overlay results showed that the four carrier materials were not cytotoxic to L929 fibroblasts. Inductively coupled plasma-mass spectroscopy results showed that the metallic materials had small mass loss rates. Scanning electron microscopy showed no evidence of pitting or crevice corrosion.

Mercury vapour suppression by various liquid media.

Fresh and used photographic fixer, Merconvap and water were evaluated for their ability to suppress the vapourization of mercury. Mercury vapour concentration above the four test storage liquids was measured at various times between 10 min and 335 days, using a mercury vapour measuring instrument. The data were analysed using a Student-Newman-Keuls multiple comparison test (P = 0.05). The results showed that fresh and used fixer and Merconvap suppressed the vapourization of mercury to below the detection limit of the measuring instrument (0.01 mg/m3). Water was much less effective compared with the other liquids and showed an increase in mercury vapour concentration with log t.

Malocclusion prevalence in an ethnic Chinese population.

Population norms derived from one ethnic group may not necessarily be valid and accurate for other ethnic groups. With the increasing number of ethnic Chinese immigrants in Australia, Europe, and America, it would be useful for dental practitioners to be informed about malocclusion prevalence among Chinese. This study was carried out on 1050 Chinese school children (aged 12-14 years) to assess both qualitatively and quantitatively certain occlusal features. The population was found to have a high incidence of Class III malocclusions compared with caucasians. However, the incidence of Class II malocclusions was quite similar to those reported in caucasians. Normal occlusions occurred in about 7 per cent of this population. Although this percentage was much lower than those reported in blacks, it was similar to those reported in caucasians. Crowding occurred in about 50 per cent of cases, which was slightly less than for those reported for caucasians. Increased overbites were also less common in this Chinese population compared with caucasians. Compared with caucasians, crossbites were also less frequent in this Chinese population.

Treatment of antigen-induced arthritis in rabbits by the intra-articular injection of methylprednisolone, 90Y or chlorambucil.

Rabbits with a bilateral antigen-induced arthritis were injected intra-articularly (i.a.) in one joint with methylprednisolone (1 mg), 90Y (18.5 MBq) or chlorambucil (1 mg) as a single dose. The severity of arthritis was determined by measuring joint swelling and skin surface temperature, macroscopic and histological changes in the joint being assessed 8 weeks after induction of arthritis when the rabbits were killed. Methylprednisolone injected at the time of antigen challenge or 3 weeks later caused a reduction in joint swelling and temperature (P < 0.05) for 1 to 6 weeks after injection. 90Y had an initial proinflammatory effect lasting several days, but later caused a modest reduction in joint swelling for up to 4 weeks (P < 0.05). Eight weeks after induction of arthritis, neither methylprednisolone nor 90Y-treated joints showed any significant reduction in erosion or histopathology compared with control arthritic joints. Chlorambucil injected 1 week after antigen challenge caused a rapid reduction in joint swelling which was maintained for the duration of the study. Joint surface temperature was reduced to a lesser extent. Eight weeks after induction of arthritis, chlorambucil-treated joints showed a decrease (P < 0.05) in all of the parameters of disease pathology assessed. Treatment with chlorambucil intra-articularly was clearly more effective than with methylprednisolone or 90Y at the doses employed and deserves further study as a potential treatment for chronic synovitis.

Treatment of antigen-induced arthritis in rabbits with liposome-entrapped methotrexate injected intra-articularly.

Rabbits with a bilateral antigen-induced arthritis were injected intra-articularly in one joint with methotrexate as the free drug or entrapped in liposomes. Free methotrexate (1 mg) injected as a single dose at the time of antigen challenge, suppressed the development of joint swelling and the rise in skin surface temperature of treated joints by 20-30% compared with contralateral control arthritic joints. The beneficial effect of methotrexate occurred within 24 h of injection and was maintained for at least 56 days. However, methotrexate was ineffective in suppressing arthritis when injected 7 days after antigen challenge. Liposomal methotrexate suppressed the development of arthritis at a dose one-tenth that of the free drug and it was also effective in suppressing arthritis of 7 days duration, although significant beneficial effects of liposomal methotrexate were delayed for 10 to 14 days after injection. Neither free nor liposomal methotrexate was effective in suppressing an established arthritis, having no significant effect on joint swelling or skin surface temperature when injected 21 and 35 days after antigen challenge. At the end of the study, 8 or 9 weeks after induction of arthritis, the joints were examined morphologically and histologically. Free methotrexate generally had no significant effect on joint pathology. However, liposomal methotrexate suppressed the development of synovial hyperplasia, cellular infiltration and the erosion of cartilage and bone when injected at the time of antigen challenge or 7 days later, but affected none of these parameters in an established arthritis of 3 weeks duration.

Horizontal skeletal typing in an ethnic Chinese population with true Class III malocclusions.

Eighty Chinese adults with true Class III malocclusions were analysed cephalometrically to determine the percentage in each horizontal skeletal subtype. The maxillary and mandibular skeletal bases for each subject were analysed using angular (SNA/SNB) as well as linear (point A/B to McNamara's line) criteria. Results indicated that mandibular hyperplasias with normal anteroposterior maxillary position comprised the majority of true Class III malocclusions. While the majority of Class III in males were due to hyperplastic mandibles and normal maxillary antero-posterior relationship, most of the female Class III malocclusions were due to normal mandibles and hypoplastic maxillae. There was no significant difference between the incidence in Class III subtypes when using either angular or linear criteria.

Hamster cheek-pouch testing of dental soft polymers.

The hamster cheek pouch provides a suitable model system for the mucous-membrane irritation testing of dental materials. Poor retention of materials or difficulties in histopathological interpretation caused by surgical artifacts have been reported in published techniques. We describe a new "pouch-in-pouch" technique for mucous membrane irritation tests. The retention rate of polymer discs was 97% and 87% at 14 and 35 days, respectively. Clear differentiation was obtained between the tissue reaction to the test materials and the surgical procedure. Polymer discs containing dibutyltin diacetate (DBTD) or dibutyl phthalate (DBP) as plasticizer resulted in epithelial changes, including epithelial atypia, early papillomas, and areas resembling dysplasia. The potentially pre-malignant nature of these changes requires further investigation.

Adenomyomatosis of the gall bladder: the NUH experience.

Adenomyomatosis (AD) is a degenerative disorder of the gall bladder wall which can be complicated by chronic inflammation and calculi. The true incidence of this disorder in South East Asians is not known. Nine Chinese patients with AD were discovered amongst 200 consecutive right upper quadrant ultrasound examinations. Four of them had cholecystectomy and were diagnosed as cholecystitis by the pathologist. Adenomyomatosis can be suspected on ultrasonography, but should be confirmed by oral cholecystography (OCG). There is great disparity in the ultrasound, OCG, surgical and histopathological diagnosis of this condition. This may be due to the fact that only complicated cases of AD come to surgery, where the presence of chronic cholecystitis or calculi detracts from recognising or overshadows the presence of AD. It is not known whether uncomplicated AD has any clinical significance and whether it, if given sufficient time, will lead to inflammation of the gall bladder.

Effect of liposomes on hamster oral mucosa.

The histologic reaction to topically applied or intramucosally injected DPPC/chol (2:1 molar ratio) liposomes was investigated. No reaction to liposomes was observed 4 days after daily topical application. However, a mild focal immune type inflammatory reaction was observed after 21 days topical treatment. Intramucosal injection of liposome produced no irritation but a macrophage reaction limited to the injection site, which was followed by healing and complete tissue regeneration.

Retention and distribution of liposome-entrapped [3H]methotrexate injected into normal or arthritic rabbit joints.

Normal or arthritic rabbits were injected intra-articularly (i.a.) with free [3H]methotrexate ([3H]MTX) or liposomes containing [3H]MTX with [14C]cholesteryl oleate as a lipid marker. The distribution of 3H and 14C in the injected joint and other tissues was determined. Free [3H]MTX was rapidly cleared from the joint, 79% being excreted in the urine within 24 h of injection. Liposome-entrapment retarded [3H]MTX clearance from the joint (P less than 0.001), 45.5% being recovered from the joint 24 h after injection. Uptake of liposomes by the inflamed synovium was lower than expected, 4% liposomal [3H]MTX injected being associated with the synovium after 24 h. Nevertheless, this was 40-fold greater than when free [3H]MTX was injected. Liposome entrapment should improve the efficacy and reduce the side effects of drugs injected directly into the joint cavity.

Association of liposome-entrapped [3H]methotrexate with thioglycollate-elicited macrophages in-vitro.

The association of free or liposome-entrapped [3H]methotrexate [( 3H]MTX) with thioglycollate-elicited macrophages was investigated in-vitro. [14C]Cholesteryl oleate was incorporated into the liposomes as a lipid marker. [3H]MTX association with the macrophages was 5 to 9-fold higher with liposome-entrapped [3H]MTX than with the free drug. Macrophage-liposome association was biphasic, temperature-dependent and saturable at high liposomal lipid concentration. A high liposome cholesterol (CH) content or the presence of 2,4-dinitrophenol or colchicine also reduced macrophage-liposome association.

Clinico-pathological prognostic factors of large bowel cancer in Singapore: a multivariate analysis.

Clinical and pathological data from 219 cases of large bowel cancer were analysed using the Cox regression model to evaluate their effects on survival. Clinical variables such as sex, change in bowel habit, bleeding per rectum, tumour site, size and duration of symptoms had no significant influence on survival. Individually, age, abdominal distension, Dukes' stage and tumour grade had significant influence on survival. When considered together, Dukes' stage was the only variable selected. Therefore Dukes' stage is the most important prognostic factor in colorectal cancer. The distribution of patients was 25, 18, 26 and 31 percent for Dukes' A, B, C and D respectively. The probabilities of survival at five years were 71, 55, 36 and 16 percent for the respective Duke's stages. These data show that the clinical and pathological variables of patients with colorectal cancer in Singapore and the factors significantly associated with survival are similar to those in western countries.

Acute cholangitis in Singapore.

115 cases of acute calculous cholangitis were analysed for their presentations, treatment and complications. There were slightly more Chinese males than females (1.4:1) and the mean age was 62 years old. Though pain was the commonest symptom (95.7%), only 35.7% of patients had complete Charcot's triad. 21.7% presented in septicaemic shock. E. Coli and Klebsiella were the commonest organisms isolated. All patients had cholecystectomy and exploration of common bile ducts. Twenty patients had additional choledochontrostomy performed. 50.4% of patients developed complications and the overall mortality was 16.5%. Patients over 60 presented in shock carried a significantly higher mortality (40%).

Primary hepatocellular carcinoma associated with Wilson's disease in a young woman.

A 27 year old woman with hepato-lenticular degeneration (Wilson's disease) was found to have primary hepatocellular carcinoma (PHC) three and a half years after she was started on treatment with D-penicillamine. The tumour was resected since when she has remained well. Her liver function tests were normal throughout the course of her disease. The available literature is reviewed and possible mechanisms for this association proposed.