Orbital Cavernous Venous Malformation in a 35-Year-Old Man: A Case Report.

In this article we present a case of a 35-year-old patient with a massive 43 × 35 × 34 mm cavernous venous malformation of the left orbit. The orbital lesion was initially observed in 2008 and remained untreated to 2021 due to the patient's refusal to consent to the surgical procedure; which caused the tumor to grow to monstrous dimensions.

Respiratory function in pregnant women.

Respiratory disorders during pregnancy are connected with its physiology. About half of pregnant women suffer from dyspnea on exertion and some 20 % also from dyspnea at rest. Symptoms may intensify in obese patients. Smoking and respiratory disorders influence the well-being of the fetus. This study evaluates respiratory function in pregnant women as assessed by spirometry. The tests were carried out in 54 pregnant women in the 2nd and 3rd trimester. We found reduced values of vital capacity and expiratory reserve volume in all women, which suggests the existence a restrictive respiratory disorder in physiological pregnancy. Smoking seems to cause obstructive disorders; in smoking patients there was a reduction of the Tiffenau ratio. Participation in birth classes had a positive influence on inspiratory capacity. High BMI before pregnancy, excessive weight gain during pregnancy, or age of becoming pregnant did not appreciably influence spirometry results.

Bupivacaine crystal deposits after long-term epidural infusion.

The case of a 45-year-old male patient (body weight 52 kg, height 1.61 m) with a locally invasive gastric carcinoma infiltrating into the retroperitoneal space is reported. Because of severe cancer pain a tunnelled thoracic epidural catheter (EC) was placed at thoracic spinal level 7/8 and a local anesthetic (LA) mixture of bupivacaine 0.25 % and morphine 0.005 % was infused continuously at 6 ml h(-1). To optimize pain therapy the concentration was doubled (bupivacaine 0.5 %, morphine 0.01 %) 3 months later but the infusion rate was reduced to 3 ml h(-1) thus the total daily dose did not change. The patient died 6 months after initiation of the epidural analgesia from the underlying disease. The total amount of bupivacaine infused was 69 g and of morphine 1.37 g. The patient never reported any neurological complications. The autopsy revealed large white crystalline deposits in the thoracic epidural space which were identified as bupivacaine base by infrared spectrometry. Morphine could not be detected. A histological examination showed unreactive fatty tissue necrosis within the crystalline deposits but nerve tissue could not be identified. It is concluded that the bupivacaine crystalline deposits arose due to precipitation but the clinical significance with regard to sensory level and neuraxial tissue toxicity is unknown.

A functional outcome study comparing total ankle arthroplasty (TAA) subjects with pain to subjects with absent level of pain by means of videofluoroscopy.

BACKGROUND: Total ankle arthroplasty (TAA) subjects often suffer pain on the anteromedial side of their ankle joint. Whether this prevalent pain is caused by a changed motion pattern of the TAA is unclear. Therefore, this study assessed the kinematic differences in the motion of the TAA components during gait, comparing TAA subjects with elevated versus absent levels of pain. METHODS: Eleven TAA subjects (5 with pain vs. 6 without pain), all with unilateral Mobility™ TAA and at least two years post-operation, were recruited and stratified based on standard clinical assessed patient data. The 3D motion of the TAA was assessed by means of videofluoroscopy during level, uphill and downhill walking. RESULTS: The hypothesis that the pain group shows a different kinematic motion pattern than the no pain group could not be confirmed. CONCLUSIONS: The same kinematic motion pattern causes pain in some patients, but not in others. Further investigation concerning ligament stresses is needed.

Comparison of reference points in different methods of temporomandibular joint imaging.

PURPOSE: Conventional radiography is a well-established method for imaging of the temporomandibular joint (TMJ) structures. However, the dental computer tomography becomes more important for the visualization of teeth in the jaw-bone. The applicability of dental computer tomography for the visualization of the TMJ it not yet been proven. The aim of the study was to identify TMJ structures using reference points with the magnetic resonance imaging (MRI) and the computed tomography (CT). METHODS: In order to compare the visualization and measurement of the TMJ a total of eight human cadaver heads was examined with CT and MRI and analysed using reference points. RESULTS: In both imaging techniques the selected reference points and distances are well definable and allow objective evaluation of anatomical structures. The CT images display a clearly better contrast to noise ratio than the MR images. The distance measurement of different width and length showed significant correlation of both images techniques. CONCLUSIONS: In TMJ diagnostics, maximum information could be obtained using both imaging techniques together due to synergistic effects.

3D representation of the surface topography of normal and dysplastic trochlea using MRI.

The three-dimensional (3D) image of the articular surface topography of the normal and the dysplastic trochlea has not been defined. The aim of this study was to represent both the normal and dysplastic trochlear geometry in 3D using magnetic resonance imaging (MRI). Using the segmentation software program Amira (Mercury Computer Systems, Inc., Chelmsford, USA) we created 3D reconstructions of the distal femur bone and cartilage using MRI scans. Bone and cartilage of the distal femur were traced slice by slice in the acquisitioned dimension while the Amira program reconstructed the 3D model. This model was then transferred to the Rhinoceros 4.0 software (Robert McNeel & Associates, Seattle, USA) for measuring. Using this system a non-invasive 3D representation of the articular cartilage and bone of the normal trochlea and depiction of different types of trochlear dysplasia were possible. Potential advantages of these MRI measurements are assessment of the 3D articular cartilage of the whole trochlea and the bony contours on the same image, no imaging errors from joint malpositioning, no ionizing radiation, precise preoperative planning according to the documented pathomorphology, and comparison between the preoperative and the postoperative shapes. The disadvantages include higher costs compared to radiography or CT scans, and time consuming reconstruction, making them currently a research tool.

Innate immune defenses induced by CpG do not promote vaccine-induced protection against foot-and-mouth disease virus in pigs.

Emergency vaccination as part of the control strategies against foot-and-mouth disease virus (FMDV) has the potential to limit virus spread and reduce large-scale culling. To reduce the time between vaccination and the onset of immunity, immunostimulatory CpG was tested for its capacity to promote early protection against FMDV challenge in pigs. To this end, CpG 2142, an efficient inducer of alpha interferon, was injected intramuscularly. Increased transcription of Mx1, OAS, and IRF-7 was identified as a sensitive measurement of CpG-induced innate immunity, with increased levels detectable to at least 4 days after injection of CpG formulated with Emulsigen. Despite this, CpG combined with an FMD vaccine did not promote protection. Pigs vaccinated 2 days before challenge had disease development, which was at least as acute as that of unvaccinated controls. All pigs vaccinated 7 days before challenge were protected without a noticeable effect of CpG. In summary, our results demonstrate the caution required when translating findings from mouse models to natural hosts of FMDV.

The effect of treatment with fentanyl patches on pain relief and improvement in overall daily functioning in patients with postherpetic neuralgia.

Postherpetic neuralgia often causes persistent pain, which can compromise patients' quality of life. The aim of the study was to examine the effect of pain reduction after the application of transdermal fentanyl on the quality of life of patients with postherpetic neuralgia. The study lasted 12 weeks. The study population included adult patients experiencing spontaneous pain, expressed by 4 points on the pain numeric rating scale (NRS). To assess quality of life questionnaire SF-36, the Zung depression scale and NRS were used. Pharmacotherapy included amitryptyline (Amitriptylinum VP) 10 mg orally once daily, gabapentine (Gabapentin TEVA 100 mg) 200-900 mg/24 hour orally twice daily and fentanyl skin patches (Durogesic) 12.5-100 microg/hour. Thirty four patients were qualified for the study. Comparison of pain intensity before the treatment and after 12 weeks showed that all the patients experienced relief. The treatment evidently reduced limitations in the physical and social domains. There was little improvement in the general physical capacity and mental condition. Analysis of correlation between changes in quality of life in the emotional, physical and social domains revealed that they were strongly interlinked. Increase in physical activity was accompanied by positive changes in the mental condition, better general wellbeing was correlated with increased social activity, and increased social activity was accompanied by improved physical condition. The more effective the treatment was, the more evident was improvement in the patients' quality of life in the physical, social and mental domains.

Efficacy of healing process of bone defects after apicectomy: results after 6 and 12 months.

The aim of this study was to assess the efficacy of selected surgical treatment techniques of bone defects after apectomy. A total of 106 postresection bone defects, located in maxilla and mandible were included in the study: the defects were treated with resorbable collagen membrane (BG I- 26 defects), xenogenic bovine material (BOC II- 30 defects) and xenogenic bovine material with platelet rich plasma (BOC/PRP III- 20 defects). In the control group the defects were left to heal spontaneously. Clinical and radiological assessment was performed at 6 and 12 months after the procedures. The analysis among groups revealed higher efficiency of the method of treatment that uses guide bone regeneration in comparison to the group in both post-operative control periods. After 6 months, the differences were statistically significant for each group using the regeneration methods, but after 12 months only for the BOC/PRP group. Treatment using selected guided bone regeneration techniques proved superior to the control group in both observation periods, but after 6 as well 12 months the best results in the BOC/PRP group were observed.

Macrophages and Fc-receptor interactions contribute to the antitumour activities of the anti-CD40 antibody SGN-40.

SGN-40 is a therapeutic antibody targeting CD40, which induces potent anti-lymphoma activities via direct apoptotic signalling cells and by cell-mediated cytotoxicity. Here we show antibody-dependent cellular phagocytosis (ADCP) by macrophages to contribute significantly to the therapeutic activities and that the antitumour effects of SGN-40 depend on Fc interactions.