Missing lateral incisors in Iron Age South-East Asians as possible indicators of dental agenesis.

The absence of lateral incisors is generally a reflection of agenesis or hypodontia, with a significant genetic basis and possibly environmental influence on the phenotypic expression. A human skeletal sample from the Iron Age cemetery of Noen U-Loke in Thailand has a very high prevalence at 79% of adults (30/38) with at least one incisor missing in either maxilla or mandible. If the cause of this high rate is genetic, it may be indicative of homogeneity, and, therefore, endogamy and probably isolation, of the population represented. Supporting agenesis as the explanation for this is the lack of space between the central incisors and canines in more than half the cases. An alternative explanation is that the teeth may have been lost during life through pathology or deliberate removal (ablation). There is no evidence in the form of remodelled lesions for pathological loss of the teeth. Although there were no significant differences between males and females in the numbers of teeth missing, there were significant differences in the patterns of loss, with males having more missing teeth on the right and females more on the left. No evidence was found in the clinical literature of agenesis involving side preference by sex, so this may indicate deliberate removal of the teeth. Males were also more likely than females to have no space for the missing teeth. Ablation of teeth has been recorded in other prehistoric South-East Asian populations but in these cases the evidence was much clearer. Agenesis seems to offer the most likely explanation for the missing teeth at Noen U-Loke and if so, indicates that a small, isolated population may develop a very high rate of hypodontia, with a side preference dependent on sex.

Utilization pattern and efficacy of nonsurgical techniques to establish drainage for high biliary obstruction.

PURPOSE: To review the frequency and success of percutaneous and endoscopic techniques in the relief of high biliary obstruction. MATERIALS AND METHODS: A search of the radiologic achieves was performed identifying 70 patients with cholangiographic demonstration of high biliary obstruction defined as proximal to the distal third of the extrahepatic bile duct. Record review determined the frequency and success rates of percutaneous and endoscopic techniques in providing biliary decompression for obstructive jaundice. RESULTS: Endoscopic retrograde cholangiopancreatography was performed in 35 of 70 patients, providing initial endoscopic biliary decompression (EBD) in six patients (two subsequently required percutaneous intervention). Percutaneous biliary drainage (PBD) was attempted in 60 of 70 patients, providing initial decompression in 55 patients. PBD provided decompression after failed endoscopic biliary drainage in 18 of 26 patients. Endoscopic drainage was never attempted after failed percutaneous drainage. Overall EBD success was 23% and overall PBD success was 95%. The complication rate attributed to EBD was 26%; that attributed to PBD was 25%. For those patients who underwent attempts at both EBD and PBD, the complication rate was 16%. CONCLUSION: At an institution with well-developed gastrointestinal medical services and interventional radiologic services, PBD was more successful in providing initial biliary decompression than endoscopic techniques for high biliary obstruction.

Combined transrectal sonographic and fluoroscopic guidance for deep pelvic abscess drainage.

We attempted to determine the feasibility, safety, and success of transrectal catheter drainage of deep pelvic abscesses using a combination of transrectal sonography and fluoroscopic guidance. In this retrospective review of five cases, transrectal catheters were placed within abscess cavities over a 20 month period. Clinical improvement was prompt, catheters were removed within 7 days, and no complications were detected. No patient required further intervention (follow-up 2 to 20 months). Transrectal sonographically guided catheter drainage proved to be safe and effective in our series. This method is a promising alternative to the posterior (sciatic notch) approach when the anterior transabdominal approach is contraindicated.

Persistent reactive airway dysfunction syndrome after exposure to toluene diisocyanate.

Two police officers developed asthma like illness after a single but prolonged exposure to toluene diisocyanate (TDI) by being in the immediate vicinity of a tank car that had overturned on a highway. One officer experienced upper and lower respiratory tract symptoms with chest tightness about 4.5 hours after initial exposure. Shortness of breath, cough, and wheezing were noted the following day. The other experienced symptoms immediately on exposure, developed shortness of breath 20 minutes later, and presented with wheezing four hours after that. Follow up examinations over seven years showed persistence of respiratory symptoms and continuation of airway hyperreactivity requiring treatment.