The role of state public health agencies in genetics and disease prevention: results of a national survey.

OBJECTIVES: The onset and severity of the clinical expression of most diseases that are of public health importance are influenced by genetic predisposition. The ability to assess human genetic predisposition for many diseases is increasing rapidly. Therefore, state public health agencies should be incorporating new developments in genetics and disease prevention into their core functions of assessment, policy development, and assurance. The authors assessed the status of this process. METHODS: The Council of State and Territorial Epidemiologists (CSTE) surveyed states about projects and concerns related to genetics and public health activities. Respondents were the Health Officer, the Maternal and Child Health/Genetics Program Director, the Chronic Disease Program Director, and the Laboratory Director. Where applicable, responses were categorized into assessment, policy development, and assurance functions. RESULTS: Thirty-eight (76%) state health departments responded. Ongoing genetics activities were assurance (82%), assessment (17%), and policy development (2%). In contrast, Health Officers responded that future genetics activities would be distributed differently: assurance, 41%; assessment, 36%; and policy development, 23%. Future assurance activities would be largely educational. Topics of interest and recently initiated activities in genetics were primarily assessment functions. Funding was the greatest concern, followed by lack of proven disease prevention measures and outcomes data. CONCLUSIONS: State health departments recognize a need to realign their activities to meet future developments in genetics. Lack of adequate resources, proven disease prevention measures, and outcomes data are potential barriers. Public health agencies need to develop a strategic plan to meet the opportunities associated with the development and implementation of genetic tests and procedures.

Association of human papillomavirus with HIV and CD4 cell count in women with high or low numbers of sex partners.

OBJECTIVE: To explore whether HIV serostatus (HIV-1, HIV-2, and dual (HIV-D) reactivity) and CD4 cell count affect human papillomavirus (HPV) in two groups of women from Côte d'Ivoire. METHODS: We conducted a cross sectional study of two groups of women. One group had low numbers of lifetime sex partners (maternal women, n = 258) and were enrolled based on HIV serostatus. The other group had high numbers of sex partners (female sex workers, n = 278) and all consenting self identified sex workers were admitted to this study. We collected epidemiological and clinical data, and cervicovaginal lavage for HPV testing. RESULTS: The groups had different distributions of HIV seroreactivity, but the rates of HPV DNA detection were similar. Most of the HPV DNAs detected in both groups were high risk types. A strong association of high risk HPV DNA and HIV-1 seropositivity was found in both maternal women (adjusted odds ratio (OR) 7.5 (95% CI 3.2-17.4)) and in sex workers (OR 5.0 (2.1-12.0)). The maternal group also showed an association of high risk HPV DNA detection with HIV-2 (OR 3.7 (1.6-8.5)) and HIV-D (OR 12.7 (4.3-37.5)) that was not observed in the sex workers. In addition, the association of high risk HPV DNA with HIV-1 in the maternal group was independent of low CD4 cell count, while in the sex workers the association depended on CD4 cell counts < or = 500 x 10(6)/l. CONCLUSIONS: We found that an association between HPV and HIV varied depending on the sexual behaviour and CD4 cell count of the population examined.

HIV and human papillomavirus as independent risk factors for cervical neoplasia in women with high or low numbers of sex partners.

OBJECTIVE: To explore whether HIV types 1 and 2 and CD4 cell count affect cervical neoplasia independent of human papillomavirus (HPV) in women with high or low numbers of sexual partners residing in Abidjan, Côte d'Ivoire. METHODS: The study population and methods are described in the companion paper. Additional methods include a Papanicolaou smear for cytological diagnosis and statistical analysis. RESULTS: In maternal women, both HIV-1 and high risk HPV were significant independent risk factors for squamous intraepithelial lesions (SIL) (adjusted odds ratio (OR) 11.0 (95% CI 1.1-112) and 5.4 (1.5-18.8), respectively). Only high levels of HPV DNA in the lavage were associated with SIL (OR 13.2 (3.6-47.8)) in the maternal group. In female sex workers, high risk HPV was significantly associated with SIL (OR 23.7 (4.4-126)); HIV seropositivity was not. Any positive level (high or low amounts) of HPV DNA was significantly associated with SIL in sex workers (ORs 15.9 (3.3-76) and 12.7 (3.6-44), respectively). There was no association of SIL with CD4 cell counts < or = 500 x 10(6)/l in HIV seropositive women from either group. CONCLUSION: HPV or HIV-1 infection independently affect cervical neoplasia in women with low numbers of sex partners.

Osteonecrosis of the mandibular condyle. Pathophysiology and core decompression.

Deviations of the condylar form are usually ascribed to "degenerative arthritis" or "osteoarthritis." More recently, osteonecrosis has been discussed as a possible cause of condylar degeneration and pain. This article presents a review of the literature on osteonecrosis, emphasizing the spectrum of degenerative osseous disease, which includes osteoarthrosis, condylsis, osteomyelitis, and osteonecrosis. Preliminary results of mandibular core decompression with and without bone grafting are presented suggesting a therapeutic benefit. Further study is recommended to elucidate this process.

Recurrent giant cell reaction to residual Proplast in the temporomandibular joint.

Exuberant foreign-body inflammatory reaction to polytetrafluoroethylene implants of the temporomandibular joint, marketed as Proplast-Teflon implants, has been widely recognized. Presently, removal of these implants is generally advised. Extensive damage of the joint and surrounding structures has been reported, including severe bony degeneration, perforation into the middle cranial fossa, and cerebrospinal fluid leak. However, recurrent foreign-body giant cell reaction, presumably as a result of residual Proplast material, has not been reported. We review our experience with Proplast-Teflon implant removal from 112 joints in 71 patients over a 6-year period, including four joints with recurrent giant cell reaction at various times after removal. Emphasis is placed on the phenomenon of recurrence and on microsurgical techniques to facilitate implant removal.

Avascular necrosis of the mandibular condyle-pathogenesis and concepts of management.

A vascular necrosis is a well-recognized pathologic entity in orthopedic surgery which most commonly affects the femoral head. Avascular necrosis of the mandibular condyle has been recognized recently, although controversy exists as to the appropriate methods of diagnosis and treatment. We present a discussion of the pathogenesis of avascular necrosis derived from the orthopedic literature and its extrapolation to management of the temporomandibular joint in the form of decompression corticotomy of the condyle by two techniques.

Cerebrospinal fluid leak associated with proplast implant removal from the temporomandibular joint.

Severe bone erosion within the temporomandibular joint reconstructed with polytetrafluoroethylene implants is a well-recognized phenomenon. Although erosion into the middle cranial fossa has been reported, we know of no report of dural disruption with cerebrospinal fluid leakage. We report a case of cerebrospinal fluid leak noted at the time of PTFE implant removal and its subsequent management. Perforation of the contralateral glenoid fossa and its reconstruction is also reported.

Mandibular retrusion, temporomandibular joint derangement, and orthognathic surgery planning.

One-hundred consecutive orthognathic surgery candidates with mandibular retrusion were selected for retrospective analysis. Patients had undergone imaging studies that included magnetic resonance imaging (MRI) of both temporomandibular joints to assess the presence or absence, stage, and activity of suspected internal derangement(s). Patients were divided into stable and unstable deformity groups based on the presence or absence of change in their facial contour and/or occlusal disturbances in the 24 months prior to evaluation. Each of the 58 unstable and 30 of 42 stable patients were found to have internal derangements of at least one temporomandibular joint. The degree of joint degeneration directly paralleled the severity of retrognathia in most cases. We concluded that temporomandibular joint internal derangement is common in cases of mandibular retrusion and leads to the facial morphology in a high percentage of patients. Preoperative temporomandibular joint imaging with MRI is recommended prior to orthognathic surgical correction of retrognathic deformities.

Pneumomediastinum and subcutaneous emphysema associated with temporomandibular joint surgery.

Pneumomediastinum may occur as a result of trauma or surgery of the head and neck. It has been reported in association with various dental procedures and with a variety of maxillofacial surgical procedures. However, this potentially life-threatening problem has not previously been reported in association with temporomandibular joint surgery. This report reviews two cases of pneumomediastinum and subcutaneous emphysema occurring in association with temporomandibular joint surgery and presents an overview of the dental and medical literature concerning this phenomenon occurring in association with injuries and treatment of the maxillofacial complex.

Facial skeleton remodeling due to temporomandibular joint degeneration: an imaging study of 100 patients.

One hundred patients with recently acquired, externally visible mandibular deformity and no history of previous extraarticular mandible fracture were selected for retrospective analysis. All had been investigated clinically and with radiography, tomography, and high-field surface-coil MR imaging to determine the presence or absence and extent of temporomandibular joint degeneration. Temporomandibular joint degeneration was found in either one or both joints of each patient studied. Chin deviation was always toward the smaller mandibular condyle or more diseased joint, and many patients either complained of or exhibited malocclusion, often manifested by unstable or fluctuating occlusion disturbances. Three radiologically distinct forms of degenerative vs adaptive osteocartilaginous processes--(1) osteoarthritis, (2) avascular necrosis, and (3) regressive remodeling--involving the mandibular condyle and temporal bone were identified in joints most often exhibiting meniscus derangement. Osteoarthritis and avascular necrosis of the mandibular condyle and temporal bone were generally associated with pain, mechanical joint symptoms, and occlusion disturbances. Regressive remodeling was less frequently associated with occlusion disturbances, despite remodeling of the facial skeleton, and appears to result from regional osteoporosis. Forty patients (52 joints) underwent open arthroplasty procedures, including either meniscectomy or microsurgical meniscus repair, at which time major radiologic diagnoses were confirmed. Surgical and pathologic findings included meniscus displacement, disk degeneration, synovitis, joint effusion, articular cartilage erosion, cartilage healing/fibrosis, cartilage hypertrophy, osseous sclerosis, osteophyte formation, osteochondritis dissecans, localized or extensive avascular necrosis, and decreased mandibular condyle mass and vertical dimension. We conclude that temporomandibular joint degeneration is the principal cause of both acquired facial skeleton remodeling and unstable occlusion in patients with intact dentition and without previous mandible fracture.

Sinus bradycardia related to temporomandibular joint surgery.

The carotid artery lies in close relationship to the temporomandibular joint (TMJ). Manipulation of the mandible during TMJ surgery has been observed in several cases to be directly associated with the development of sinus bradycardia as the joint is distracted during arthrotomy and arthroplasty procedures. We report several cases and discuss differential diagnosis of sinus bradycardia associated with positional changes of the TMJ. This report emphasizes the importance to the surgeon and to the anesthesiologist of recognition of this cardiac phenomenon, mediated through the trigeminovagal reflex, to appropriately manage the patients during TMJ surgery.

Facial skeleton remodeling due to temporomandibular joint degeneration: an imaging study of 100 patients.

One hundred patients with recently acquired, externally visible mandibular deformity and no history of previous extraarticular mandible fracture were selected for retrospective analysis. All had been investigated clinically and with radiography, tomography, and high-field surface-coil MR imaging to determine the presence or absence and extent of temporomandibular joint degeneration. Temporomandibular joint degeneration was found in either one or both joints of each patient studied. Chin deviation was always toward the smaller mandibular condyle or more diseased joint, and many patients either complained of or exhibited malocclusion, often manifested by unstable or fluctuating occlusion disturbances. Three radiologically distinct forms of degenerative vs adaptive osteocartilaginous processes--(1) osteoarthritis, (2) avascular necrosis, and (3) regressive remodeling--involving the mandibular condyle and temporal bone were identified in joints most often exhibiting meniscus derangement. Osteoarthritis and avascular necrosis of the mandibular condyle and temporal bone were generally associated with pain, mechanical joint symptoms, and occlusion disturbances. Regressive remodeling was less frequently associated with occlusion disturbances, despite remodeling of the facial skeleton, and appears to result from regional osteoporosis. Forty patients (52 joints) underwent open arthroplasty procedures, including either meniscectomy or microsurgical meniscus repair, at which time major radiologic diagnoses were confirmed. Surgical and pathologic findings included meniscus displacement, disk degeneration, synovitis, joint effusion, articular cartilage erosion, cartilage healing/fibrosis, cartilage hypertrophy, osseous sclerosis, osteophyte formation, osteochondritis dissecans, localized or extensive avascular necrosis, and decreased mandibular condyle mass and vertical dimension. We conclude that temporomandibular joint degeneration is the principal cause of both acquired facial skeleton remodeling and unstable occlusion in patients with intact dentition and without previous mandible fracture.

Facial skeleton remodeling due to temporomandibular joint degeneration: an imaging study of 100 patients.

One hundred patients with recently acquired, externally visible mandibular deformity and no history of previous extraarticular mandible fracture were selected for retrospective analysis. All had been investigated clinically and with radiography, tomography, and high-field surface-coil MR imaging to determine the presence or absence and extent of temporomandibular joint degeneration. Temporomandibular joint degeneration was found in either one or both joints of each patient studied. Chin deviation was always toward the smaller mandibular condyle or more diseased joint, and many patients either complained of or exhibited malocclusion, often manifested by unstable or fluctuating occlusion disturbances. Three radiologically distinct forms of degenerative vs adaptive osteocartilaginous processes--(1) osteoarthritis, (2) avascular necrosis, and (3) regressive remodeling--involving the mandibular condyle and temporal bone were identified in joints most often exhibiting meniscus derangement. Osteoarthritis and avascular necrosis of the mandibular condyle and temporal bone were generally associated with pain, mechanical joint symptoms, and occlusion disturbances. Regressive remodeling was less frequently associated with occlusion disturbances, despite remodeling of the facial skeleton, and appears to result from regional osteoporosis. Forty patients (52 joints) underwent open arthroplasty procedures, including either meniscectomy or microsurgical meniscus repair, at which time major radiologic diagnoses were confirmed. Surgical and pathologic findings included meniscus displacement, disk degeneration, synovitis, joint effusion, articular cartilage erosion, cartilage healing/fibrosis, cartilage hypertrophy, osseous sclerosis, osteophyte formation, osteochondritis dissecans, localized or extensive avascular necrosis, and decreased mandibular condyle mass and vertical dimension. We conclude that temporomandibular joint degeneration is the principal cause of both acquired facial skeleton remodeling and unstable occlusion in patients with intact dentition and without previous mandible fracture.

Open reduction of condylar fractions of the mandible in conjunction with repair of discal injury: a preliminary report.

Fractures of the condylar process of the mandible may require open reduction and internal fixation in some instances. In previous reports on the management of such cases, no discussion has focused on the associated soft tissue injuries of the temporomandibular joint. In this article, the authors review their experiences with open reduction of condylar fractures in conjunction with soft tissue reconstruction of the disc and associated structures.

Immunofluorescent detection of actin and myosin in healing gingival epithelium.

Indirect immunofluorescent labeling shows a sequential increase in detectable epithelial cell actin and myosin during wound repair migration and maturation. While actin shows a substantial increase between pre-wound and migration levels, the relative detectable myosin is omnipresent at apparently high levels, and it increases only slightly during active migration.