Parapharyngeal lipoma.

Lipomas of the parapharyngeal space provide both a diagnostic and therapeutic challenge. They are extremely rare with only a few cases having been reported. We present the case of a right parapharyngeal space lipoma in a 69-year-old man that was excised via a transcervical approach.

VELACS project : A summary of achievements

In a collaborative and unprecedentent effort, seven major universities from United States and England studied the liquefaction phenomena and its consequences by conducting extensive centrifuge tests on nine carefully selected centrifuge models. In addition, more than 20 groups of researchers from all over the world participated in a Class-A prediction exercise to predict the response of centrifuge models before they were conducted. This paper summarizes the lessons learned from the VELACS project in relation to repeatability of centrifuge models and perfomance of the existing numerical procedures in analyzing soil liquefaction and its consequences.(AU)

Multiple central giant cell lesions with a Noonan-like phenotype.

A small number of patients with the phenotypic features of Noonan syndrome have also developed giant cell lesions of the jaws similar to those seen in cherubism. This case report describes an individual with the features of the recently described Noonan-like/multiple giant cell lesion syndrome. Previously reported cases and issues relative to diagnosis and management are considered.

The Dentofacial Deformity Program of the University of Michigan: organization, analysis of data, and benefits of program.

The Dentofacial Deformity Program of the University of Michigan was established in 1984 to provide a consulting service for the diagnosis, treatment recommendations, and management of patients with dentofacial deformities. This program was designed as a service commitment for the patient, referring doctors, and the medical and dental communities. Educational and research aspects of the program provide benefits for orthodontic and oral and maxillofacial surgery graduate students, and the dental school faculty. The organization, data analysis, and education, research, and service benefits of this program are discussed.

A technique for evaluating bony changes in the anterior edentulous maxilla: a modification of a cephalometric analysis.

A modification of a cephalometric analysis is presented for evaluating maxillary bone loss in the edentulous maxilla. The analysis involves tracing a lateral cephalometric radiograph of an edentulous maxilla, identifying the new landmarks, and measuring the appropriate vertical and horizontal distances of the maxilla. Comparison of the measurements for the patient's initial or baseline radiographic analysis with those of the patient's follow-up radiographic analysis identifies the amount of bone loss that has occurred between the two examinations.

Epizootiology and distribution of transmissible sarcoma in Maryland softshell clams, Mya arenaria, 1984-1988.

Seasonal and geographic studies of transmissible sarcoma in Maryland softshell clams, Mya arenaria, were carried out from 1984 to 1988. Three major epizootics occurred in our sampling location during this time, resulting in prevalences as high as 90%, with comparable mortalities in other high prevalence areas. The disease invaded populations of large adult clams first, later spreading to the small juvenile clam populations. An apparent 2-year cycle was noted with varying seasonal effects. Affected sites tended to be in the main stem of Chesapeake Bay north of Tangier Sound, primarily in the areas where the major harvesting occurs. Several sites, mostly in upstream locations, were consistently free of disease. The epizootiological study supports the interpretation that the disease is infectious exclusively to this species. Regression analysis between sarcoma prevalence and contaminant levels in clam tissues showed a significant correlation (p = 0.0001) between chlordane levels and this disease. No correlations were found with other contaminants that were analyzed.

A screening and alerting questionnaire for parkinsonism.

A self-administered eight-symptom questionnaire on parkinsonism was completed by 35 patients known to have parkinsonism and 88 controls independently selected by a local general practice. The presence of shaking and difficulty opening things/doing small buttons were the commonest positive responses among the cases (27/35). While a shuffling walk and difficulty turning in bed were the least frequent positive responses among the cases, they were also the two questions least likely to be positive in the control group. The question on shaking was the most discriminating between cases and controls. When the question on a shuffling walk was added, a positive answer to questions correctly identified 91% of cases and 92% of controls. These questions can form the basis of an alerting/screening questionnaire for parkinsonism and could be useful in screening smaller targeted populations such as a general practice list.

Evaluation of anterior maxillary alveolar ridge resorption when opposed by the transmandibular implant.

Fifteen edentulous patients with complaints regarding denture comfort and/or function were treated with the transmandibular implant. All patients were restored with conventional maxillary dentures opposed by implant-supported removable prostheses. Two to 4 years after surgery, these patients were evaluated for vertical and horizontal maxillary bone loss with a radiographic analysis developed by the authors. With this technique, attention was focused on vertical alveolar ridge resorption in the anterior maxilla. Although the sample size was small, the findings from this study indicate that vertical bone loss in the anterior maxilla does occur when a maxillary denture is opposed by an implant-supported overdenture. Comparison of these results with a previous study that evaluated anterior maxillary resorption when a complete maxillary denture opposed natural mandibular anterior teeth and a distal extension removable partial denture demonstrated no statistically significant difference.

Prosthodontic considerations for the transmandibular implant.

The transmandibular implant has been designed to provide the patient with a severely atrophic mandible an implant that will bear the masticatory load. Thirteen edentulous patients treated with maxillary complete dentures and mandibular overdentures retained by the transmandibular implant were examined biannually for 2 years. Prosthodontic complications included the development of parafunctional habits, "combination syndrome," and epulis in association with the mandibular denture. Surgery was necessary to control chronic mucosal irritation related to muscle pull in one patient. Among the soft tissue parameters, plaque index, gingival index, and sulcus depth demonstrated statistically significant correlations (Spearman). All patients reported an absence of discomfort and those with previous functional complaints reported the ability to masticate all foods. Patient response to overdenture reconstruction with the transmandibular implant seems to be similar to that observed with the combination case. Oral hygiene appears to be directly related to the soft tissue response.

Management of oral squamous cell carcinoma in situ with topical 5-fluorouracil and laser surgery.

Oral squamous cell carcinoma in situ has been described as a relatively rare lesion. However, difficult decisions with respect to clinical management of the lesion in this location parallel those reported for other mucosal sites, such as the cervix or the larynx. The lesion, though superficial, may extend over a large area of tissue, and attempts at irradication with surgery or radiation therapy may be associated with a great deal of morbidity. However, the risks in deferral of treatment while "watchfully waiting" may also be unacceptable. A method and rationale for management of oral squamous cell carcinoma in situ with the use of topical 5-fluorouracil and carbon dioxide laser are described in this article. A technique for using an intraoral prosthesis to potentiate drug delivery is also described. Though morbidity can be very significantly reduced, patient compliance is an important consideration for success with this protocol.

The transmandibular implant: a 2-year prospective study.

Thirteen consecutive patients with complaints of dysfunction and pain associated with a mandibular denture were treated with the transmandibular implant. The implant was placed from a submental approach with an atraumatic surgical technique. No load was placed on the implant for 12 weeks. Patients were evaluated for pain, paresthesia, healing of the submental wound, soft tissue response, radiographic change, and mobility of the implant for a period of 2 years. Patient satisfaction was recorded at the 1- and 2-year examinations. The results demonstrate the reliability and reparability of the transmandibular implant system.

Ultrasonography of the advanced tuberculous kidney.

Ultrasonography is a quick and non-invasive method of evaluating the kidney which cannot be seen on excretory urography. If advanced renal tuberculosis is the reason, then ultrasonography is frequently diagnostic.

A study of the utility of measuring mandibular mobility by means of the interincisal dimension.

The purpose of this investigation was to determine the reliability of using the interincisal dimension as a measure of mandibular range of motion. Thirty patients who underwent mandibular advancement and 15 patients who underwent mandibular setback were included in this study. Preoperatively, a lateral cephalogram in centric relation and a second cephalogram with the mandible at maximum voluntary gape were obtained. Immediately following surgery, another centric relation cephalogram was obtained. A composite tracing of the two preoperative tracings was made to show how the mandible changed in position from the closed-mouth to the open-mouth radiographs. The proximal segment (ramus) of the postoperative cephalogram was then superimposed on the open-mouth mandibular ramus, and the distal segment of the postoperative mandible was drawn. This composite produced a tracing of what the postoperative maximal gape cephalogram would be if the same amount of condylar rotation and translation as in the preoperative tracing had occurred. The preoperative interincisal dimension was recorded on the composite tracings (factoring in any overbite or openbite) as was the would-be postoperative interincisal dimension. These measures were compared using the paired t test and Pearson's correlations to determine if there were any significant differences between them. The results showed that the interincisal dimension is a fairly reliable measure of mandibular mobility even when the length of the mandible is altered with surgery.

Endothelial cell denudation, labelling indices and monocyte attachment in advanced swine coronary artery lesions.

This study shows that frank endothelial denudation, as measured by scanning electron microscopy, is associated with coronary artery atherosclerotic lesions in swine fed hyperlipidemic diets for 9 or 18 months. The largest areas of endothelial cell denudation were found to be associated with the most advanced atherosclerotic lesions, and lesser areas of denudation were present in less severely atherosclerotic arteries. Overall, the study suggests that frank endothelial denudation in swine coronaries occurs secondarily to advanced lesion development, and is proportionate to the amount of lesion present. In contrast attachment of monocytes to the endothelial surface was not proportionate to the amount of lesion present. While the number of attached monocytes after 9 or 18 months of a hyperlipidemic diet was much greater than in the mash-fed swine, there was no difference between the two hyperlipidemic groups. In both hyperlipidemic groups, the attached monocytes were concentrated over lesion areas. By scanning electron microscopy, most attached monocytes in these perfused coronary arteries showed a slender foot process extending into a gap between endothelial cells. Endothelial cell turnover, as measured by tritiated thymidine labelling indices, increased with the amount of coronary artery atherosclerosis. However, it did not become significantly greater than in mash-fed swine until advanced lesions developed.

Persistent cemento-ossifying fibroma of the mandible: report of a case and review of literature.

This case report describes an unusual recurrence of a cemento-ossifying fibroma and illustrates the diagnostic difficulties that may be encountered when treating fibro-osseous lesions.