[Transoral approach for sublingual-plunging ranula]. / Transoraler Zugang bei sublingualer Tauchranula.

The case of a 7-year-old boy suffering from progressive submental/submandibular swelling is reported. Following clinical and imaging diagnostics (MRI), the suspected diagnosis of a sublingual-plunging ranula was made. Surgery was performed with transoral excision of the sublingual gland in combination with excision of the ranula. Additional submandibular gland excision should be avoided.

Magnetic resonance imaging: a useful tool to distinguish between keratocystic odontogenic tumours and odontogenic cysts.

In contrast to odontogenic cysts, keratocystic odontogenic tumours often recur and require more aggressive surgical treatment, so we tried to find features that distinguished between them on magnetic resonance imaging (MRI). Without knowing the diagnosis, two radiologists reviewed intensity (low, intermediate, or high) and homogeneity (homogeneous or heterogeneous) of signals in short-tau-inversion-recovery (STIR), T1- and T2-weighted, and fat-suppressed, contrast-enhanced MRI in 20 consecutive patients with oval, radiolucent lesions of the mandible on panoramic radiography, and who were subsequently confirmed histopathologically to have either an odontogenic cyst or a keratocystic odontogenic tumour (n=10 in each group). Fisher's exact test was statistically significant at p<0.05. Delineation of a contrast-enhanced wall of a cyst with high signal intensity distinguished odontogenic cysts (9/10 and 8/10, respectively) from keratocystic odontogenic tumours (3/10, p=0.02, and 1/10, p=0.01, respectively). One radiologist found odontogenic cysts were more likely to be homogeneous on unenhanced T1-weighted images (odontogenic cysts 9/10, keratocystic odontogenic tumours 3/10, p=0.02) and one on contrast-enhanced MRI, when the cyst wall was enhanced (odontogenic cysts 7/9, keratocystic odontogenic tumours 0/3, p=0.01). There were no other significant distinguishing features on MRI. In conclusion, the signal intensity of the enhanced wall seems to be a feature on contrast-enhanced MRI that differentiates odontogenic cysts from keratocystic odontogenic tumours.

[Craniofacial augmentation with porous polyethylene implants (Medpor: first clinical results]. / Gesichtsschädelaugmentationen mit porösen Polyethylenimplantaten (Medpor): Erste klinische Ergebnisse.

SUBJECT: Porous polyethylene (Medpor) is an alloplastic material commonly used in craniofacial reconstruction. We report about our first clinical experiences with Medpor for facial augmentation procedures. PATIENTS AND METHODS: We treated 27 patients between 2001 and 2005 (11 female, 16 male) with 48 Medpor-implants. The indications for application of porous polyethylene implants in our clinic were congenital malformations (15), post-traumatic defects (10), and reconstructions after tumor resection (2). The implants were used for nasal/paranasal augmentations (16), for zygomatico-orbital augmentations (18), and for augmentations of the chin and malar region (11). The procedures were performed in a standardized manner. We used prefabricated, self-contoured implants and fixed them subperiosteally with titanium osteosynthesis screws. All operations were performed under general anesthesia. We evaluated the aesthetic results and the ingrowth behavior clinically and histologically. RESULTS: We achieved good aesthetic results and the patients showed no signs of discomfort or rejection. Four patients required a second intervention. These revision surgeries included two cases of local infections and two for aesthetic contouring. The necessary reduction of the implants allowed the harvesting of tissue and implant samples for microscopy. CONCLUSION: Porous polyethylene implants showed a good fibrovascular integration without encapsulation under the light microscope. Giant cells were detected on the surface of the implants. Besides this there was evidence for resorption of the implant material. Fixation with titanium screws is very effective. No implant dislocation or implant fracture occurred. The implants showed high volume stability and were easily handled and contoured. It is not possible to visualize Medpor implants with current imaging techniques, because polyethylene shows no contrast.

Unique regulation of carbohydrate chemotaxis in Bacillus subtilis by the phosphoenolpyruvate-dependent phosphotransferase system and the methyl-accepting chemotaxis protein McpC.

The phosphoenolpyruvate-dependent phosphotransferase system (PTS) plays a major role in the ability of Escherichia coli to migrate toward PTS carbohydrates. The present study establishes that chemotaxis toward PTS substrates in Bacillus subtilis is mediated by the PTS as well as by a methyl-accepting chemotaxis protein (MCP). As for E. coli, a B. subtilis ptsH null mutant is severely deficient in chemotaxis toward most PTS carbohydrates. Tethering analysis revealed that this mutant does respond normally to the stepwise addition of a PTS substrate (positive stimulus) but fails to respond normally to the stepwise removal of such a substrate (negative stimulus). An mcpC null mutant showed no response to the stepwise addition or removal of D-glucose or D-mannitol, both of which are PTS substrates. Therefore, in contrast to E. coli PTS carbohydrate chemotaxis, B. subtilis PTS carbohydrate chemotaxis is mediated by both MCPs and the PTS; the response to positive stimulus is primarily McpC mediated, while the duration or magnitude of the response to negative PTS carbohydrate stimulus is greatly influenced by components of the PTS and McpC. In the case of the PTS substrate D-glucose, the response to negative stimulus is also partially mediated by McpA. Finally, we show that B. subtilis EnzymeI-P has the ability to inhibit B. subtilis CheA autophosphorylation in vitro. We hypothesize that chemotaxis in the spatial gradient of the capillary assay may result from a combination of a transient increase in the intracellular concentration of EnzymeI-P and a decrease in the concentration of carbohydrate-associated McpC as the cell moves down the carbohydrate concentration gradient. Both events appear to contribute to inhibition of CheA activity that increases the tendency of the bacteria to tumble. In the case of D-glucose, a decrease in D-glucose-associated McpA may also contribute to the inhibition of CheA. This bias on the otherwise random walk allows net migration, or chemotaxis, to occur.