The effects of zygomatic complex fracture on masseteric muscle force.

The masseter muscle often has been implicated as a primary cause of postreduction displacement of the fractured zygomatic complex. However, this contention has never been proved. This study compared masseter muscle force in 10 male controls with that in 10 male patients who had sustained unilateral zygomaticomaxillary complex (ZMC) fractures. Calculation of muscle force was based on measured bite force, electromyogram, and radiographic determination of muscle vectors. It was found that the masseter muscle in patients with ZMC fractures developed significantly less force than masseter muscle in controls. Following fracture, the masseter force slowly increased, but at 4 weeks following surgery the majority of patients were still well below control levels. The results of this study cast uncertainty on the role of the masseter muscle in postreduction displacement of the fractured ZMC.     

HISTOPATHOLOGIC STUDY OF CONJUNC-TIVA IN PATIENTS WITH HYPEREMIA DURING BIMATOPROST THERAPY

Purpose: Conjunctival hyperemia has been reported as a frequent side effect of bimatoprost, a prostamide with efficacious ocular hypotensive action. To investigate the possible inflammatory basis of the hyperemia, we analysed, by means of light microscopy, the conjunctival specimens of patients who developed ocular hyperemia during bimatoprost therapy and who underwent cataract surgery. Methods: Patients were divided in two groups;     

Effect of intervention to improve breastfeeding technique on the frequency of exclusive breastfeeding and lactation-related problems.

This randomized clinical trial compared frequencies of exclusive breastfeeding and lactation-related problems during the first 30 days among 74 mothers who received a 30-minute counseling session on breastfeeding technique in the maternity ward, and 137 controls. The frequency of exclusive breastfeeding among mothers who had received intervention was similar to controls by 7 days (79.7% vs 82.5%, respectively) and 30 days (60.8% vs 53.3%). There was no difference between groups in the frequency of sore nipples at 7 and 30 days, in breast engorgement and mastitis, and in the quality of breastfeeding technique at 30 days. Therefore, a single intervention at maternity was not sufficient to improve breastfeeding technique, increase exclusive breastfeeding rates, and reduce the incidence of breastfeeding problems during the first month.     

Assessment of enamel hypoplasia in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED)

The features of enamel hypoplasia in a small group of patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) are described. Using a recently developed method, the authors evaluated quantitatively the amount of defect in each tooth by measuring the width of the hypoplastic lesions and dividing the value by the crown height. They then assessed the degree of damage in each tooth type (from central incisors to second premolars) and patient. Canines were the most severely affected among maxillary and mandibular teeth, but all tooth types were involved. Analysing both the differences between patients and their age at the beginning of the defect, the authors observe that hypoparathyroidism is not responsible for the onset of enamel hypoplasia in APECED, although it may contribute to the damage.     

Production of immune interferon is regulated by more than one T cell subset: Lyt-1,2,3 and Qat-5 phenotypes of murine T lymphocytes involved in IFN-γ production in primary and secondary mixed lymphocyte reaction

Lymphocytes responsible for the production of IFN-γ (immune interferon) in primary and secondary mixed lymphocyte reactions have been characterized with antisera specific for the Lyt-1,2,3 and Qat-5 alloantigens. A comparison was made between selected T cell subsets with respect to their ability to proliferate, generate cytolytic activity and produce IFN-γ in response to H-2 alloantigens. The data indicate that (a) in primary mixed lymphocyte reactions, IFN-γ is produced by Lyt-1⁺, Qat-5⁺ and by Lyt-123⁺, Qat-5⁺ T cells, (b) in secondary mixed lymphocyte reactions, an additional T cell subset, which is Lyt-23⁺, Qat-5^?, participates in the generation of IFN-γ and (c) the production of IFN-γ does not correlate with either proliferation or the generation of cytotoxic lymphocytes.     

SHAFT syndrome revisited

Wallace aptly described patients with overriding psychological problems and upper extremity complaints as possessing the Shaft syndrome. SHAFT patients studied fell into two categories. The first group inflicted physical harm on themselves, creating factitious injuries. The second group postured their limbs in attitudes that are not explainable anatomically. This latter group is described by Simmons as the clenched fist syndrome. Although patients who had factitious injuries invariably healed with protective casting, 4 patients relapsed. Eight of 14 patients who were employed at the onset of their complaints returned to gainful employment. Some patients received psychological counseling but most lacked sufficient insight to make gainful progress. Reaching a diagnoses was often difficult. At least 5 patients had unwarranted operations. The surgeon needs a high index of suspicion when the history and findings do not match for patients harboring complaints of pain, numbness, stiffness, or inability to use their limb.     

Berengario da Carpi

Berengario da Carpi was magister of anatomy and surgery at the University of Bologna from 1502 to 1527. Eustachio and Falloppia defined him as 'the restaurator of anatomy'. He was a great surgeon, anatomist and physician of illustrious patients including Lorenzo II dei Medici, Giovanni dalle Bande Nere, Galeazzo Pallavicini, Cardinal Colonna, and Alessandro Soderini. He had strong links to the intellectuals of his time (Forni, Bonamici, Manuzio, Pomponazzi) as well as with the Medici family. He was respected by the Popes Julius II, Leo X and Clement VII. His main contributions are the Isogogae Breves, De Fractura calvae sive cranei, and the illustrated Commentaria on the Anatomy of Mondino de Liucci, a textbook utilized for more than 200 years, which Berengario aimed to restore to its initial text. The Commentaria constitutes the material for the last part of this paper which concludes with a personal translation of some passages on 'The kidney', where the author gives poignant examples of experimental ingenuity.