Eyes wide shut - unusual two stage repair of pectus excavatum and annuloaortic ectasia in a 37 year old marfan patient: case report

We report about a 37 year old male patient with a pectus excavatum. The patient was in NYHA functional class III. After performed computed tomography the symptoms were thought to be related to the severity of chest deformation. A Ravitch-procedure had been accomplished in a district hospital in 2009. The crack of a metal bar led to a reevaluation 2010, in which surprisingly the presence of an annuloaortic ectasia (root 73 × 74 mm) in direct neighborhood of the formerly implanted metal-bars was diagnosed. Echocardiography revealed a severe aortic valve regurgitation, the left ventricle was massively dilated presenting a reduced ejection fraction of 45%. A marfan syndrome was suspected and the patient underwent a valve sparing aortic root replacement (David procedure) in our institution with an uneventful postoperative course. A review of the literature in combination with discussion of our case suggests the application of stronger recommendations towards preoperative cardiovascular assessment in patients with pectus excavatum.     

Isolation of a novel receptor tyrosine kinase cDNA expressed by developing erythroid progenitors

Activation of distinct receptor tyrosine kinases (RTK), such as the products of the c-fms and c-kit proto-oncogenes, profoundly affects hematopoietic development. We have isolated a novel RTK cDNA, called met-related kinase (MRK), which is expressed on early erythroid progenitors. MRK is also expressed in many hematopoietic cell lines, and is not lineage restricted. Several regions within the catalytic domain of MRK have amino acid similarity to the c-met proto-oncogene and v-sea oncogene. Specific polyclonal anti-MRK antisera detects an 84- Kd polypeptide in COS cells transfected with an expression vector containing the MRK cDNA. Further studies of this novel RTK will provide potential insight into its role during hematopoiesis.     

Skeletally anchored forsus fatigue resistant device for correction of Class II malocclusions—A systematic review and meta-analysis

The use of skeletal anchorage with fixed functional appliances (FFA) has been proposed by various authors to produce skeletal changes and reduce lower incisor proclination. To compare the skeletal and dentoalveolar effects of Forsus Fatigue Resistant Device (FFRD) with or without skeletal anchorage (miniplates and mini-implants). The electronic database PubMed, Cochrane Library, Medline, Embase and Google Scholar along with a manual search of orthodontic journals till the year 2019. Only randomized control trials (RCTs) were included in the systematic review. One controlled clinical trial (CCT) which involved FFRD was included in the review since it was a continuation of an RCT which was expanded to a CCT. Skeletal and dentoalveolar outcome data were extracted to collect study characteristics. After evaluating risk of bias, the standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. Three RCTs and one prospective CCT were evaluated. The analysis included data from 116 Class II subjects [(58) treated with FFA along with skeletal anchorage and (58) treated with FFA]. There were no significant difference between the two groups with respect to mandibular length changes (P value = .10) and SNB angle changes (P value = .22). With respect to lower incisor inclination however, there was a significant difference between the two groups (P value = .005) signifying better results with respect to skeletal anchorage. The studies reviewed provide insufficient evidence to form a conclusion regarding the effects of the use of skeletal anchorage with FFRD. The available weak evidence suggests that the use of skeletal anchorage with FFRD has no superior skeletal effects but is able to reduce proclination of the lower incisors. Control of lower incisor proclination remains the most significant advantage of skeletal reinforcement, and miniplate-anchored FFRD showed more promising results in preventing lower incisor proclination than miniscrew-anchored FFRD.     

The distribution of porcine pancreatic beta-cells at ages 5, 12 and 24 weeks

Jay TR, Heald KA, Carless NJ, Topham DE, Downing R. The distribution of porcine pancreatic beta-cells at ages 5, 12 and 24 weeks. Xenotransplantation 1999; 6: 131-140. ©Munksgaard, Copenhagen Islet transplantation is a potential treatment for diabetes mellitus and porcine pancreata may provide a readily available source of islets. The size, number and distribution of islets within the pancreas may influence the choice of age of donor for xenotransplantation. Samples (n = 3 per age group) from the dorsal and ventral pancreas of 5-, 12- and 24-week-old hybrid pigs were fixed in formal saline, processed in paraffin wax and stained with an avidin/biotin immunohistochemical kit for insulin, glucagon, somatostatin and pancreatic polypeptide. The arrangement of endocrine cells within the pancreata were studied and mean diameter of β-cell groups were measured (from insulin stained sections) in 1 mm² grid areas (n = 10 per section) and collated into groups according to size. Percentage volume density of β-cells in relation to the whole pancreas was calculated and also the distribution of β-cell groups, according to their size, within the total β-cell mass. There were differences in the frequency and arrangement of endocrine cells within islets at the different ages studied. β-Cell groups < 50 µm in diameter occupied 70 to 80% of the total β-cell mass at 5 weeks but, as the age of the pig increased, larger cell groups were more abundant. However, the percentage volume density of β-cells within the total pancreas did not change as the pancreas matured.This study shows that the endocrine porcine pancreas was maturing and its structure changed between the ages of 5 and 24 weeks. The relevance of these findings may have implications on the isolation and function of islets if young pigs are to be used as donors for transplantation as a treatment for diabetes mellitus.     

Eflornithine Cream Combined with Laser Therapy in the Management of Unwanted Facial Hair Growth in Women: A Randomized Trial

BACKGROUND: Eflornithine cream is approved for the reduction of unwanted facial hair in women. The mechanism of action for eflornithine is reduction in follicular cell growth rate, while laser photoepilation heats hair and adjacent tissues to suspend growth. OBJECTIVE: The objective was to assess the efficacy and safety of eflornithine or vehicle with laser therapy in the treatment of unwanted facial hair in women. METHODS: Subjects were randomized to treatment with eflornithine on one side of the face and vehicle on the contralateral side for 34 weeks. Subjects received Nd:YAG or alexandrite laser therapy to both sides of the face at Weeks 2 and 10. Blinded evaluations included left to right comparisons and appearance relative to baseline. RESULTS: Fifty-four women completed the trial. From Weeks 6 through 22, eflornithine-treated sides showed significant reduction in hair growth. By Week 34, no significant differences were seen. Subject grading showed significant and persistent hair reduction through Week 34 for eflornithine-treated sides. The safety profile for combination therapy is similar to eflornithine alone. CONCLUSION: Eflornithine is safely used in conjunction with laser hair removal treatments and promotes more rapid hair removal when combined with laser treatment. Patients demonstrate a clear preference for treatment with laser and eflornithine.