Camel bite: an unusual type of head injury in an infant

Small children are predisposed for animal bite wounds in the craniofacial region, because the likelihood of sustaining trunk and extremity injuries increases with height. The clinical picture of animal bite wounds is highly variable. Depending on the dental anatomy of the biting animal, such wounds may range from sharp stitch wounds to extensive lacerations with or without tissue loss. The ears and nose are injured most often because of their exposed location. Nevertheless, depressed skull fractures with injury to the dura and to the brain parenchyma are extremely rare. This case presentation describes the rare case of a craniocerebral camel bite wound (Lackmann stage IV B) in a 3-year-old girl that required immediate neurosurgical management. The neurosurgical management, choice of antibiotic, postoperative treatment, and clinical course are discussed, and background information on camel bite injuries is given.     

Absence of the genetic variant Val79Met in human chorionic gonadotropin-beta gene 5 in five European populations

Chorionic gonadotropin (CG) is an essential signal in establishment and maintenance of pregnancy in humans and higher primates. A G-to-A transition in exon 3 of human CGbeta gene 5, changing the naturally occurring valine residue to methionine in codon 79 (Val(79)Met) has been reported at carrier frequency 4.2% in a random population from the Midwest of the United States. The biological activity of the variant hCG was similar to that of wild-type (WT) hCG. However, the Val(79)Met beta-subunit displayed impaired ability to assemble with alpha-subunit, and the amount of hCG alpha/beta heterodimers formed and secreted by transfected cells was seriously impaired in the previous study. Because of these functional implications we found it important to study the occurrence of the Val(79)Met hCGbeta variant in other populations. By using a PCR-RFLP method, a search for the Val(79)Met hCGbeta variant was carried out on a total of 580 DNA samples from five European populations (Finland, Denmark, Greece, Germany and the UK). The results demonstrated an absence of the polymorphism in these populations. Hence, the naturally occurring variant (Val(79)Met) of the hCGbeta gene 5, found previously at high frequency in the US, is clearly less common, or absent, in the European populations studied.     

Ultrasonically activated scalpel compared with electrocautery in tonsillectomy

The occurrence of postoperative bleeding, the quantity of operative bleeding and the duration of operation were retrospectively evaluated in 407 patients who underwent tonsillectomy within a 32-month period. They were operated on with either an ultrasonically activated scalpel (UAS), bipolar diathermy (BPD) or blunt dissection with monopolar diathermy (MPD) with the following results. (1) Primary bleeding was more common with MPD: MPD 7.1% vs. BPD 2.4% (p < 0.01) vs. UAS 1.0% (p < 0.001). Secondary bleeding was more common with UAS: UAS 19.6% vs. MPD 14.5% (p < 0.001) vs. BPD 14.5% (p < 0.01). There was no statistical significance in the differences between overall postoperative bleeding rates. (2) There was statistically significantly less operative bleeding with UAS:UAS 24.8 ml vs. MPD 58.7 ml vs. BPD 43.8 ml. (3) On the other hand, the operation time was on average longer with UAS: UAS 32.3 min vs. MPD 18.4 min vs. BPD 22.1 min. Our results suggest that UAS offers no significant advantage over MPD or BPD in tonsillectomy other than minimal operative bleeding possibly due to longer duration of operation.     

Reproductive disturbances,pituitary lactotrope adenomas,and mammary gland tumors in transgenic female mice producing high levels of human chorionic gonadotropin

To assess the consequences of prolonged exposure to elevated levels of LH/human chorionic gonadotropin (hCG) in the female, we developed a transgenic (TG) mouse model (hCGbeta+) that overexpresses the hCGbeta-subunit cDNA. Because of the promoter used, ubiquitin C, the transgene is expressed in multiple tissues, including the pituitary gland, in which coupling with the endogenous common alpha-subunit results in synthesis of high levels of bioactive hCG. The TG females presented with precocious puberty, infertility, enhanced ovarian steroidogenesis, and abnormal uterine structure. Pituitary enlargement was evident from the age of 2 months, which progressed to adenomas by the age of 10-12 months. Immunohistochemical studies and electron microscopy demonstrated lactotrope origin for the adenomas, associated with severe hyperprolactinemia. The mammary glands of TG females showed marked lobuloalveolar development followed by mammary tumors with characteristics of adenocarcinoma at the age of 9-12 months. More than 90% of penetrance and high frequency of metastasis (47%) was observed. Formation of the pituitary and mammary gland tumors was totally abolished by ovariectomy despite persistently elevated hCG levels. Taken together, these findings suggest that the hCG-induced aberrations of ovarian function are clearly responsible for the extragonadal tumors observed in these TG mice.     

Lumbar disc herniation in patients up to 25 years of age

Retrospective analysis of 165 patients (105 males, 60 females) with a mean age of 21.2 years (range 14 to 25 years) of 6933 surgically treated patients from January 1987 to May 1999 focused on age and sex distribution, body mass, familial predisposition, trauma, histology, and clinical course. The incidence of herniated lumbar discs was 2.3% in patients aged up to 25 years. A valid family history was obtained in 121 patients and a positive history was found in 82 of these patients (67.8%). The patients had a higher body mass index compared to a group of individuals with a similar age structure. Radiography demonstrated bony changes in 124 patients (75.2%), primarily attributable to postural deformities such as scoliosis. The condition of the bony structures seems to be more important than the condition of the disc tissue in the occurrence of this disease in young patients.     

Spermine deficiency resulting from targeted disruption of the spermine synthase gene in embryonic stem cells leads to enhanced sensitivity to antiproliferative drugs

Polyamines are known to be essential for normal cell growth and differentiation. However, despite numerous studies, specific cellular functions of polyamines in general and individual polyamines in particular have remained only tentative, because of a lack of appropriate cell lines in which genes of polyamine-synthesizing enzymes have been disrupted by gene targeting. With the use of homologous recombination technique, we disrupted the gene encoding spermine synthase in mouse embryonic stem cells. The spermine synthase gene is located on X chromosome in mouse and, because the cells used in this study were of XY karyotype, a single targeting event was sufficient to result in null genotype. The targeted cells did not have any measurable spermine synthase activity and were totally devoid of the polyamine spermine. Spermine deficiency led to a substantial increase in spermidine content, but the total polyamine content was nearly unchanged. Despite the lack of spermine, these cells displayed a growth rate that was nearly similar to that of the parental cells and showed no overt morphological changes. However, the spermine-deficient cells were significantly more sensitive to the growth inhibition exerted by 2-difluoromethylornithine, an inhibitor of ornithine decarboxylase. Similarly, methylglyoxal bis(guanylhydrazone), an inhibitor of S-adenosylmethionine decarboxylase, and diethylnorspermine, a polyamine analog, although exerting cytostatic growth inhibition on wild-type cells, were clearly cytotoxic to the spermine-deficient cells. The spermine-deficient cells were also much more sensitive to etoposide-induced DNA damage than their wild-type counterparts.     

Motivation for and satisfaction with orthodontic-surgical treatment: a retrospective study of 28 patients

Motivation for starting treatment and satisfaction with treatment results were evaluated on the basis of replies to a 14-item questionnaire and clinical examination of 28 orthognathic patients from 6 months to 2 years after treatment. The most common reasons for seeking professional help were problems in biting and chewing (68 per cent). Another major reason was dissatisfaction with facial appearance (36 per cent). Many patients also complained of temporomandibular joint symptoms (32 per cent) and headache (32 per cent). Women (8/19) were more often dissatisfied with their facial appearance than men (2/9), but the difference was not statistically significant. In agreement with earlier studies, the results of orthognathic treatment fulfilled the expectations of almost every patient. Nearly 100 per cent of the patients (27/28) were satisfied with treatment results, although 40 per cent experienced some degree of numbness in the lips and/or jaw 1 year post-operatively. The most satisfied patients were those who stated temporomandibular disorders as the main reason for seeking treatment and whose PAR-index had improved greatly. The majority of the patients experienced the orthodontic treatment as painful and as the most unpleasant part of the whole treatment, but all the patients were satisfied with the pre-treatment information they were given on orthodontics. Orthodontic-surgical therapy should be of a high professional standard technically, but the psychological aspects are equally important in the treatment protocol. The professionals should make efforts to understand the patient's motivations for and expectations of treatment. Patients should be well prepared for surgery and supported for a long time after to help them to adjust to post-surgical changes.     

A midwife-public-health nurse's work in northern Finland, 1950-87

This paper describes the work of Jouki Nykänen, a midwife-public-health nurse in northern Finland during the years 1950–87. The material for the study was collected by a biographical interview. On the basis of content analysis, the work of the interviewee consisted of the following phases: (i) midwife-public-health nurse in the district of Sevettijärvi (1950–58); (ii) municipal midwife in Pyhäntä (1958–60); and (iii) midwife-public-health nurse in the rural district of Karunki (1962–87). In Sevettijärvi, Jouki’s work emphasised independent planning and implementation. In Pyhäntä, her health-care clinics were well organised. In Karunki, another midwife-public-health nurse working with Jouki made conditions flexible, with personal districts for the two nurses. During home visits, Jouki took care of the whole family, from the grandfather to the baby. The Finnish Public Health Act (1972) changed the character of Jouki’s work. The number of home visits decreased and clinics, fragmented into several fields of health care, took the place of home visits, requiring efficiency and results. The results of the study showed the core of a midwife-public-health nurse’s work in Finland in a changing historical and social context, as well as showing the changes in a midwife-public-nurse’s work since the post-war years.     

Impact of a very low-energy diet on the fecal microbiota of obese individuals

Purpose

Study how the dietary intake affects the fecal microbiota of a group of obese individuals after a 6-week very low-energy diet (VLED) and thereafter during a follow-up period of 5, 8, and 12 months. Additionally, we compared two different methods, fluorescent in situ hybridization (FISH) and real-time PCR (qPCR), for the quantification of fecal samples.

Methods

Sixteen subjects participated in a 12-month dietary intervention which consisted of a VLED high in protein and low in carbohydrates followed by a personalized diet plan, combined with exercise and lifestyle counseling. Fecal samples were analyzed using qPCR, FISH, and denaturing gradient gel electrophoresis.

Results

The VLED affected the fecal microbiota, in particular bifidobacteria that decreased approximately two logs compared with the baseline numbers. The change in numbers of the bacterial groups studied followed the dietary intake and not the weight variations during the 12-month intervention. Methanogens were detected in 56 % of the participants at every sampling point, regardless of the dietary intake. Moreover, although absolute numbers of comparable bacterial groups were similar between FISH and qPCR measurements, relative proportions were higher according to FISH results.

Conclusions

Changes in the fecal microbial numbers of obese individuals were primarily affected by the dietary intake rather than weight changes.