A preplanned surgical obturator prosthesis for alternative resection lines in the anterior region

A technique is described that enables adaptation of a surgical obturator to accommodate anterior teeth that may or may not be resected with the lesion at surgery. This is designed and fabricated by placing additional clasps on the teeth in question and providing for a clasp on one of the anterior teeth that can be determined at the time of surgery, thereby allowing anterior retention of the obturator immediately postoperatively. This technique is cost-effective and useful, especially if no prosthodontist is available at the time of surgery to perform obturator modifications.     

A consumer health record for supporting the patient-centered management of chronic diseases

OBJECTIVES: To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. METHODS: A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach (formative evaluation) was used to let users (patients and care providers) assess the system leading to incremental changes in the system. RESULTS: The evaluation provided us with sufficient information about which parts of the system needed adaptation. The final consumer health record system was well accepted by patients and care providers. The system is Web-based and is used at home by patients having diabetes. Both care providers and patients enter data. The system can download the data from a glucose meter. It provides feedback to patients on the basis of entered data and incorporated guidelines. It also allows discussion forums. CONCLUSION: Formative evaluation is useful for obtaining feedback from users about prototype systems. Care providers and patients together worked with the consumer health record. Both parties appreciated the system. The approach described here can be used for developing systems for other chronic patient groups.     

ATP release in human kidney cortex and its mitogenic effects in visceral glomerular epithelial cells

BACKGROUND: In chronic renal failure the sympathetic nervous system is activated. Sympathetic cotransmitters released within the kidney may contribute to the progression of renal disease through receptor-mediated proliferative mechanisms. METHODS: In human renal cortex electrical stimulation induced adenosine 5'-triphosphate (ATP; luciferin-luciferase-assay) and norepinephrine (HPLC) release was measured. ATP release also was induced by alpha1- and alpha2-adrenergic agonists. [3H]-thymidine uptake was tested in human visceral glomerular epithelial cells (vGEC) and mitogen-activated protein kinase (MAPK42/44) activation in vGEC and kidney cortex. The involved P2-receptors were characterized pharmacologically and by RT-PCR. RESULTS: Sympathetic nerve stimulation and alpha-adrenergic agonists induced release of ATP from human kidney cortex. Seventy-five percent of the ATP released originated from non-neuronal sources, mainly through activation of alpha2-adrenergic receptors. ATP (1 to 100 micromol/L) and related nucleotides (1 to 100 micromol/L) increased [3H]-thymidine uptake. The adenine nucleotides ATP, ATPgammaS, ADP and ADPbetaS were about equally potent. UTP, UDP and alpha,beta-methylene ATP had no effect. ATP, ADPbetaS but not alpha,beta-methylene ATP activated MAPK42/44. ATP induced MAPK42/44 activation, and [3H]-thymidine uptake was abolished in the presence of the MAPK inhibitor PD 98059 (100 micromol/L). mRNA for P2X4,5,6,7 and P2Y1,2,4,6,11 were detected in human vGEC by RT-PCR. CONCLUSIONS: In human renal cortex, adrenergic stimulation releases ATP from neuronal and non-neuronal sources. ATP has mitogenic effects in vGEC and therefore the potential to contribute to progression in chronic renal disease. The pattern of purinoceptor agonist effects on DNA synthesis together with the mRNA expression suggests a major contribution of a P2Y1-like receptor.     

Calcium solubility of dental enamel following sub-ablative Er:YAG and Er:YSGG laser irradiation in vitro

BACKGROUND AND OBJECTIVE: The objective of the present study was to investigate the effect of sub-ablative Er:YAG (lambda = 2.94 microm) and Er:YSGG (lambda = 2.79 microm) laser radiation on the acid solubility of dental enamel. The influence of fluoride application prior to laser irradiation was additionally evaluated. STUDY DESIGN/MATERIALS AND METHODS: To this end, 294 enamel specimens were prepared from bovine teeth and divided into 14 groups of 21 specimens each. The enamel samples were irradiated in their groups with the Er:YAG and the Er:YSGG laser, using energy densities of 4, 6, and 8 J/cm(2) in each case. Irradiation was additionally repeated in the same way on specimens, which had previously been immersed in 1% sodium fluoride solution for 15 minutes. One group was left untreated and served as a control group. A further group was not irradiated, but only immersed in the 1% fluoride solution for 15 minutes. The enamel specimens were demineralised for 24 hours in an acetate buffer solution. The calcium content in the demineralisation solution was subsequently determined with the aid of atomic absorption spectrometry. RESULTS: The results indicate a decline in calcium solubility after laser irradiation. Compared to the control group, a 20% lower calcium content was detected in the demineralisation solution after irradiation with the Er:YSGG laser at 8 J/cm(2). The difference between the laser-irradiated groups and the untreated control group was, however, not statistically significant. A significantly lower calcium content was found in the demineralisation solution after fluoridation of the specimens. Additional laser radiation had no further effect on this result. CONCLUSIONS: In summary, it can be stated that, although the erbium laser wavelengths apparently have the potential to increase acid resistance, their application solely for caries prevention would not appear to be sensible under the prevailing conditions.     

Diffuse magnetic resonance imaging white-matter changes in a 15-year-old boy with mitochondrial encephalomyopathy

We report a 15-year-old boy who presented with recurrent headaches associated with numbness, confusion, and speech difficulty. Brain magnetic resonance imaging (MRI) revealed diffuse bilateral white-matter hyperintensity on fluid-attenuated inversion-recovery and T2-weighted images in the internal capsule, periventricular and subcortical white matter, base of the pons, and middle cerebellar peduncles. Lesions were isointense on T1-weighted images and nonenhancing. Muscle biopsy showed changes consistent with a mitochondrial myopathy. Mitochondrial respiratory chain enzyme activity analysis revealed a significant reduction in complex II activity. Genetic testing was negative. We conclude that mitochondrial encephalomyopathy may present with unusual diffuse supratentorial and infratentorial white-matter changes on MRI.     

Critical role for GALR1 galanin receptor in galanin regulation of neuroendocrine function and seizure activity

The GALR1 galanin receptor is expressed at high levels within the central nervous system. To determine which specific actions of galanin are mediated by GALR1, we have developed mice with an insertional inactivating mutation within the gene encoding GALR1 (Galr1). Homozygous Galr1-/- mice are viable and capable of breeding. They exhibit no significant difference in growth rate relative to Galr1+/+ controls but have reduced circulating levels of insulin-like growth factor-I (IGF-I) and exhibit spontaneous tonic-clonic seizures. The phenotype of these mice identifies a critical role for GALR1 in neuroendocrine regulation and in mediating the anti-seizure activity of galanin.     

Clinical association of acute lateral ankle sprain with syndesmotic involvement: a stress radiography and magnetic resonance imaging study

BACKGROUND: Information concerning the clinical association between syndesmosis injury and grade of lateral ankle ligament damage would aid in the diagnosis and treatment of ankle sprains. HYPOTHESIS: Evaluation of lateral ligament injury in terms of percentage tear of both the anterior talofibular and calcaneofibular ligaments can provide information on the extent of syndesmotic involvement. STUDY DESIGN: Prospective cohort study. METHODS: Twenty-five patients volunteered to have magnetic resonance imaging examinations performed and 21 volunteered to undergo graded stress radiographs. Talar tilt angles were measured from radiographs taken with 0, 6, 9, 12, and 15 daN of force applied medially just above the ankle joint, and the percentage of ligament tear and grade of injury were determined. Scans were obtained with the foot in neutral and plantar flexion to image the anterior talofibular and calcaneofibular ligaments. RESULTS: Grades of lateral ligament injury determined by magnetic resonance imaging and graded stress radiography were the same. The extent of syndesmotic injury could be assessed for all patients. CONCLUSIONS: Intact tibiofibular ligaments were found equally frequently among patients with normal or any grade of lateral ligament damage, but the more severe injuries to the syndesmotic ligaments were associated with normal or minimally traumatized lateral ligaments. The inverse correlation can be explained on the basis of the difference between the mechanisms that precipitate these injuries.     

Minimally invasive ablative approaches in the treatment of renal cell carcinoma

Ablative techniques for the treatment of renal cell carcinoma (RCC) are an extension of nephron-sparing surgery and include cryoablation, radiofrequency ablation (RFA), and high-intensity focused ultrasound (HIFU). Although experimental, these are evolving treatment modalities. The widespread use of computed tomography scans, ultrasound, and magnetic resonance imaging caused an increase in the diagnosis rate of small renal masses amenable to nephron-sparing surgery. The same imaging modalities permit interactive monitoring both during the delivery of ablative measures and at postoperative followup. Cryosurgery is the most studied of the ablative approaches, and clinical studies have demonstrated promising short-term results and a remarkable safety profile. Long-term studies, however, are needed in order to determine the appropriate selection criteria and to confirm a response as durable as that for partial and radical nephrectomy. More data are needed to evaluate the efficacy of RFA. Currently, preclinical results with HIFU do not justify its use for treating RCC in humans.