Enamel matrix proteins in the treatment of periodontal sites with horizontal type of bone loss

OBJECTIVES: The present study aims to assess the clinical and radiographic outcome of horizontal type of bone loss over a period of 8 months following periodontal surgery with adjunctive use of enamel matrix proteins (EMP). MATERIALS AND METHODS: Twenty patients, who received nonsurgical periodontal therapy and had radiographic horizontal bone loss with an associated probing depth (PD) of > or =4 mm at the maxillary incisor/canine segment, were included. One side of the selected segment divided by the mid-sagittal plane was treated with EMP as part of a crevicular flap. The other side was treated either with a similar intracrevicular (ICI) or a reverse bevel incision (RBI) as part of a conventional flap debridement. Therefore, patients were divided into two groups of 10 patients according to the type of incision performed on the control side. The analysis was based on a classification of two severity groups according to preoperative PD, with the patient's means of measurements for each treatment being the experimental units for the statistical analysis. RESULTS: For pockets of 4-6 mm, EMP treatment was significantly better than the ICI/flap debridement in terms of PD reduction (p<0.001), relative attachment level (RAL) gain (p<0.001) and recession (REC) (p<0.05). Although sites exposed to EMP treatment exhibited significantly greater RAL gain than RBI/flap debridement sites (p<0.01), both treatments resulted in equally effective PD reduction. Less REC occurred with EMP application than with ICI-RBI/flap debridement (p<0.05). Treatment of shallow sites by the conventional flap with both incisions resulted in a tendency for loss of attachment whereas EMP treatment maintained the attachment levels. No significant difference in the degree of probing and radiographic bone levels was found between the treatments. CONCLUSION: EMP treatment showed better clinical improvements as compared to the conventional flap debridement performed with two different incisions. Clinical improvements were more pronounced at periodontal sites with deep, rather than shallow, periodontal pockets. The results of this study provided an important preliminary base for further clinical and histologic studies.     

Breast cancer: regional blood flow and blood volume measured with magnetic susceptibility-based MR imaging--initial results

The purpose of this study was to quantify microcirculation in breast neoplasms with magnetic susceptibility-based contrast material-enhanced magnetic resonance imaging. With this imaging method for invasive cancers, the mean values of the ratios of tumor to normal blood flow and blood volume were significantly higher (P <.002) than those for benign or normal tissue. The method allows independent measurement of regional blood flow and blood volume in breast cancers.     

The effect of intraoperative colonic lavage withN G -nitro-l-arginine methyl ester (l-NAME) on anastomotic healing in the presence of left-sided colonic obstruction in the rat

-arginine methyl ester (L-NAME) on the healing of colonic anastomosis in the presence of a left-sided obstruction in the rat was investigated. Left-sided colonic obstruction was created in 144 Wistar rats. The obstruction site was excised 24 h later and anastomosis was performed after either no irrigation or colonic lavage with either saline, povidone iodine (PI), short-chain fatty acids (SCFA), L-NAME, or glutamine, in 24 animals each. Animals were killed on days 3 and 6, and a 4-cm colonic segment with the anastomosis at the center was excised. Bursting pressure (BP) and hydroxyproline (HP) content were measured. In the saline, PI, and SCFA groups, BP was higher (P < 0.05, P < 0.05, and P < 0.001, respectively) and HP concentration was similar compared with controls. Both the BP and HP concentrations were higher in the glutamine group compared with controls (P < 0.001). BP was lower (P < 0.05) and HP concentration was similar in the L-NAME group compared with the control group. Colonocyte nutrition and tissue perfusion are the mainstays of anastomotic healing. Intraoperative colonic lavage with L-NAME suppresses colonic anastomotic healing in the presence of a left-sided obstruction. (Received for publication on Mar. 29, 1999; accepted on Nov. 11, 1999)     

Local Recurrence After Laparoscopic Radiofrequency Thermal Ablation of Hepatic Tumors

Background: Since we first described laparoscopic radiofrequency ablation (LRFA) of liver tumors, several reports have documented technical and safety aspects of this procedure. Little is known, however, about the long-term follow-up of such patients.Methods: From January 1996 to February 1999, we performed LRFA on 250 liver tumors in 66 patients. Triphasic spiral computed tomographic scanning was obtained preoperatively and at 1 week, and every 3 months postoperatively. Lesion diameter was measured in the x- and y-axes and the volume estimated; 181 lesions in 43 patients for whom computed tomographic scans available were included in the study. The tumor types were as follows: 64 metastatic adenocarcinomas, 79 neuroendocrine metastases, 27 other metastases, and 11 primary liver tumors.Results: One week postoperatively, the ablated zone was larger than the original tumor in 178 of 181 lesions, which suggests ablation of the tumor and a margin of normal liver tissue. A progressive decline in lesion size was seen in 156 (88%) of 178 lesions, followed for at least 3 months (mean, 13.9 months; range, 4.9–37.8 months), which suggests resorption of the ablated tissue. Fourteen definite local treatment failures were apparent by increase in size and change in computed tomographic scan appearance, and eight lesions were scored as failures because of multifocal recurrence that encroached on ablated foci (22 total recurrences). Predictors of failure include lack of increased lesion size at 1 week (2 of 3 such lesions failed), adenocarcinoma or sarcoma (18 of 22 failures; P < .05), larger tumors (failures, M < 18cm³ vs. successes, M < 7cm³; P < .005) and vascular invasion on laparoscopic ultrasonography. By size criteria, 17 of 22 failures were apparent by 6 months. Energy delivered per gram of tissue was not significantly different (P < .45).Conclusions: LRFA has a 12% local failure rate, with larger adenocarcinomas and sarcomas at greatest risk. Failures occur early in follow-up, with most occurring by 6 months. LRFA seems to be a safe and effective treatment technique for patients with primary and metastatic liver malignancies.Presented at the 52nd Annual Meeting of the Society of Surgical Oncology, Orlando, Florida, March 4–7, 1999     

Total scalp replantation based on one artery and one vein

A successful replantation of a totally avulsed scalp, including both eyebrows, with only one arterial and one venous anastomosis to the superficial temporal vessels is described. Apart from a small partial skin necrosis of the right eyebrow, the entire transplant survived. Subsequently, the patient required only minor additional skin grafting, correction of scars with a skin expander, and reconstruction of the eyebrow with hair micrografts. Replantation of the total scalp based on two or more vessels has previously been recommended and reported elsewhere. In the present case, complete survival of the scalp on only one artery and one vein was demonstrated, indicating that replantation should be considered even if available vessels for anastomosis are minimal. © 1993 Wiley-Liss Inc.     

An asymptomatic ruptured hepatic hydatid cyst case presenting with subdiaphragmatic gas in a traumatic patient

Hydatid disease presents as hydatid cysts primarily in the liver and lungs. Although hepatic hydatid cysts (HHCs) may be asymptomatic for many years, they may be symptomatic due to expansion, rupture, and pyogenic infection. Rupture of the HHC into the biliary tract is one of the most serious complications and is frequently related to overenlargement of the cyst or major trauma. Patients with this disease usually have jaundice or fever. We report an asymptomatic HHC ruptured after minor trauma. While the ruptured cyst was presented as the subdiaphragmatic gas on the chest radiography, it was detected as a large cyst with multiple daughter cysts on ultrasound, computed tomography scan, and magnetic resonance imaging.     

Physiologic changes in breast magnetic resonance imaging during the menstrual cycle: perfusion imaging, signal enhancement, and influence of the T1 relaxation time of breast tissue

This study was undertaken to determine the best time during the menstrual cycle to perform dynamic breast magnetic resonance imaging (MRI). The contralateral "normal" breast of 50 premenopausal women (mean age 40.4 +/- 6.4 years, range 30--52 years) were enrolled in a protocol designed to correlate an ipsilateral suspicious breast lesion with pathology. The contralateral breast in each patient was examined with palpation and mammography prior to MRI on a 1.5 T scanner using gradient echo and dynamic contrast-enhanced echo-planar without and following gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) injection. Pre-contrast T1 relaxation times were measured before calculating extraction flow product (EFP) maps using a multicompartmental model. T1, EFP, and enhancement were measured in the control breast on four slices centered around the nipple and recorded as a function of the phases of the menstrual cycle. Lesions or areas with focal enhancement were excluded. Analysis of variance and Fisher's tests were performed. The cyclic changes in T1 relaxation time were not significant (p>0.2). EFP and enhancement varied significantly during the cycle (p<0.003 and p<0.004, respectively), with low values during the first half of the cycle and high values during the second half. The lowest values of EFP and enhancement (5.5+/-2.9 ml/100 g/min and 26+/-17%) were observed during the proliferative phase (days 3--7), and the highest values (17+/-10.2 ml/100 g/min and 104+/-28%) were observed during the secretory phase (days 21-27) (p<0.0006 and p<0.0008, respectively). Dynamic breast MRI should be performed during first half of the menstrual cycle (days 3--14) in order to minimize interpretative difficulties related to the uptake of gadolinium in normal breast tissue due to hormonal fluctuations during the menstrual cycle.