Bilateral multicystic dysplastic kidneys -- an unusual case diagnosed on antenatal ultrasound

While it is true that unilateral multicystic dysplastic kidney is commonly associated with abnormalities in the contralateral kidney, it is not widely known that the condition may be bilateral. The recognition of the bilaterality of the multicystic dysplastic kidney by ultrasound has grave prognostic implications as this condition is uniformly fatal. High resolution ultrasound examination of the foetus enables early detection of congenital malformations of the urinary tract. This information is of value in determining foetalprognosis, in deciding the method of delivery, and in alerting the paediatricians to supportive and corrective measures which may need to be taken in postnatal period.     

Predictors of outcome after acute ischemic stroke

The aim of this study was to determine which variables should be the predictors for clinical outcome at discharge and sixth month after acute ischemic stroke. METHODS: Two hundred and sixty-six consecutive patients, each with an acute ischemic cerebrovascular disease, were evaluated within 24 h of symptom onset. We divided our patients into two groups; 1 - Independent (Rankin scale RS < or = 2) and, 2 - Dependent (RS>3) and death. Baseline characteristics, clinical variables, risk factors, infarct subtypes and radiologic parameters were analyzed. RESULTS: Canadian Neurological Scale (CNS) on admission <6.5 [odds ratio (OR) 22] and posterior circulation infarction (OR 4.2) were associated with a poor outcome at discharge from hospital whereas only a CNS score <6.5 (OR 14) was associated with a poor outcome at 6 months. CONCLUSIONS: Severity of neurologic deficit is the most important indicator for clinical outcome in acute ischemic stroke both at short-term and at sixth month, whereas posterior circulation infarction also predicts a poor outcome at discharge.     

Caspase inhibition enhances ischemic tolerance of fasciocutaneous flaps

OBJECTIVES/HYPOTHESIS: To demonstrate the significance of apoptosis in ischemia-reperfusion injury in revascularized fasciocutaneous flaps and test the hypothesis that pharmacologic inhibition of caspases prolongs the allowable primary ischemia time of these flaps. STUDY DESIGN: Animal study using the epigastric flap in adult male Sprague-Dawley rats. METHODS: Fifty-nine rats were treated with the caspase inhibitor (Q-VD-OPH) reconstituted in dimethylsulfoxide (DMSO) (n = 20, 8 mg/kg:0.8 mL/kg), DMSO alone (n = 19, 0.8 mL/kg), or saline (n = 20, 0.8 mL/kg). Treatment was given as a single intraperitoneal injection 30 minutes before starting primary ischemia. Epigastric flaps were subjected to increasing ischemia times followed by reperfusion. The flaps were harvested and analyzed 7 days later, and viability was assessed. Probit statistical analysis was used to determine the critical ischemia time. This was defined as the time point when 50% of the flaps in each group were expected to survive. RESULTS: The calculated critical ischemia times were 8.92 hours (95% confidence interval 7.19-10.47 h) for the saline group, 16.35 hours (95% confidence interval 11.82-19.89 h) for the DMSO group, and 21.73 hours (95% confidence interval 19.39-25.37 h) for the DMSO with Q-VD-OPH group. These differences were significantly different from each other. CONCLUSIONS: Pretreatment of fasciocutaneous flaps with a free radical scavenger alone or in combination with a caspase inhibitor significantly increases the flap's tolerance of primary ischemia. The added benefit of the caspase inhibitor suggests that apoptosis plays an important role in ischemia-reperfusion injury in soft tissue flaps.     

The evaluation of vertical heights of maxillary and mandibular bones and the location of anatomic landmarks in panoramic radiographs of edentulous patients for implant dentistry

The purpose of this study was to determine variations in the vertical height measurements in the edentulous maxilla and mandible, and to assess positions of the maxillary sinus, mandibular foramen, and the mandibular canal, which are important for implant length selection and planning using panoramic radiographs. The study sample included 346 edentulous alveolar ridges of 90 men and 83 women. Sixty-three dentate patients' panoramic radiographs were used for location of the first premolar and molar area. Panoramic radiographs were made with a Siemens Orthophos panoramic machine which had been standardized previously. All radiographs were made using a standardized manner by the same technician. Fourteen sites were measured on every panoramic radiograph whenever possible, eight sites in the maxilla and six sites in the mandible. Correlation analyses were performed between age groups and all measurements to determine if age is significant as a covariate. In order to examine the effect of gender the statistical analysis of differences between men and women was performed with Student t-test. The 5% significance level was used for statistical significancy. The height of the maxilla and the mandible in the anterior, first premolar, and first molar regions were significantly greater in men than in women. A majority of the most inferior border of the maxillary sinuses was located anterior to the first molar area (premolar regions) both in men (48.9%) and women (55.4%). Although, there was no statistically significant difference between edentulous men and women for the vertical distances from the mental foramen to the alveolar crest, and horizontal distances from mental foramen to midline, there were statistically significant differences between edentulous men and edentulous women for the vertical distances from the upper border of the mandibular canal to the alveolar crest in the first molar area. Mental foramens were located at the crest of the ridge in 7.2% of the edentulous women, and 6.7% of the edentulous men. The results of this study may guide clinicians to make primer decision of implant insertion area for implant supported prosthesis in edentulous patients.     

Cytokine and chemokine levels in radicular and residual cyst fluids

Background:  Cytokines were thought to play an important role for the expansion of odontogenic cysts. The purpose of this study was to evaluate the cytokine and chemokine levels of radicular and residual cyst fluids.
Methods:  Cyst fluids were aspirated from 21 patients (11 radicular and 10 residual cysts) and the levels of interleukin-1 alpha (IL-1α), tumor necrosis factor-alpha (TNF-α), monocyte chemotactic protein-1 (MCP-1), and regulated upon activation normal T cell expressed and secreted (RANTES) were determined by ELISA using commercially available kits.
Results:  Both radicular and residual cyst fluids contained IL-1α, TNF-α, MCP-1, and RANTES, concentrations of which were significantly higher in the radicular cyst fluids than those in the residual cysts ( P  < 0.001 for IL-1α, TNF-α, and RANTES; P  < 0.01 for MCP-1). Compared to the other mediators, the concentration of IL-1α was found to be highest in both of the cyst fluids. In addition, positive correlations were found between IL-1α, TNF-α, MCP-1, and RANTES in radicular and residual cyst fluids.
Conclusion:  If the radicular cyst is inadvertently left behind following tooth extraction, some degree of inflammation may carry on. Residual cysts, although to a lesser extend than radicular cysts, have the potential to expand.