Implant-retained prostheses for facial defects: an up to 14-year follow-up report on the survival rates of implants at UCLA

PURPOSE: An analysis of retrospective data was conducted to establish the survival rates of osseointegrated implants used to retain orbital, nasal, and auricular prostheses over a 14-year period and to recommend guidelines in the restorative treatment of such facial defects. MATERIALS AND METHODS: Included in this study were all patients who received implant-retained prostheses for auricular, nasal, or orbital defects from 1987 to 2001 in the Maxillofacial Clinics at the UCLA and City of Hope Medical Centers. Data were obtained from patient charts. Two methods were used to determine survival rates: (1) the percentage of the total exposed implants that survived was determined, and (2) life table analysis was used to calculate cumulative survival rates at different time intervals. RESULTS: A total of 207 implants were placed in 72 patients, and 182 implants had been uncovered. During the study period, 35 implants failed to integrate, and the survival rate for all exposed implants was 80%. Auricular implants showed the highest survival rate (95%), and orbital implants showed the lowest survival rate (53%). The life table analysis demonstrated a cumulative 6-year survival rate of 92% for auricular implants and 87% for piriform/nasal implants. In contrast, the survival rate for orbital implants showed a steady downward trend and reached 59% at 66 months. CONCLUSION: It is possible to achieve high survival rates of implants in the auricular and piriform/nasal sites through careful presurgical and radiographic planning. The less favorable long-term survival of implants in the orbital rim, especially at irradiated sites, requires further study.     

Differential long-term effects of MDMA on the serotoninergic system and hippocampal cell proliferation in 5-HTT knock-out vs. wild-type mice

Although numerous studies investigated the mechanisms underlying 3,4-methylenedioxymethamphetamine (MDMA)-induced neurotoxicity, little is known about its long-term functional consequences on 5-HT neurotransmission in mice. This led us to evaluate the delayed effects of MDMA exposure on the 5-HT system, using in-vitro and in-vivo approaches in both 5-HTT wild-type and knock-out mice. Acute MDMA in-vitro application on slices of the dorsal raphe nucleus (DRN) induced concentration-dependent 5-HT release and 5-HT cell firing inhibition. Four weeks after MDMA administration (20 mg/kg b.i.d for 4 d), a 2-fold increase in the potency of the 5-HT1A receptor agonist ipsapirone to inhibit the discharge of DRN 5-HT neurons and a larger hypothermic response to 8-OH-DPAT were observed in MDMA- compared to saline-treated mice. This adaptive 5-HT1A autoreceptor supersensitivity was associated with decreases in 5-HT levels but no changes of [3H]citalopram binding in brain. Long-term MDMA treatment also induced a 30% decrease in BrdU labelling of proliferating hippocampal cells and an increased immobility duration in the forced swim test suggesting a depressive-like behaviour induced by MDMA treatment. All these effects were abolished in 5-HTT-/- knock-out mice. These data indicated that, in mice, MDMA administration induced a delayed adaptive supersensitivity of 5-HT1A autoreceptors in the DRN, a deficit in hippocampal cell proliferation and a depressive-like behaviour. These 5-HTT-dependent effects, opposite to those of antidepressants, might contribute to MDMA-induced mood disorders.     

Mandibular lesions of vasoocclusive origin in sickle cell hemoglobinopathy

Sickle cell hemoglobinopathy is an inherited disorder characterized by vasoocclusive crises. Involvement of the maxillofacial skeleton leading to radiopaque lesions that correspond to bone infarcts has rarely been reported in the literature. Forty-two adult patients suffering from sickle cell anemia were examined radiographically for radiopaque lesions situated in the course of a known vessel or in the apical region of the teeth. In 6 cases, such lesions were combined with facial pain during sickle cell crisis and absence of dental pathology and were considered to be of possible vasoocclusive origin. In conclusion, vasoocclusive involvement should be taken into consideration when assessing painful episodes or neurological symptoms in the maxillofacial region in this patient population.     

Comparison of abdominal adiposity and overall obesity in relation to risk of small intestinal cancer in a European Prospective Cohort

Background

The etiology of small intestinal cancer (SIC) is largely unknown, and there are very few epidemiological studies published to date. No studies have investigated abdominal adiposity in relation to SIC.

Methods

We investigated overall obesity and abdominal adiposity in relation to SIC in the European Prospective Investigation into Cancer and Nutrition (EPIC), a large prospective cohort of approximately half a million men and women from ten European countries. Overall obesity and abdominal obesity were assessed by body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Multivariate Cox proportional hazards regression modeling was performed to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). Stratified analyses were conducted by sex, BMI, and smoking status.

Results

During an average of 13.9 years of follow-up, 131 incident cases of SIC (including 41 adenocarcinomas, 44 malignant carcinoid tumors, 15 sarcomas and 10 lymphomas, and 21 unknown histology) were identified. WC was positively associated with SIC in a crude model that also included BMI (HR per 5-cm increase = 1.20, 95 % CI 1.04, 1.39), but this association attenuated in the multivariable model (HR 1.18, 95 % CI 0.98, 1.42). However, the association between WC and SIC was strengthened when the analysis was restricted to adenocarcinoma of the small intestine (multivariable HR adjusted for BMI = 1.56, 95 % CI 1.11, 2.17). There were no other significant associations.

Conclusion

WC, rather than BMI, may be positively associated with adenocarcinomas but not carcinoid tumors of the small intestine.

Impact

Abdominal obesity is a potential risk factor for adenocarcinoma in the small intestine.

     

Pneumopericardium after blunt chest trauma: mechanical ventilation with positive pressure must be avoided

A 38-year-old polytraumatized man was admitted with signs of cardiogenic shock (low blood pressure, tachycardia, tachypnea, and elevated central venous pressure). A near tension pneumopericardium was revealed by thorax CT. Air from the pericardial sac remissed 4 days later conservatively, avoiding invasive or non-invasive mechanical ventilation. The use of positive-pressure ventilation, with or without intubation, would probably lead to tension pneumopericardium-cardiac tamponade, needing emergent decompression.     

Cardiogenic and aortogenic brain embolism

Cardioaortic brain embolism is a potentially devastating condition that presents frequent diagnostic and therapeutic challenges. In this report, we review key aspects of the etiology, clinical presentation, diagnosis, prognosis, and treatment of cardiogenic and aortogenic stroke. Emphasis is on advances in diagnostic imaging capabilities and on recent literature addressing secondary prevention for specific cardioembolic sources, upon which diagnosis and prognosis primarily depend. While early evaluation with modern neuroimaging techniques offers to enhance diagnostic accuracy, additional study is required to define optimal utilization. Appropriate imaging of the heart and aorta is paramount to identifying potential sources of embolism. Secondary prevention for high-risk embolic sources generally involves anticoagulation, but immediate initiation of anticoagulation is not routinely indicated. Medium-risk sources have more modest or undefined risks and little randomized comparative evidence to guide management, but antiplatelet therapy is generally favored. One possible exception is patent foramen ovale, for which high-risk features may warrant anticoagulation or mechanical closure. Definitive recommendations for this and other findings await completion of ongoing clinical trials.     

Chronic valproate normalizes behavior in mice overexpressing calcineurin

Calcineurin (PP2B) is a Ca(2+)-dependent protein phosphatase enriched in the brain that takes part in intracellular signaling pathways regulating synaptic plasticity and complex brain functions. We report here that when these pathways are activated by transgenic expression of calcineurin, locomotor activity of mice in response to novelty is increased, as well as the behavioral and molecular responses of the psychostimulant cocaine. We also observed that the anxious-like behavior is altered. These behavioral changes are indicative of a generally increased behavioral responsiveness and could be normalized by chronic treatment with the mood stabilizer valproate. These results provide proof of concept that calcineurin-dependent dephosphorylation plays an important role in behavioral reactivity and in the effects of mood regulators. Mice overexpressing calcineurin represent a novel tool to study affective responses related to psychiatric disorders.     

Influence of the habitat altitude on the (proto)hypericin and (proto)pseudohypericin levels of hypericum plants from Crete

Environmental factors are known to influence strongly the accumulation of secondary metabolites in plant tissues. In a previous paper, we studied the contents of (pseudo)hypericin and its immediate precursors in wild populations of various HYPERICUM species on the island of Crete, Greece, in dependence on their developmental stage. In this study, we investigated the effect of the habitat altitude on the total hypericins content of the plants, which is defined as the sum of protohypericin, hypericin, protopseudohypericin and pseudohypericin. Taking into account our previous finding that the highest accumulation is found during the flowering period in June, we collected the aerial parts of spontaneously growing H. PERFORATUM L. , H. TRIQUENTRIFOLIUM Turra , H. EMPETRIFOLIUM Willd. and H. PERFOLIATUM L. during that time frame at elevations between 100 and 600 m above sea level, however, bearing in mind the time lag in development with increasing altitude. HPLC analysis of the plant material, separated again into a flowers and a leaves/petioles fraction, revealed great differences in the total hypericin content in dependence on the altitude of the habitat. Specifically, a clear trend was revealed, showing an increase of the total hypericin content with increasing altitude. However, no changes could be observed in the ratio of hypericin to protohypericin and in that of pseudohypericin to protopseudohypericin. The habitats of the employed plants were again randomly distributed all over Crete. It is proposed that higher light intensities accompanied by enhanced UV-B radiation and lower air temperature might be responsible for the increasing levels of total hypericins with increasing altitude