Image-guided minimally invasive surgical access to the temporomandibular joint: A preliminary report.

PURPOSE: To establish a protocol for image-guided minimally invasive surgical access to the temporomandibular joint (TMJ). MATERIALS AND METHODS: This study involved 2 patients with TMJ pain and mandibular motion dysfunction. Axial magnetic resonance imaging (MRI) of the TMJ was obtained and loaded into an intra-operative navigation system to guide joint space injection. With a navigated syringe, 1 mL synvisc Hylan G-F 20 was directly injected into the superior and inferior joint spaces under navigation guidance. RESULTS: With the assistance of an intraoperative navigational system, the TMJ MRI images were visualized in 3 dimensions and enabled guiding a needle into the superior and inferior joint spaces for therapeutic injection. The treatment outcome for both patients was satisfactory with improvement in pain score and mandibular motion. CONCLUSIONS: A protocol for image-guided minimally invasive surgical access to the TMJ was established. This could provide the technical basis for evaluation of accurate joint space intervention as a form of treatment of appropriate TMJ disorders.     

Hemangiopericytoma of the lumbar spine

Hemangiocytoma are rare malignant vascular tumor. Vertebral location is uncommun. They occur preferentially at the lumbo-sacrul spine with paravertebral extension. The features include spinal pains, para vertebral tumefaction and paresthesia. The CT and MRI scans can help to diagnosis which is histological. The treatment is surgical combined or no with radiotherapy. The pronostic is marqued by the recidive risk and metastases. We report a new case of vertebral hemangiopericytoma of the thoraco-lumbar spine with litteratur review.     

Medical and surgical management of priapism

Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Pathologically and clinically, two subtypes are seen-the high flow (non-ischaemic) variety and the low flow (ischaemic) priapism. The low flow type is more dangerous, as these patients are susceptible to greater complications and the long term recovery of erectile function is dependent on prompt and urgent intervention. Many of the causes of priapism are medical, including pharmacological agents, and as such, priapism should be considered as a medical and surgical emergency.     

Quantitative correlations among CYP3A sensitive substrates and inhibitors: literature analysis

As a follow-up to the new classification of CYP3A inhibitors, the present work was undertaken to search for quantitative correlations of AUC ratios between sensitive substrates and midazolam (reference). A large set of clinical studies was obtained utilizing the M&T Drug Interaction Database, and recent Product Labels. Linear relationships were found between midazolam and four CYP3A substrates: simvastatin, buspirone, triazolam and eplerenone. Simvastatin and buspirone were consistently more sensitive than midazolam, independent of the inhibitor. Quantitative correlations of AUC ratios between four CYP3A inhibitors (fluconazole, erythromycin, verapamil, diltiazem) and ketoconazole (400 mg/day) were also uncovered. The average potencies of these inhibitors relative to ketoconazole were 27% for erythromycin, 17% for fluconazole and 19% for verapamil.     

Comparison of 4 diets of varying glycemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults: a randomized controlled trial

BACKGROUND: Despite the popularity of low-glycemic index (GI) and high-protein diets, to our knowledge no randomized, controlled trials have systematically compared their relative effects on weight loss and cardiovascular risk. METHODS: A total of 129 overweight or obese young adults (body mass index, > or =25 [calculated as weight in kilograms divided by the square of height in meters]) were assigned to 1 of 4 reduced-fat, high-fiber diets for 12 weeks. Diets 1 and 2 were high carbohydrate (55% of total energy intake), with high and low GIs, respectively; diets 3 and 4 were high protein (25% of total energy intake), with high and low GIs, respectively. The glycemic load was highest in diet 1 and lowest in diet 4. Changes in weight, body composition, and blood chemistry profile were studied. RESULTS: While all groups lost a similar mean +/- SE percentage of weight (diet 1, -4.2% +/- 0.6%; diet 2, -5.5% +/- 0.5%; diet 3, -6.2% +/- 0.4%; and diet 4, -4.8% +/- 0.7%; P = .09), the proportion of subjects in each group who lost 5% or more of body weight varied significantly by diet (diet 1, 31%; diet 2, 56%; diet 3, 66%; and diet 4, 33%; P = .01). Women on diets 2 and 3 lost approximately 80% more fat mass (-4.5 +/- 0.5 [mean +/- SE] kg and -4.6 +/- 0.5 kg) than those on diet 1 (-2.5 +/- 0.5 kg; P = .007). Mean +/- SE low-density-lipoprotein cholesterol levels declined significantly in the diet 2 group (-6.6 +/- 3.9 mg/dL [-0.17 +/- 0.10 mmol/L]) but increased in the diet 3 group (+10.0 +/- 3.9 mg/dL [+0.26 +/- 0.10 mmol/L]; P = .02). Goals for energy distribution were not achieved exactly: both carbohydrate groups ate less fat, and the diet 2 group ate more fiber. CONCLUSION: Both high-protein and low-GI regimens increase body fat loss, but cardiovascular risk reduction is optimized by a high-carbohydrate, low-GI diet.     

Recurrence related to treatment modalities of unicystic ameloblastoma: a systematic review

This systematic review aims to identify all studies pertinent to the clinical question, ‘which treatment for unicystic ameloblastoma results in the lowest recurrence rate?’ A structured systematic search of the literature, with predefined inclusion and exclusion criteria, using computer and manual searches as well as personal communication, was performed. Evaluations and critical appraisal were done separately in 3 rounds. All searches were performed by 2 independent judges and any disagreement was settled by discussion with a third party. Four treatment modalities for unicystic ameloblastomas were identified. The recurrence rates were 3.6% for resection, 30.5% for enucleation alone, 16% for enucleation followed by application of Carnoy's solution and 18% for marsupialization with/without other treatment in a second phase. It was concluded that there is only weak evidence showing that jaw resection resulted in the lowest recurrence rate, followed by enucleation with application of Carnoy's solution. Enucleation alone resulted in the highest recurrence rate and treatment by marsupialization cannot be sufficiently evaluated since most cases were followed by a second stage surgery of some kind.