Eruption of the central incisor,the intermaxillary suture,and maxillary growth in patients with a single median maxillary central incisor

The occurrence of a single median maxillary central incisor (SMMCI) is a very rare condition and might be a sign of a more severe midline defect, which could be a mild degree of holoprosencephaly. Absence of the internasal and partial absence of the intermaxillary suture has been observed in a fetus with holoprosencephaly. The purpose of this study was to evaluate the intermaxillary suture, the eruption pattern of the single central incisor in the SMMCI condition, and the growth of the maxilla in a group of patients with SMMCI. A similar study was not found in the scientific literature. The material included orthopantomographs, dental radiographs, and lateral cephalometric radiographs from 11 patients with an SMMCI. The orthopantomographs and dental radiographs showed that the intermaxillary suture was abnormal anterior to the incisive foramen; however, the SMMCI erupted within the expected time interval. Superimposition on stable structures on lateral cephalometric radiographs from two untreated patients, in which growth analysis was possible, showed that the horizontal and vertical growth of the maxilla was normal. Due to the sutural midline defect it is suggested that a transversal growth analysis is included in all treatment planning of SMMCI patients.     

Hypertriglyceridemia is associated with insulin levels in adult cystic fibrosis patients

BackgroundRecent studies have identified hypertriglyceridemic cystic fibrosis patients (CF-TG). However, whether hypertriglyceridemia is associated with an altered metabolic profile remains unknown.ObjectiveTo characterize CF-TG and determine whether triglycerides (TG) levels are associated with metabolic alterations.Methods210 adult CF subjects from the Montreal Cystic Fibrosis Cohort without known diabetes were included in the analysis. All subjects underwent an OGTT to assess glucose tolerance, insulin secretion (insulin AUC) and insulin sensitivity (Stumvoll index). Fasting lipid profiles, pulmonary function (%FEV₁) and BMI were determined. Hypertriglyceridemia (TG > 1.7 mmol/L) was observed in 20 CF patients. These subjects were matched for age, sex and glucose tolerance category with 20 CF patients (CF-normal-TG) and 20 healthy controls that had TG levels below 1.7 mmol/L. Pearson correlations were performed in the complete study sample (n = 210) to examine the associations between TG levels and other parameters.ResultsThe prevalence of hypertriglyceridemia was 9.5%. Compared to CF-normal-TG, CF-TG subjects displayed significantly higher %FEV_1, insulin AUC (AUC_0–120, AUC_0–30, AUC_30–120), cholesterol levels and a higher ratio of total cholesterol to HDL-cholesterol. Pearson analysis demonstrated that TG levels were associated with BMI, %FEV₁, fasting insulin, insulin AUC_0–120 and AUC_30–120, Stumvoll index, cholesterol levels and the ratio of total cholesterol to HDL-cholesterol. All these correlations remained significant after correction for BMI except %FEV₁.ConclusionTG levels are associated with a mild alteration of the metabolic profile. Whether these changes will increase the long-term risk of CF patients in developing cardiometabolic complications remains to be investigated.     

Missed isolated volar dislocation of the scaphoid

A patient presented with volar dislocation of the scaphoid, the diagnosis of which had been missed for two weeks. He was treated with open reduction through a combined volar and dorsal approach with decompression of the median nerve, internal fixation, and a cast for eight weeks. One year postoperatively the functional result was good. A radiograph showed no sign of avascular necrosis.     

Genetic and environmental influences on plasma homocysteine: results from a Danish twin study

BACKGROUND: Increased plasma homocysteine has been linked to many clinical conditions including atherosclerosis and ischemic stroke. We assessed the genetic and environmental influences on homocysteine in adult twins and tested the influence of 3 candidate polymorphisms. METHODS: Homocysteine was analyzed in 1206 healthy twins, who were genotyped for 3 polymorphisms: MTHFR 677C>T, MTR 2756A>G, and NNMT (dbSNP: rs694539). To perform quantitative trait linkage analysis of the MTHFR locus, the genotyping was supplemented with 2 genetic markers localized on each site of the MTHFR locus. The twin data were analyzed using biometric structural equation models as well as a combined association and linkage analysis in 2 age cohorts. RESULTS: Age, sex, and MTHFR genotype have a significant impact on homocysteine concentrations, whereas the other genotypes were not associated with homocysteine concentrations. The variance in homocysteine could be solely ascribed to additive genetic and nonshared environmental factors, with an estimated additive genetic proportion of total variation at age 18-39 years of 0.63 (95% CI, 0.53-0.71) and at age 40-65 years of 0.27 (95% CI, 0.10-0.41). The impact of the MTHFR locus is estimated to explain 53% (95% CI, 0.07-0.67) of the total phenotypic variation in persons 18-39 years old and 24% (95% CI, 0.00-0.39) in persons 40-65 years old, i.e., almost all additive genetic variance. CONCLUSIONS: Homocysteine concentrations have a high heritability that decreases with age. The MTHFR gene locus is responsible for almost all the variation attributable to genetic factors, leaving very little influence of other genetic variations.     

Determination of total serum insulin (IRI) in insulin-treated diabetic patients

Summary A routine method is described for the determination of total IRI (imraunoreactive insulin) in insulintreated diabetics. The method involves an easy acid ethanol extraction, whereby antibody-bound IRI is dissociated and separated, together with the free IRI from the serum proteins and the antibodies. The recovery of IRI in this procedure is about 80%. After the separation, the isolated total IRI is measured in an immunoassay, using ethanol for the separation of free and antibody bound¹²⁵I-insulin. In 169 diabetic patients treated with insulin in doses of from 6 to 120 units/day, the fasting serum total IRI was between 6 and 4374 U/ml, with a mean of 392 U/ml. During treatment with insulin, the level of total IRI increased from normal values, registered during the first two months, to a higher level which became stable after about 5 months of treatment. The increase in IRI occurred simultaneously with the formation of antibodies. Insulin-resistant patients showed very high IRI levels.

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Bestimmung des Gesamtserum-Insulins (IRI) bei insulinbehandelten Diabetikern

Zusammenfassung Für die Bestimmung des Gesamt-IRI (immunoreaktiven Insulins) bei Diabetikern, die mit Insulin behandelt wurden, wird eine Routinemethode beschrieben. Die Methode schließt eine einfache SäureÄthanol-Extraktion ein, wobei das antikörpergebundene IRI dissoziiert und zusammen mit dem freien IRI von den Serumproteinen, einschließlich den Antikörpern, getrennt wird. Bei diesem Verfahren werden etwa 80% des IRI wiedergefunden. Nach der Trennung wird das isolierte Gesamt-IRI immunologisch gemessen. Für die Trennung des freien von dem an Antikörper gebundenen¹²⁵I-Insulin wird Äthanol verwendet. Bei 169 Diabetikern, die mit 6 bis 120 E Insulin/Tag behandelt wurden, lag das Nuchternserum-Gesamt-IRI zwischen 6 und 4374 E/ml (Mittelwert 392 E/ml). Im Laufe der Insulinbehandlung stieg das Gesamt-IRI von Normalwerten, die während der ersten 2 Monate registriert wurden, auf ein höheres Niveau an, das sich nach etwa 5 Monaten Behandlungsdauer stabilisierte. Der Anstieg des IRI erfolgte gleichzeitig mit der Bildung von Antikörpern. Bei insulinresistenten Patienten ergaben sich sehr hohe IRI-Konzentrationen.

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Determination de l'insuline totale chez les diabétiques traités a l'insuline

Résumé On décrit une méthode de routine pour le dosage de l'IRI (insuline immunoréactive) totale chez les diabétiques traités par l'insuline. La méthode comprend une extraction à l'acide-éthanol, très simple, pendant laquelle l'IRI liée aux anticorps est dissociée et séparée ainsi que l'IRI »libre« des protéines sériques, anticorps compris. La récupération de l'IRI par cette méthode est aux environs de 80%. Après la séparation, l'IRI totale isolée est mesurée par un dosage immunologique qui se sert de l'éthanol afin de séparer l'I¹²⁵-insuline libre de celle liée aux anticorps. Chez 169 malades diabétiques traités par l'insuline à des doses allant de 6 à 120 unités par jour, l'IRI totale sérique à jeun était de 6 à 4374 U/ml, avec une moyenne de 392 U/ml. Pendant le traitement par l'insuline le taux de l'IRI totale est passé des niveaux normaux, enregistrés pendant les deux premiers mois, à des niveaux plus éleévs qui se stabilisent 5 mois environ apres le début du traitement. L'augmentation de l'IRI coïncide avec la formation d'anticorps. Les malades insulino-résistants présentent des valeurs très hautes d'IRI.