Rehabilitation of Patient with Acquired Maxillary Defect, using a Closed Hollow Bulb Obturator

Palliative care means providing support and care for patients with life-threatening or debilitating illness so that they can live their life as comfortably as possible. The fact that cure is no longer a reality does not mean that care cannot be made available. Partial maxillectomy defect presents a prosthodontic challenge in terms of re-establishing oronasal separation. Such defect has direct effect on cosmetic, function and psychology of the patient. This article describes step by step clinical and laboratory procedures involved in the rehabilitation of a hemimaxillectomy patient, using a definitive closed hollow bulb obturator, which improved his physical, emotional, functional, social and spiritual needs.     

Expression of short chain fatty acid receptors and pro-inflammatory cytokines in utero-placental tissues is altered in cows developing retention of fetal membranes

Introduction

Retention of fetal membranes (RFM) is an economically important condition in dairy cattle disturbing the health and production in affected animals. In spite of extensive research, pathogenesis for RFM and identification of a predictive marker for the condition still remains elusive. Since expulsion of fetal membranes in an inflammatory process, studying the expression of inflammatory molecules is expected to give an idea about the pathogenesis of RFM.

Methods

Expression of pro-inflammatory cytokines, short chain fatty acid (SCFA) receptors and adhesion molecules was studied using qRT-PCR in the utero-placental tissues obtained from the cows that expelled fetal membranes normally (n = 12) and from the cows that developed RFM (n = 12). Concentrations of SCFAs were estimated in the utero-placental tissues using Gas Chromatography.

Results

The concentration of butyrate in the utero-placental tissue extract was 3–4 times lower, and GPR41 and GPR43 mRNA expression was 7.7–10.0 and 3.4–4.4 folds lower (p < 0.05) in cows that developed RFM compared to those that expelled the fetal membranes normally. The expression of IL-1, IL-6, IL-8, TNF-α, ICAM and PECAM was higher (p < 0.05) in the cows that normally expelled the fetal membranes compared to those that developed RFM.

Discussion

Since a clear association of butyrate levels, expression of pro-inflammatory cytokines, adhesion molecules and SCFAs receptors was observed with expulsion of fetal membranes, modulating the levels of these molecules prior to parturition might help in reducing the incidence of RFM in cows.

Conclusion

Inflammatory response is essential for normal expulsion of fetal membranes and that inadequate or altered expression of pro-inflammatory cytokines, adhesion molecules and SCFA receptors is associated with RFM in cows.     

Treatment of Class II, division 2 in the late growth period

The Deckbiss with skeletal Class II jaw relationship sometimes presents a considerable therapeutic problem, particularly in the late growth period (DP3U), as regards the coordination of dental and skeletal treatment objectives. An effective treatment approach was demonstrated: a modified Herbst appliance used simultaneously with fixed appliances in the maxilla. The sample comprised 12 male (14.0±0.9 years old) and 10 female (12.3±0.4 years old) patients. Correction of the distal occlusion was achieved in all patients by means of the Herbst appliance, which was removed after an average time period of 6.4±0.2 months. In the mandible the multibracket appliances were then immediately inserted, and Class II elastics were used for retention. Maximum anchorage was required in the maxilla as well as in the mandible. Complete diagnostic records were made at the begnning of the treatment as well as 6 and 12 months later, in order to document skeletal and dental changes.A dental and skeletal Class I relationship was achieved in all cases. A significant improvement was recorded in the vertical jaw base relationship; this was still stable after a period of 12 months. In the dental area in particular, a so-called high-pull headgear effect (intrusion and distalization 16, 26) and intrusion of teeth 34, 44 were registered. Only a minor protrusion of the mandibular incisors was observed. Reinforcement of the bands reduced the failure rate significantly.The Herbst appliance does not represent a standard treatment for Class II. Its indication range is limited.     

Intra-individual comparison of patient acceptability of multidetector-row CT colonography and double-contrast barium enema

AIMS: To compare the subjective acceptability of CT colonography in comparison with barium enema in older symptomatic patients, and to ascertain preferences for future colonic investigation. MATERIALS AND METHODS: The study population comprised 78 persons aged 60 years or over with symptoms suggestive of colorectal neoplasia, who underwent CT colonography followed the same day by barium enema. A 25-point questionnaire was administered after each procedure and an additional follow-up questionnaire a week later. Responses were compared using Wilcoxon matched pairs testing, Mann-Whitney test statistics and binomial exact testing. RESULTS: Participants suffered less physical discomfort during CT colonography (p = 0.03) and overall satisfaction was greater compared with barium enema (p = 0.03). On follow-up, respondents reported significantly better tolerance of CT colonography (p = 0.002), and were less prepared to undergo barium enema again (p < 0.001). Of 52 subjects expressing an opinion, all preferred CT to barium enema. CONCLUSION: Patient satisfaction was higher with CT colonography than barium enema. CT colonography caused significantly less physical discomfort and was overwhelmingly preferred by patients.     

脉冲式空气灌肠治疗小儿肠套叠(附86例分析)

目的:探讨脉冲式空气灌肠治疗小儿急性肠套叠的临床价值和疗效。方法:经肛门插入Foley气囊导管,连接脉冲灌肠整复仪,先行诊断性空气灌肠,确诊为肠套叠后行脉冲空气整复,难复型结合手法按摩,本组病例气压选择在8~16KPa之间。结果:86例患者中,回—结肠型72例(83.7%),回—回—结肠型14例(16.3%),套头位于回盲部25例,升结肠17例,结肠肝曲14例,横结肠8例,结肠脾曲9例,降结肠5例。81例患者复位成功,成功率约94.2%。结论:脉冲式空气灌肠能减轻套叠部位的痉挛与水肿,提高肠套叠的整复成功率。     

侧方扩展型大肠肿瘤的X线特征

目的:探讨扩展型大肠肿瘤的X线与病理学特征。方法:分析了经组织病理学证实的46例54处病变的X线钡灌肠造影表现和内镜图像,将病变分为非结节扁平隆起、结节集簇性隆起和混合性结节集簇隆起3种类型,与病理组织学进行对照研究。结果:扩展型大肠肿瘤好发于直肠、盲肠和升结肠近段,组织病理学多为腺瘤或黏膜内癌,混合结节集簇隆起型病变癌变率高、浸润较深,且有进展期癌。结论:扩展型大肠肿瘤表面的形态改变,可以作为推测有无癌变与癌变浸润深度的指标。     

赫什朋病的X线诊断(附49例分析)

目的：提高对赫什朋病特征性X线征象的认识。方法：49例患儿均行钡剂灌肠检查，并经手术病理证实，将其X线征象狭窄段、移行段、24h钡剂残留情况及狭窄段肠管不规则收缩进行统计学处理，计算其敏感性、特异性、阳性预告值、假阳性率、阴性预告值、假阴性率、约登指数。结果：49例中，短段型(17／49)、常见型(24／49)、长段型(8／49)；赫什朋病39例，非赫什朋病10例，它们的敏感性、特异性、阳性预告值、假阳性率、阴性预告值、假阴性率、约登指数，狭窄段分别是95％、30％、84％、70％、60％、5％、25％；移行段分别是74％、90％、97％、10％、47％、26％、64％；24h钡剂残留情况分别是79％、60％、89％、40％、43％、21％、39％；狭窄段肠管不规则收缩分别是31％、100％、100％、0、27％、69％、31％。结论：在赫什朋病的钡剂灌肠X线征象中，移行段最高可靠，狭窄段最常见，狭窄段肠管不规则收缩的特异性最高，24h钡剂残留对早期不典型的赫什朋病的诊断具有重要意义，常见型X线诊断最可靠。     

低张结肠水灌肠CT检查诊断结肠癌的价值

目的 :探讨低张结肠水灌肠CT检查对结肠癌的CT表现及诊断价值。材料和方法 :肌注 65 4 2 2 0mg后 ,结肠灌注微温生理盐水进行CT扫描。分析经手术病理证实的 3 8例结肠癌资料。结果 :CT显示肿瘤部位准确率为 10 0 % ,CT分期与手术分期符合率为 92 % ,低张结肠水灌肠CT可见病变肠壁增厚、突出腔内的肿块、肠腔狭窄及其浆膜面毛糙 ;可见结肠癌侵犯邻近器官、淋巴结肿大及远处转移。结论 :低张结肠水灌肠CT检查对结肠癌的术前诊断有很大的价值。     

大肠癌的螺旋CT三维重建研究及外科应用评价

目的 :探讨螺旋CT三维重建技术在大肠癌外科术前诊断中的价值。材料和方法 :选 2 0例有低张气钡灌肠造影及病理证实的大肠癌 ,行低张充气螺旋CT扫描 ,表面覆盖显示 (SSD)、容积漫游技术 (VRT)、多平面重组 (MPR)等三维重建 ;另 10例行常规及低张注生理盐水CT检查。本法与造影、常规CT、低张注水CT及手术、病理对照观察。结果 :常规CT检出率为 4/ 10 ;低张注水CT检出率为 7/ 10 ;低张气钡灌肠造影检出率为 2 0 / 2 0 ;螺旋CT三维重建检出率为 2 0 / 2 0。前三者在检出率或观察内容上均有各自限度 ,后者可弥补。结论 :SSD、VRT可显示 6mm隆起病变和 3mm管腔狭窄 ,VRT可显示 1mm细沟凹陷 ;MPR对轻微的肠壁增厚、僵硬很敏感 ,能准确判断病灶外侵程度 ;SSD酷似内窥镜 ,VRT可比低张气钡灌肠造影 ,SCT三维重建可一法多用。     

胃癌大肠转移的X线钡灌肠表现

目的:分析胃癌大肠转移的X线钡灌肠表现。方法:104例胃癌入院术前检查发现结肠转移或胃癌术后转移入院治疗的病例。分析钡灌肠初次发现大肠转移征象的年龄、发现胃癌原发病变距初次发现大肠转移的间隔时间、转移病变的发生部位和病变造成的X线钡灌肠图像上的肠管变形和粘膜面的改变。结果:104例胃癌结肠转移,男67例,女37例。胃癌术前检查中发现结肠转移者32例,术后发现的大肠转移中,多数转移发生在手术后3年内(占91.3%)。胃癌原发灶的肉眼形态BorrmannⅢ型(28例)和BorrmannⅣ型(65例)者占89.4%,组织学中以低分化腺癌和印戒细胞癌为主要成分者占91.3%。X线钡灌肠检查显示大肠转移的好发部位为横结肠(80),其次为直肠(50)。转移灶可累及多节段肠管,其中横结肠中1/3段(47),横结肠左1/3(44),横结肠右1/3(39)和直肠腹膜返折之上(39)。X线显示肠管单侧变形者227处,双侧变形者96处。黏膜面表现为梳齿状黏膜纹聚集改变253处,颗粒结节状改变23处,外压性改变20处,弥漫性改变62处。结论:胃癌大肠转移的好发部位为横结肠和直肠,结肠黏膜面的梳齿状黏膜纹聚集为胃癌大肠转移的主要X线钡剂灌肠表现。